thesis statement about abortion laws

Princeton Legal Journal

The First Amendment and the Abortion Rights Debate

Sofia Cipriano

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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• v.4(1); 2023 Jan 17

Abortion bans and their impacts: A view from the United States

Laura j. frye.

1 Gynuity Health Projects, New York, NY, USA

Beverly Winikoff

A retrospective study of abortion facilities in and around Texas by White et al. 1 and a spatial analysis by Rader et al. 2 are combined to illustrate the detrimental effects of abortion bans enacted in the United States.

Abortion restrictions have been introduced in various forms across many states for years, but since June 2022, when the right to abortion was no longer federally protected, we have seen a rapid increase in these restrictions. We are just starting to quantify and qualify their effects. Two recent studies published in JAMA offer early indications of the effects of draconian bans.

In “Association of Texas’ 2021 Ban on Abortion in Early Pregnancy with the Number of Facility-Based Abortion in Texas and Surrounding States,” White et al. used a large dataset containing information before and after the passage of SB8 in September 2021. 1 This bill banned most abortions after 6 weeks in the state of Texas. The data presented in this article allow for a careful examination of the law’s effects, and the authors paint a picture of how rapidly destabilizing such bans can be. The study clearly shows that, in the immediate aftermath of SB8’s implementation, there was both an absolute drop in documented abortions and a shift in the location of abortions as Texans went to neighboring states for medical care.

The paper explicitly examines abortions after 12 weeks as an important indicator of change, not because of the small decrease in safety and efficacy with increasing gestational durations, but rather because of the major increase in burdens to affected individuals (cost, time, travel) and to clinics (resources, scheduling) with gestations beyond this point.

A clearer and more detailed sense of how these patient travel dynamics play out can be found in the “Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women’s Health Decision” by Rader et al., which uses simulation and spatial analysis to measure changes in surface travel time to the closest abortion facility before and after the June 2022 Dobbs decision. 2

The average travel time to reach the nearest abortion facility significantly increased in the simulated post-Dobbs world, and, while the median change from 11 to 17 min is not jaw dropping, the spread of the data and the extremes of the curve are where the biggest problems lie. The authors show a doubling of the number of individuals who must travel more than 60 min to access abortion care. Then, through sensitivity analyses on geographic heterogeneity, they illustrate some of the extreme increases in travel time for people in the South, as in Texas, with a mean increase of over 7 h.

While the White paper notes that their data did not include individual-level demographic information (and thus was not able to explore the disparate effects of the ban on various subpopulations), the Raden paper is able to shed some light on the disproportionate impacts of abortion restrictions by use of census data. The latter paper shows that longer travel times occur more frequently in populations without insurance, with lower incomes, and who are racial and ethnic minorities. Documentation of these effects is important for advocacy, policy change, and resource allocation.

The White et al. paper wisely uses care in describing the data they have as “documented facility-based abortions,” acknowledging the now-frequent practice of non-facility-based self-managed abortion with pills. Similarly, Rader et al. note that their data are predicated on the idea of traveling to a physical facility and do not account for the mailing of pills to a person’s home. The TelAbortion study from 2016 to 2021 provided evidence on the safety and efficacy of direct-to-patient telemedicine abortion with mailing of pills, 3 , 4 and the FDA now allows for this method of abortion pill provision. We also know that self-managed abortion can be a safe and effective option 5 and is currently common in the United States. 6 , 7 There is increasing interest in determining its role in the care landscape. 8 , 9 , 10 Moving forward, it would be beneficial to see more information on how remote provision of care and self-management play into the dynamics illustrated in these articles.

These two papers, used together, can help prepare clinics in protective states for the influx of affected individuals as additional oppressive laws are passed in other states. The lessons documented only grow in relevance as the map of the United States darkens with more and more states passing restrictive abortion laws. We can use these data both to decry the negative and disproportionate effect of these bans and to call for action to prepare receiving clinics in protective states as they take on the care of more people who are denied medical services in their home states.

Declaration of interests

The authors declare no competing interests.

• < Previous

Home > Student Scholarship > THESES > 1033

Senior Theses and Projects

Abortion in america after roe: an examination of the impact of dobbs v. jackson women’s health organization on women’s reproductive health access.

Natalie Maria Caffrey Follow

Date of Award

Spring 5-12-2023

Degree Name

Bachelor of Arts

Public Policy and Law

First Advisor

Professor Adrienne Fulco

Second Advisor

Professor Glenn Falk

This thesis will examine the limitations in access to abortion and other necessary reproductive healthcare in states that are hostile to abortion rights, as well as discuss the ongoing litigation within those states between pro-choice and pro-life advocates. After analyzing the legal landscape and the different abortion laws within these states, this thesis will focus on the practical consequences of Dobbs on women’s lives, with particular attention to its impact on women of color and poor women in states with the most restrictive laws. The effect of these restrictive laws on poor women will be felt disproportionately due to their lack of ability to travel to obtain care from other states that might offer abortion services. And even if these women find a way to obtain access to abortions, there is now the real possibility of criminal prosecution for those who seek or assist women who obtain abortions post- Dobbs . To compound the problem, the Court made clear in Dobbs that its decision to revisit the privacy rights issue signals the possibility of new limitations on protections previously taken for granted in the areas of In vitro fertilization, birth control, emergency contraception, and other civil rights such as gay marriage. Finally, this thesis will examine the political and legal efforts of liberal states, private companies, and grassroots organizations attempting to mitigate Dobbs ’s effects. These pro-choice actors have, to some extent, joined forces to protect access for women in the United States through protective legislation and expanding access in all facets of reproductive healthcare, particularly for minority women who will be disproportionately affected by abortion bans in conservative states. The current efforts to mitigate the legal and medical implications of Dobbs will determine the future of women’s rights in America, not only regarding abortion but more broadly in terms of adequate reproductive care access.

Senior thesis completed at Trinity College, Hartford CT for the degree of Bachelor of Arts in Public Policy & Law.

Recommended Citation

Caffrey, Natalie Maria, "Abortion in America After Roe: An Examination of the Impact of Dobbs v. Jackson Women’s Health Organization on Women’s Reproductive Health Access". Senior Theses, Trinity College, Hartford, CT 2023. Trinity College Digital Repository, https://digitalrepository.trincoll.edu/theses/1033

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• America’s Abortion Quandary

1. Americans’ views on whether, and in what circumstances, abortion should be legal

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

As the long-running debate over abortion reaches another  key moment at the Supreme Court  and in  state legislatures across the country , a majority of U.S. adults continue to say that abortion should be legal in all or most cases. About six-in-ten Americans (61%) say abortion should be legal in “all” or “most” cases, while 37% think abortion should be  illegal  in all or most cases. These views have changed little over the past several years: In 2019, for example, 61% of adults said abortion should be legal in all or most cases, while 38% said it should be illegal in all or most cases.    Most respondents in the new survey took one of the middle options when first asked about their views on abortion, saying either that abortion should be legal in  most  cases (36%) or illegal in  most  cases (27%). 

Respondents who said abortion should either be legal in  all  cases or illegal in  all  cases received a follow-up question asking whether there should be any exceptions to such laws. Overall, 25% of adults initially said abortion should be legal in all cases, but about a quarter of this group (6% of all U.S. adults) went on to say that there should be some exceptions when abortion should be against the law.

One-in-ten adults initially answered that abortion should be illegal in all cases, but about one-in-five of these respondents (2% of all U.S. adults) followed up by saying that there are some exceptions when abortion should be permitted. 

Altogether, seven-in-ten Americans say abortion should be legal in some cases and illegal in others, including 42% who say abortion should be generally legal, but with some exceptions, and 29% who say it should be generally illegal, except in certain cases. Much smaller shares take absolutist views when it comes to the legality of abortion in the U.S., maintaining that abortion should be legal in all cases with no exceptions (19%) or illegal in all circumstances (8%). 

There is a modest gender gap in views of whether abortion should be legal, with women slightly more likely than men to say abortion should be legal in all cases or in all cases but with some exceptions (63% vs. 58%). 

Younger adults are considerably more likely than older adults to say abortion should be legal: Three-quarters of adults under 30 (74%) say abortion should be generally legal, including 30% who say it should be legal in all cases without exception. 

But there is an even larger gap in views toward abortion by partisanship: 80% of Democrats and Democratic-leaning independents say abortion should be legal in all or most cases, compared with 38% of Republicans and GOP leaners.  Previous Center research  has shown this gap widening over the past 15 years. 

Still, while partisans diverge in views of whether abortion should mostly be legal or illegal, most Democrats and Republicans do not view abortion in absolutist terms. Just 13% of Republicans say abortion should be against the law in all cases without exception; 47% say it should be illegal with some exceptions. And while three-in-ten Democrats say abortion should be permitted in all circumstances, half say it should mostly be legal – but with some exceptions. 

There also are sizable divisions within both partisan coalitions by ideology. For instance, while a majority of moderate and liberal Republicans say abortion should mostly be legal (60%), just 27% of conservative Republicans say the same. Among Democrats, self-described liberals are twice as apt as moderates and conservatives to say abortion should be legal in all cases without exception (42% vs. 20%).

Regardless of partisan affiliation, adults who say they personally know someone who has had an abortion – such as a friend, relative or themselves – are more likely to say abortion should be legal than those who say they do not know anyone who had an abortion.

Views toward abortion also vary considerably by religious affiliation – specifically among large Christian subgroups and religiously unaffiliated Americans. 

For example, roughly three-quarters of White evangelical Protestants say abortion should be illegal in all or most cases. This is far higher than the share of White non-evangelical Protestants (38%) or Black Protestants (28%) who say the same. 

Despite  Catholic teaching on abortion , a slim majority of U.S. Catholics (56%) say abortion should be legal. This includes 13% who say it should be legal in all cases without exception, and 43% who say it should be legal, but with some exceptions. 

Compared with Christians, religiously unaffiliated adults are far more likely to say abortion should be legal overall – and significantly more inclined to say it should be legal in all cases without exception. Within this group, atheists stand out: 97% say abortion should be legal, including 53% who say it should be legal in all cases without exception. Agnostics and those who describe their religion as “nothing in particular” also overwhelmingly say that abortion should be legal, but they are more likely than atheists to say there are some circumstances when abortion should be against the law.

Although the survey was conducted among Americans of many religious backgrounds, including Jews, Muslims, Buddhists and Hindus, it did not obtain enough respondents from non-Christian groups to report separately on their responses.

As a  growing number of states  debate legislation to restrict abortion – often after a certain stage of pregnancy – Americans express complex views about when   abortion should generally be legal and when it should be against the law. Overall, a majority of adults (56%) say that how long a woman has been pregnant should matter in determining when abortion should be legal, while far fewer (14%) say that this should  not  be a factor. An additional one-quarter of the public says that abortion should either be legal (19%) or illegal (8%) in all circumstances without exception; these respondents did not receive this question.

Among men and women, Republicans and Democrats, and Christians and religious “nones” who do not take absolutist positions about abortion on either side of the debate, the prevailing view is that the stage of the pregnancy should be a factor in determining whether abortion should be legal.

Americans broadly are more likely to favor restrictions on abortion later in pregnancy than earlier in pregnancy. Many adults also say the legality of abortion depends on other factors at every stage of pregnancy. 

Overall, a plurality of adults (44%) say that abortion should be legal six weeks into a pregnancy, which is about when cardiac activity (sometimes called a fetal heartbeat) may be detected and before many women know they are pregnant; this includes 19% of adults who say abortion should be legal in all cases without exception, as well as 25% of adults who say it should be legal at that point in a pregnancy. An additional 7% say abortion generally should be legal in most cases, but that the stage of the pregnancy should not matter in determining legality. 1

One-in-five Americans (21%) say abortion should be  illegal  at six weeks. This includes 8% of adults who say abortion should be illegal in all cases without exception as well as 12% of adults who say that abortion should be illegal at this point. Additionally, 6% say abortion should be illegal in most cases and how long a woman has been pregnant should not matter in determining abortion’s legality. Nearly one-in-five respondents, when asked whether abortion should be legal six weeks into a pregnancy, say “it depends.” 

Americans are more divided about what should be permitted 14 weeks into a pregnancy – roughly at the end of the first trimester – although still, more people say abortion should be legal at this stage (34%) than illegal (27%), and about one-in-five say “it depends.”

Fewer adults say abortion should be legal 24 weeks into a pregnancy – about when a healthy fetus could survive outside the womb with medical care. At this stage, 22% of adults say abortion should be legal, while nearly twice as many (43%) say it should be  illegal . Again, about one-in-five adults (18%) say whether abortion should be legal at 24 weeks depends on other factors. 

Respondents who said that abortion should be illegal 24 weeks into a pregnancy or that “it depends” were asked a follow-up question about whether abortion at that point should be legal if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Most who received this question say abortion in these circumstances should be legal (54%) or that it depends on other factors (40%). Just 4% of this group maintained that abortion should be illegal in this case.

This pattern in views of abortion – whereby more favor greater restrictions on abortion as a pregnancy progresses – is evident across a variety of demographic and political groups. 

Democrats are far more likely than Republicans to say that abortion should be legal at each of the three stages of pregnancy asked about on the survey. For example, while 26% of Republicans say abortion should be legal at six weeks of pregnancy, more than twice as many Democrats say the same (61%). Similarly, while about a third of Democrats say abortion should be legal at 24 weeks of pregnancy, just 8% of Republicans say the same. 

However, neither Republicans nor Democrats uniformly express absolutist views about abortion throughout a pregnancy. Republicans are divided on abortion at six weeks: Roughly a quarter say it should be legal (26%), while a similar share say it depends (24%). A third say it should be illegal. 

Democrats are divided about whether abortion should be legal or illegal at 24 weeks, with 34% saying it should be legal, 29% saying it should be illegal, and 21% saying it depends. 

There also is considerable division among each partisan group by ideology. At six weeks of pregnancy, just one-in-five conservative Republicans (19%) say that abortion should be legal; moderate and liberal Republicans are twice as likely as their conservative counterparts to say this (39%). 

At the same time, about half of liberal Democrats (48%) say abortion at 24 weeks should be legal, while 17% say it should be illegal. Among conservative and moderate Democrats, the pattern is reversed: A plurality (39%) say abortion at this stage should be illegal, while 24% say it should be legal. 

Christian adults are far less likely than religiously unaffiliated Americans to say abortion should be legal at each stage of pregnancy.  

Among Protestants, White evangelicals stand out for their opposition to abortion. At six weeks of pregnancy, for example, 44% say abortion should be illegal, compared with 17% of White non-evangelical Protestants and 15% of Black Protestants. This pattern also is evident at 14 and 24 weeks of pregnancy, when half or more of White evangelicals say abortion should be illegal.

At six weeks, a plurality of Catholics (41%) say abortion should be legal, while smaller shares say it depends or it should be illegal. But by 24 weeks, about half of Catholics (49%) say abortion should be illegal. 

Among adults who are religiously unaffiliated, atheists stand out for their views. They are the only group in which a sizable majority says abortion should be  legal  at each point in a pregnancy. Even at 24 weeks, 62% of self-described atheists say abortion should be legal, compared with smaller shares of agnostics (43%) and those who say their religion is “nothing in particular” (31%). 

As is the case with adults overall, most religiously affiliated and religiously unaffiliated adults who originally say that abortion should be illegal or “it depends” at 24 weeks go on to say either it should be legal or it depends if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Few (4% and 5%, respectively) say abortion should be illegal at 24 weeks in these situations.

The stage of the pregnancy is not the only factor that shapes people’s views of when abortion should be legal. Sizable majorities of U.S. adults say that abortion should be legal if the pregnancy threatens the life or health of the pregnant woman (73%) or if pregnancy is the result of rape (69%). 

There is less consensus when it comes to circumstances in which a baby may be born with severe disabilities or health problems: 53% of Americans overall say abortion should be legal in such circumstances, including 19% who say abortion should be legal in all cases and 35% who say there are some situations where abortions should be illegal, but that it should be legal in this specific type of case. A quarter of adults say “it depends” in this situation, and about one-in-five say it should be illegal (10% who say illegal in this specific circumstance and 8% who say illegal in all circumstances). 

There are sizable divides between and among partisans when it comes to views of abortion in these situations. Overall, Republicans are less likely than Democrats to say abortion should be legal in each of the three circumstances outlined in the survey. However, both partisan groups are less likely to say abortion should be legal when the baby may be born with severe disabilities or health problems than when the woman’s life is in danger or the pregnancy is the result of rape. 

Just as there are wide gaps among Republicans by ideology on whether how long a woman has been pregnant should be a factor in determining abortion’s legality, there are large gaps when it comes to circumstances in which abortions should be legal. For example, while a clear majority of moderate and liberal Republicans (71%) say abortion should be permitted when the pregnancy is the result of rape, conservative Republicans are more divided. About half (48%) say it should be legal in this situation, while 29% say it should be illegal and 21% say it depends.

The ideological gaps among Democrats are slightly less pronounced. Most Democrats say abortion should be legal in each of the three circumstances – just to varying degrees. While 77% of liberal Democrats say abortion should be legal if a baby will be born with severe disabilities or health problems, for example, a smaller majority of conservative and moderate Democrats (60%) say the same. 

White evangelical Protestants again stand out for their views on abortion in various circumstances; they are far less likely than White non-evangelical or Black Protestants to say abortion should be legal across each of the three circumstances described in the survey. 

While about half of White evangelical Protestants (51%) say abortion should be legal if a pregnancy threatens the woman’s life or health, clear majorities of other Protestant groups and Catholics say this should be the case. The same pattern holds in views of whether abortion should be legal if the pregnancy is the result of rape. Most White non-evangelical Protestants (75%), Black Protestants (71%) and Catholics (66%) say abortion should be permitted in this instance, while White evangelicals are more divided: 40% say it should be legal, while 34% say it should be  illegal  and about a quarter say it depends. 

Mirroring the pattern seen among adults overall, opinions are more varied about a situation where a baby might be born with severe disabilities or health issues. For instance, half of Catholics say abortion should be legal in such cases, while 21% say it should be illegal and 27% say it depends on the situation. 

Most religiously unaffiliated adults – including overwhelming majorities of self-described atheists – say abortion should be legal in each of the three circumstances. 

Seven-in-ten U.S. adults say that doctors or other health care providers should be required to notify a parent or legal guardian if the pregnant woman seeking an abortion is under 18, while 28% say they should not be required to do so.  

Women are slightly less likely than men to say this should be a requirement (67% vs. 74%). And younger adults are far less likely than those who are older to say a parent or guardian should be notified before a doctor performs an abortion on a pregnant woman who is under 18. In fact, about half of adults ages 18 to 24 (53%) say a doctor should  not  be required to notify a parent. By contrast, 64% of adults ages 25 to 29 say doctors  should  be required to notify parents of minors seeking an abortion, as do 68% of adults ages 30 to 49 and 78% of those 50 and older. 

A large majority of Republicans (85%) say that a doctor should be required to notify the parents of a minor before an abortion, though conservative Republicans are somewhat more likely than moderate and liberal Republicans to take this position (90% vs. 77%). 

The ideological divide is even more pronounced among Democrats. Overall, a slim majority of Democrats (57%) say a parent should be notified in this circumstance, but while 72% of conservative and moderate Democrats hold this view, just 39% of liberal Democrats agree. 

By and large, most Protestant (81%) and Catholic (78%) adults say doctors should be required to notify parents of minors before an abortion. But religiously unaffiliated Americans are more divided. Majorities of both atheists (71%) and agnostics (58%) say doctors should  not  be required to notify parents of minors seeking an abortion, while six-in-ten of those who describe their religion as “nothing in particular” say such notification should be required. 

Americans are divided over who should be penalized – and what that penalty should be – in a situation where an abortion occurs illegally. 

Overall, a 60% majority of adults say that if a doctor or provider performs an abortion in a situation where it is illegal, they should face a penalty. But there is less agreement when it comes to others who may have been involved in the procedure. 

While about half of the public (47%) says a woman who has an illegal abortion should face a penalty, a nearly identical share (50%) says she should not. And adults are more likely to say people who help find and schedule or pay for an abortion in a situation where it is illegal should  not  face a penalty than they are to say they should.

Views about penalties are closely correlated with overall attitudes about whether abortion should be legal or illegal. For example, just 20% of adults who say abortion should be legal in all cases without exception think doctors or providers should face a penalty if an abortion were carried out in a situation where it was illegal. This compares with 91% of those who think abortion should be illegal in all cases without exceptions. Still, regardless of how they feel about whether abortion should be legal or not, Americans are more likely to say a doctor or provider should face a penalty compared with others involved in the procedure. 

Among those who say medical providers and/or women should face penalties for illegal abortions, there is no consensus about whether they should get jail time or a less severe punishment. Among U.S. adults overall, 14% say women should serve jail time if they have an abortion in a situation where it is illegal, while 16% say they should receive a fine or community service and 17% say they are not sure what the penalty should be. 

A somewhat larger share of Americans (25%) say doctors or other medical providers should face jail time for providing illegal abortion services, while 18% say they should face fines or community service and 17% are not sure. About three-in-ten U.S. adults (31%) say doctors should lose their medical license if they perform an abortion in a situation where it is illegal.

Men are more likely than women to favor penalties for the woman or doctor in situations where abortion is illegal. About half of men (52%) say women should face a penalty, while just 43% of women say the same. Similarly, about two-thirds of men (64%) say a doctor should face a penalty, while 56% of women agree.

Republicans are considerably more likely than Democrats to say both women and doctors should face penalties – including jail time. For example, 21% of Republicans say the woman who had the abortion should face jail time, and 40% say this about the doctor who performed the abortion. Among Democrats, far smaller shares say the woman (8%) or doctor (13%) should serve jail time.  

White evangelical Protestants are more likely than other Protestant groups to favor penalties for abortions in situations where they are illegal. Fully 24% say the woman who had the abortion should serve time in jail, compared with just 12% of White non-evangelical Protestants or Black Protestants. And while about half of White evangelicals (48%) say doctors who perform illegal abortions should serve jail time, just 26% of White non-evangelical Protestants and 18% of Black Protestants share this view.

• Only respondents who said that abortion should be legal in some cases but not others and that how long a woman has been pregnant should matter in determining whether abortion should be legal received questions about abortion’s legality at specific points in the pregnancy.  ↩

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Public Health in the Field: The Public Health Case for Abortion Rights

Annalies Winny

Lindsay Smith Rogers

This article is adapted from a special episode of the Public Health On Call Podcast called Public Health in the Field. You can hear the full episode here .

Please note: Throughout this article, the gendered terms “woman” and “women” are used as that’s how the CDC and other sources record related data. 

More coverage:

• Overturning Roe v. Wade and Public Health
• What We Know—and Don't Yet Know—About The Leaked Supreme Court Draft Opinion That Could Overturn Roe v. Wade

A single case before the Supreme Court will likely decide the future of Roe v. Wade.

In 2018, the Mississippi legislature passed and the governor signed House Bill 1510, known as the  Gestational Age Act , which bans abortions after 15 weeks. There are exceptions if the life of the fetus or parent is at risk—but not in cases of rape or incest. The law violated Roe v. Wade, a Supreme Court decision that protects the right to abortion prior to “viability” of the fetus, which is at around 24 weeks. The bill was quickly blocked by lower federal courts but now the law’s fate is up to the Supreme Court.

The outcome of this case— Dobbs v. Jackson Women’s Health Organization —has implications for abortion rights far beyond Mississippi: A decision that previability bans are not unconstitutional could upend longstanding protections established by Roe v. Wade, the 1973 landmark case that legalized abortion nationwide. 

The conversation about abortion rights in the U.S. is a noisy one involving politics, precedents, and personal beliefs. What often gets short shrift, however, is the public health reality that restricting access to abortion results in erosion of the health of women, especially low-income and women of color. This is why abortion is so much more than a legal battle. 

The Public Health Case for Abortion Rights

Many women who were denied wanted abortions had higher levels of household poverty, debt, evictions, and other economic hardships and instabilities, according to Joanne Rosen , JD , associate director of the  Johns Hopkins Center for Law and the Public’s Health .

The findings come from a 10-year study,  The Turnaway Study , which followed nearly 1,000 women who either had or were denied abortions and tracked their mental and physical health and financial impacts. 

“The study also found that women who were seeking but unable to obtain abortions endured higher levels of physical violence from the men who had fathered these children,” Rosen says. “And people who were turned away when seeking abortions endured more health problems than women who were able to obtain [them], as well as more serious health problems.

“That gives you a sense of the ways in which being unable to obtain abortions had really long lasting impacts on these peoples’ lives.”

A 2020 study in the  American Journal of Preventive Medicine found that women living in states with less restrictive reproductive health policies were less likely to give birth to low-weight babies. Other research  published in The Lancet found that restrictive abortion laws actually mean a higher rate of abortion-related maternal deaths.

Restrictive abortion laws affect more than just the health of individuals and families—they affect the economy, too. Research from The Lancet found that “ensuring women’s access to safe abortion services does lower medical costs for health systems.”  

The  Institute for Women’s Policy Research has a host of data around how reproductive health restrictions impact women’s earning potential, including an interactive map tool, Total Economic Losses Due to State-level Abortion Restrictions. In Mississippi , for example, the data indicate that an absence of abortion restrictions would translate to a 1.8% increase of Black women in the labor force, over 2% for Hispanic women, and a leap of more than 2.6% for women who identify as Asian-Pacific Islander. This same tool calculates that removing abortion restrictions would translate to an estimated $13.4 million in increased earnings at the state level for Black women alone. 

Abortion restrictions disproportionately affect people of color and those with low-incomes. According to  data from the CDC , Black women are five times more likely to have an abortion than white women, and Latinx women are two times as likely as whites. Seventy-five percent of people who have abortions are low-income or poor. 

Mississippi, Texas, and The Supreme Court   

On December 1, the Supreme Court will hear Dobbs v. Jackson Women’s Health Organization and Joanne Rosen thinks it’s unlikely the Court would agree to hear the case if they were just going to affirm the status quo. 

The case isn’t the only one on the docket, however. Texas’ Senate Bill 8, which bans abortion after six weeks of pregnancy, made headlines earlier this month and may impact SCOTUS’ ultimate decision on the Mississippi case. The high-profile law came before the Supreme Court in November 2021 and Rosen said the important thing to note is that the Court didn’t actually address whether the six-week ban is constitutional. Rather, they examined the unusual enforcement scheme of the law—where, when, and by whom the Texas law could be challenged.

Rosen says that the justices may compare the Texas law with the Mississippi law and, when considering a six-week abortion ban, a 15-week ban may seem less extreme. In this way, the Texas case could give the Court some cover to uphold Mississippi’s 15-week ban.

It’s likely to be months before an opinion is released; Rosen says the Court typically releases its decisions on high-stakes or controversial cases in June. And high stakes this is: for the future of abortion, for reproductive health rights, and for public health. 

Annalies Winny is an associate editor for  Global Health NOW . 

Alissa Zhu is a journalist and current  MSPH student at the Bloomberg School.

Lindsay Smith Rogers, MA, is the producer of the  Public Health On Call podcast and the associate director of content strategy for the Johns Hopkins Bloomberg School of Public Health.

RELATED CONTENT:

• Public Health Law Experts Discuss the Supreme Court Vacancy and Barrett Nomination

Public Health On Call

This article is adapted from a special episode of the  Public Health On Call Podcast  called Public Health in the Field.

Subscribe to Podcast

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Ramapo College of New Jersey Home Page » Academics » SSHS » Ramapo Journal of Law & Society » Thesis » Why Women Should Make the Abortion Decision: Damned If You Do, Damned If You Don’t

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Why Women Should Make the Abortion Decision: Damned If You Do, Damned If You Don’t

Related resources.

• Law and Society Major
• School of Social Science and Human Services (SSHS)

( PDF ) (DOC) (JPG) September 17, 2020

Christina San Filippo [1]

As a woman in today’s society, a woman who has had life-altering decisions about her body made for her throughout her entire life, I want to call attention to other women who are just trying to make their own decisions about their own bodies.

With this work, I recognize that within society there is a split between those who support a woman’s choice to have an abortion, and those who do not. I argue that both the decisions, to have an abortion, as well as to carry a pregnancy to term, have consequences. These consequences can be physical, sociological, and/or psychological. Therefore, the decision should be left to individual women to decide which consequences they are able to bear. For this reason, access to safe, medical care regarding reproduction and abortion should be available to all women, across all states.

Initially, I will establish the foundational background on the legalization of abortion. It will begin in the early 1800s, a time where abortion before “quickening” was legal for women in the United States. However, as women began to die from abortion inducing drugs, and Dr. Horatio Storer teamed with the American Medical Association to begin the “crusade on abortion,” disdain for the procedure grew. Throughout the mid-to-late 1800s, states began passing legislation to ban the drugs used for abortions and, eventually, the procedure itself. Contraception was also federally outlawed with the Comstock Law of 1873. Almost 100 years later both became legalized again with the major Supreme Court cases Griswold v. Connecticut, Eisenstadt v. Baird, and Roe v. Wade.

This legalization has not come without obstacles, however. The second section of this work delves into the state barriers put on abortion. Although legal federally, state constitutions still allow for each state to put laws in place that restrict access to abortion, including zoning laws, mandatory counseling, mandatory waiting periods, and minor consent or notification. All of these barriers within states were upheld by the Supreme Court in the case of Planned Parenthood v. Casey. In addition to these ongoing issues in states, the current President proposed a domestic gag rule, and reinstated a global gag rule, that limits funding to abortion providers. This section will further discuss the specific details of the state laws regarding access to abortion, and the status of the issue of abortion within the current federal administration.

Thereafter, the physical, sociological, and/or psychological effects of access, or lack thereof, to abortion may have one women is considered. Reasons for having an abortion vary from financial instability to unstable relationships. Upon receiving one, there is mixed research on whether women suffer future physical, sociological, and/or psychological effects. A sad reality is that even if a woman wants an abortion and feels she is capable of handling these possible consequences, she may be unable to get one. Whether the reason be barriers related to geographic location or financial situation, being forced to carry an unwanted child may also bear physical, sociological, and/or psychological effects.

Finally, the analysis concludes that both having an abortion and not being able to have an abortion can have negative effects on a woman. These effects can be either physical, psychological, and/or sociological. Women are capable of making their own decisions, and this should include access to abortion.  

I. History of Abortion and Contraception Legalization

Today, it is easy to take certain things for granted. As people living in America, the land of the free, we do not take a second glance at some of the things we are able to do. Two of these things are the ability to receive educated medical advice on reproductive health from physicians, and the ability to get a safe and legal abortion. However, this was not always the case. At certain points in history, all things regarding contraception and abortion were outlawed in the US. Though we usually think of women’s reproductive health as happening chronologically – first contraception and then abortion – the attention to women’s bodies happened in the opposite order. Historically, abortion began to be regulated before contraception.

Legal Abortion Before “Quickening”

Before and during most of the 1800s, certain abortions were legal, and not uncommon. A woman was only allowed to seek an abortion before “quickening,” which was when she could feel the fetus moving. Before this, it was believed that human life did not exist. Surprisingly, even the Catholic Church shared this view, believing that abortions before quickening were “prior to ensoulment” (Ravitz, 2016). In society, early pregnancies that ended were not even considered abortions, but were rather seen as pregnancies that “slipped away” (Reagan, 2008, p. 8). At this time, conception was seen as something that created an imbalance within the body, due to the fact that it interrupted a woman’s menstruation cycle (Reagan, 2008, p. 8). The way abortions usually worked was that women would take certain drugs to induce abortions. If these drugs failed, a woman could then visit a medical practitioner for an actual procedure to be rid of the fetus (Ravitz, 2016). Abortions before quickening were seen as a way to “bring the body back into balance by restoring the flow,” which meant the returning of the menstrual cycle (Reagan, 2008, p. 8). It was a practice done openly and honestly for pregnant women at this time.  

Abortion Outlawed: The Beginning of the End

Although abortions done before quickening were legal, they were not entirely a safe practice. The drugs that women took to induce the abortions often ended in the death of the woman, rather than just the termination of the fetus. Due to this, states began passing statutes that controlled the sale of “abortifacient drugs” as a “poison control measures designed to protect pregnant women” (Reagan, 2008, p. 10). Each of these laws sought to punish whoever administered the drug, rather than the woman who received it (Mohr, 1979, p. 43). In 1821, Connecticut passed a statute outlawing the use of abortion inducing drugs, believing they were a threat to life by causing death by poisoning. However, the law was only applicable if the woman had already experienced quickening. It is important to note that the law was not focused on the actual act of abortion and did not even mention surgical abortions; the focus was on the drugs used for abortions. After this statute was passed in Connecticut, more states began to follow. Missouri in 1825, and then Illinois in 1827, also passed legislation outlawing the use of abortion inducing drugs in an attempt to avoid deaths by poisoning. However, both of these states did not mention quickening, and made the use of these drugs illegal at any point during a woman’s pregnancy (Mohr, 1979, pp. 22–26).

Within the next few years, several states also began passing legislation regarding abortion. However, these statutes focused more on the act of abortion, rather than the drugs that caused them. Similar to the anti-drug laws, these statutes also sought to punish the person who performed the abortion, not the woman who received it (Mohr, 1979, p. 43). In 1834, Ohio passed a law stating that “the death of either the mother or the fetus after quickening” is a felony (Mohr, 1979, p. 39). Missouri soon followed by revising their previous abortion law and making “the use of instruments to induce an abortion after quickening a crime equal to the use of poisonous substances after quickening” (Mohr, 1979, p. 40). In 1840, Maine made “attempted abortion of any woman ‘pregnant with child’ an offense, ‘whether such child be quick or not’ and regardless of what method was used” (Mohr, 1979, p. 41). This Maine offense was punishable by jailtime or a large fine. As states continued to pass anti-abortion legislation, certain groups rallied behind this new-found fight against abortion.  

American Medical Association (AMA) and Horatio Storer

Despite certain states passing laws prohibiting the sale of abortion inducing drugs, the nationwide business for them continued to grow. The drugs were openly discussed, even advertised in newspapers, and were readily available (Ravitz, 2016). A woman was able to purchase the drugs from physicians, pharmacists, or order them and have them delivered by mail (Reagan, 2008, p. 10). Along with the growth in popularity of these drugs came criticism.

In 1847, the American Medical Association was founded. The establishment of this Association was the beginning of the politicization of abortion. At this time period, when a woman and a man got married, “the husband assumed virtually all legal rights for the couple” (Primrose, 2012, p. 170). This was both a law, and a patriarchal viewpoint that was accepted within society. It was seen as the duty of women to bear children to their husbands. The American Medical Association asserted that abortions not only posed health risks to women, but also prevented wives from fulfilling this role in their marriage contract. At this time women were also seeking entry into Harvard Medical School, where many sought to pursue careers in gynecology and obstetrics. These career goals threatened the role of women as subjects of their husbands, and so created a kind of push-back by the American Medical Association (Ravitz, 2016).

American Medical Association Role in Outlawing Abortion

In 1857, the American Medical Association began focusing mainly on getting abortion to be outlawed, with Dr. Horatio Storer at the head of this crusade. On top of the previously mentioned patriarchal reasons pushing for this criminalization, a couple of other factors contributed. One was the fear of immigrants in the United States. Storer was one of many Americans who shared this fear, worrying that the nation would soon become out-populated by people of other ethnicities, leaving white people outnumbered. Another was the threat that licensed physicians felt from midwives and homeopaths, who they saw as their competition in the medical field. By outlawing abortion, this threat would be neutralized, and physicians would have power and control over practicing medicine. For these reasons, physicians supported Storer and the American Medical Association in the fight to outlaw abortion (Ravitz, 2016). Overall, Storer, backed by physicians around the nation, helped influence abortion laws by appealing to “a set of fears of white, native-born, male elites losing political power to immigrants and to women” (Reagan, 2008, p. 13). However, their anti-abortion campaign also had to try to reach women in America as well.

Dr. Horatio Storer was the son of David Humphreys Storer, a professor at Harvard Medical School in the field of Obstetrics and Medical Jurisprudence. David Storer argued that the only time an abortion was acceptable was if it was to save the life of the mother, and that a fetus becomes a human being as soon as the embryo enters the uterus. David’s son, Horatio, adopted this mentality and used it in his crusade against abortion. In 1866, he wrote a book entitled, Why Not? A Book for Every Woman , followed by Why Not? A Book for Every Man , which were widely distributed to female patients by their physicians. The books were an attempt to make women feel guilty for having abortions and convince men that they were equally guilty as the father of the unborn. Storer was smart enough to recognize that not all women may give in to arguments based on morals and guilt. For this reason, he “recommended that their physician readers appeal to women’s concerns about their own health as a way to persuade them to have their children” (Dyer, 2003). This ensured that the American Medical Association was fighting against abortion from all possible angles and viewpoints.

Anti-Abortion Laws Continue

With much help from the American Medical Association, the anti-abortion movement gained traction in the nation. This social shift towards the nonacceptance of abortion was reflected in laws passed by states at the time. Within the time period of 1860-1880, “the United States produced the most important burst of anti-abortion legislation in the nation’s history” (Mohr, 1979, p. 200). During these years, states passed “at least 40 anti-abortion [laws],” and “13 jurisdictions formally outlawed abortion for the first time” (Mohr, 1979, p. 200).

The first state to start this wave of legislation was Connecticut in 1860. The law contained four separate sections laying out all things that were now illegal regarding abortion. The first section discussed abortion in general, stating that the act was considered “a felony punishable by up to $1000 fine and up to five years in prison” (Mohr, 1979, p. 201). The second section stated that any accomplices of the person who performs the abortion is guilty of the crime as well. The third section said that the woman who receives the abortion is also guilty of the felony, even if she attempts one on herself. The fourth section discussed abortifacient information and materials, stating that the distribution of either was punishable by fines between $300 and $500 (Mohr, 1979, pp. 201–202). The contents within the third and fourth sections of this statute were things that had never been mentioned before in anti-abortion laws, and signified the “evolution of abortion policy” that was about to sweep the nation (Mohr, 1979, p. 201). This Connecticut law set the stage for other states, which began passing their own more intense abortion laws. Examples include “Colorado Territory and Nevada Territory in 1861, and Arizona Territory, Idaho Territory, and Montana Territory in 1864,” which each made abortion a punishable offense (Mohr, 1979, p. 202).

Contraception Outlawed: Comstock Law of 1873

In 1873, The American Medical Association gained a victory when the Comstock Law was passed. This statute, passed on March 2, 1873, banned both the importation and distribution of any information or drug that aimed towards the prevention of conception (Tone, 2000, p. 439). The law made it illegal to “mail contraceptives, any information about contraceptives, or any information about how to find contraceptives” (Primrose, 2012, p. 173). Congress was able to do this by “enacting the antiobscenity statute to end the ‘nefarious and diabolical traffic’ in ‘vile and immoral goods’ that purity reformers believed promoted sexual licentiousness” (Tone, 2000, p. 439). Simply put, the government banned birth control and any information related to birth control under the guise that both its availability and use would contribute to sexual promiscuity, making it obscene, and allowing it to fall under the purity laws. The penalty for anyone who was caught violating the Comstock Law was “one to ten years of hard labor, potentially in combination with a fine” (Primrose, 2012, pp. 173–174). After Congress enacted this law, twenty-four states passed their own state versions to affirm the federal law (Tone, 2000, p. 441). On top of these federal and state laws, the government also gave “the United States Postal Service authority to decide what was ‘lewd, lascivious, indecent, or obscene’” (Primrose, 2012, p. 174). This was based on the fact that the business of birth control relied heavily on interstate commerce (Tone, 2000, p. 441).

Despite the fact that birth control and all information regarding it was outlawed people did not stop having sexual intercourse. As expected, this resulted in unwanted pregnancies. Women in this position who still sought an abortion despite its illegality were forced to look elsewhere to receive the procedure, which many times consisted of unsafe and unsanitary conditions (Primrose, 2012, p. 175).

Contraception Legalized: Contribution of a “First Wave Feminist” Movement in the United States

Around 1915, coinciding with advocates for the right of women to vote, a large feminist movement began growing, headed by Margaret Sanger, which focused on the importance of birth control. Sanger was a nurse who visited homes and was often asked questions by women on how to prevent having more children. One of Sanger’s patients died from a self-induced abortion, which led her to become more vocal about the unjustness that comes from restricting information on birth control. Sanger believed that the only way to achieve equal rights among men and women was for society to release women from the expected role of being a childbearing wife. In 1916, she attempted to open a contraceptive clinic in Brooklyn, New York, but was shut down after ten days. Despite being open for a short amount of time, the clinic had visits from 464 women. This staggering number displays the desperate need for contraception at the time.

Sanger continued her efforts to fight for contraception, and with support growing, she created the American Birth Control League (Galvin). In 1932, after Sanger was arrested for mailing birth control products, a judge from the Second Circuit Court of Appeals “ordered a relaxation of the Comstock laws at the federal level” (Primrose, 2012, p. 182). The opinion, written by Judge Augustus Hand, stated that contraception could no longer be described as “obscene,” and that there was a great amount of damage caused by this ban. He “ruled that doctors could prescribe birth control not only to prevent disease, but for the ‘general well-being’ of their patients” (Galvin, 1998). This was a great win for Sanger and those who also fought for the legalization of birth control.

In 1942, the American Birth Control League decided to switch their approach and portray birth control as a means of family planning rather than a way to “liberate women” (Primrose, 2012, p. 183). With this change in approach also came a name change: Planned Parenthood. Although Sanger did not approve of this shift in philosophy or name change, both helped the organization present itself as much friendlier towards both men and women, and to become socially accepted (Primrose, 2012, pp. 183–184).

As time went on, the feminist movement towards legalized contraception and abortion continued. In the 1960s, the women’s liberation movement gained much more support after many were being “inspired by the civil rights and anti-war movements” (Ravitz, 2016). This traction in the women’s movement could be seen in the years to come within court decisions.

First Comes Marriage

After the ruling by Augustus Hand in the Second Circuit Court of Appeals, there was a large move towards the social acceptance of birth control. However, a Second Circuit decision is only binding in one jurisdiction. While this was a win for those within this area, and certainly did reflect a growing social acceptance, it was not sufficient to repeal laws nationwide. At this point, disagreement among the states on the issue of abortion was rising. For this reason, the issue rose all the way to the US Supreme Court.  

Griswold v. Connecticut , 381 U.S. 479 (1965)

In 1965, the Supreme Court helped strike down any laws within the states that mimicked the Comstock Law in Griswold v. Connecticut. In this case, Estelle Griswold was the executive director of Planned Parenthood in Connecticut. Griswold was arrested for giving out information about contraception under a Connecticut law which banned this. The Supreme Court brought up the idea of privacy within homes and ruled that although the “right to privacy” is not overtly written in the Bill of Rights, it still is a fundamental right protected under the Constitution. They discussed the idea that the Bill of Rights throws “penumbras” under which certain fundamental rights lie. In this case specifically, the First, Third, Fourth, Fifth, and Ninth Amendments all cast grey areas in which the “right to privacy” stands, which is then applied against the states using the Fourteenth Amendment. The court held that the Connecticut statute was overly broad and caused more harm than needed to be done. The statute encroached on a certain area in life where privacy is essential – inside a marriage. This ruling declared that a state is unable to ban the use of contraceptives within a marriage due to the right to privacy.

Then Comes All Persons

Eisenstadt v. Baird , 405 U.S. 438 (1972)

While this was a great win for birth control advocates, it only made the distribution of contraception legal for married couples. In 1972 came Eisenstadt v. Baird , the Supreme Court case which extended this ruling to single peoples as well. In this case, Bill Baird was arrested for selling birth control in the form of vaginal foam to multiple women at Boston University. He was charged under a Massachusetts statute that mimicked the previous federal Comstock Law. After the ruling of Griswold v. Connecticut , this statute had been amended, but it was only to legalize the distribution of birth control to married couples. In the opinion of Eisenstadt v. Baird , Supreme Court Justice William Brennan “declared that ‘whatever the right of the individual to access to contraceptives may be, the rights must be the same for the unmarried and the married alike’” (Garrow, 2001, p. 65). The foundation of this argument stemmed from the fact that “the law violated ‘the rights of single persons under the Equal Protection Clause’ of the Fourteenth Amendment” (Garrow, 2001, p. 64). This ruling helped establish legal contraception for all individuals.  

Abortion Legalized Federally

Roe v. Wade , 410 U.S. 113 (1973)

In 1973, the contraception movement came to a peak when the Supreme Court ruled in the case of Roe v. Wade , federally legalizing abortion. In this case, a single pregnant woman in the state of Texas challenged a “criminal abortion statute which only allowed abortions ‘for the purpose of saving the life of the mother’” (Zagel, 1973). The plaintiff, named anonymously as Jane Roe to protect her identity, who was later revealed to be Norma McCorvey, asserted in the legal briefs that the statute was unconstitutional and a violation of the right to privacy, therefore the law was null and void. Texas argued that it has compelling state interests in the life of the mother, the protection of prenatal life, and in the discouragement of illicit sexual activity, making this statute constitutional. The court understood the state’s concern for the mother and unborn child but did not accept the argument regarding sexual activity. After weighing the valid points brought forward by both Roe and Texas, the Court ruled accordingly. In the first trimester, the state has no say, and all decisions are to be made between a woman and her doctor. In the second trimester, a woman is still able to receive an abortion, but the state is able to make some regulations in order to protect the mother’s life. In the third trimester, abortions are contingent upon demonstrated threats to the mother’s health, due to the fact that the life of the fetus is considered viable.

Throughout history, the idea of access to “family planning” – whether that be birth control or abortion – has been controversial. Abortion drugs were initially very common but were then banned under the Comstock Law after much lobbying by the American Medical Association. After this, feminist movements began picking up the fight for contraception. The pleas of the movements were not answered until much later, when the Supreme Court made their rulings in Griswold v. Connecticut, Eisenstadt v. Baird, and Roe v. Wade.

Figure 1: Legal Historical Timeline of Abortion and Reproductive Rights

II. Current Legal Obstacles Preventing Abortion

After several federal court decisions legalized abortion and the distribution of contraception, and any information regarding it, it seemed as though the fight for reproductive rights was over. Significantly, an “undue burden” on a woman was ruled as unconstitutional. Additionally, the American Medical Association, a previously large motivator in the anti-abortion movement, moved towards a more pro-choice viewpoint and backed up from being vocal against abortion. In 1990, the AMA stated that “the issue of support or opposition to abortion is a matter for members of the AMA to decide individually, based on personal values or beliefs.” In 2013, the Association as a whole shifted further towards pro-choice, stating that “the Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion,” as long as it is done in “good medical practice” and does not violate the law (Hart, 2014, p. 292).

However, the federal court rulings only set a legislative basis for states, which were then responsible for the abortion statutes within their own borders. Despite the fact that abortion was made legal on the federal level, states were, and still are, able to enact statutes that could create certain barriers making it hard for women to obtain an abortion. These barriers include zoning laws, mandatory counseling, waiting periods, and minor consent or notification. Besides being inconvenient hurdles to overcome, these barriers also insinuate an assumption that women seeking abortions have not thoroughly contemplated their decision, and/or are not able to properly educate themselves before doing so.

Hyde Amendment of 1976

In 1976, the United States Congress passed an “amendment to a federal appropriations bill specific to [the Departments of Labor and Health and Human Services].” This amendment, titled the Hyde Amendment, “prohibits using U.S. federal funds to pay for abortions in programs administered through” the two aforementioned federal departments. One of the programs that is affected by this amendment is Medicaid, which is “a joint state-federal program for low-income people.” Under the Hyde Amendment, Medicaid programs in states are unable to access and use federal funds to help low-income people get abortions. Since its installment, the Amendment has “been altered to include exceptions for pregnancies that are the result of rape and incest” (Boston Women’s Health Book Collective, 2011, pp. 341–342, 774). This Amendment is a possible barrier for women who are unable to afford an abortion on their own, which is discussed further below.  

Planned Parenthood of Southeastern Pennsylvania v. Casey , 505 U.S. 833 (1992)

In 1989, Pennsylvania passed the Pennsylvania Abortion Control Act, which sought to intensely restrict a woman’s ability to get an abortion. Under this law:

A woman seeking an abortion must (i) be given certain state-approved information about the abortion procedure and give her informed consent; (ii) wait 24 [hours] before the abortion procedure [after receiving this information]; (iii) if the woman was a minor she had to obtain parental consent; and (iv) if the woman was married she had to notify her husband, in writing of her intended abortion (Medoff, 2009).

Following the passing of this law, the Planned Parenthood of Southeastern Pennsylvania filed a lawsuit, claiming that the law was unconstitutional. The suit made its way to the United States Supreme Court, which ruled that “states could regulate abortions before viability as long as the regulation did not place an ‘undue burden’ on a woman’s access to an abortion” (Medoff, 2009). However, the Court did not give an explicit definition of what an “undue burden” entails, giving states leeway to enact restrictions on the access to abortion. The Court also upheld the first three parts of Pennsylvania’s statute, but struck down the fourth, requiring husband notification. By upholding the first three, the Supreme Court allowed Pennsylvania to set the stage for other states across the nation which sought to limit the access to abortion (Medoff, 2009).

Types of Abortion Barriers

Zoning Laws

One possible barrier to abortion access that states are able to implement is zoning laws. Under the Constitution, each state has a certain amount of police powers that allow for the enactment of laws and regulations that aim to protect, preserve, and promote the public safety, health, morals, and general welfare of the people (Legal Information Institute). Local governments within states are able to pass zoning laws in the community under these police powers. “Zoning laws determine what types of land uses and densities can occur on each property lot in a municipality.” In some areas throughout the nation, local governments use zoning ordinances to limit the areas where abortion providers can reside (Maantay, 2002, pp. 572–575). This topic is further discussed below.

Mandatory Counseling

According to the Guttmacher Institute, as of March 1, 2019, “34 states require that women receive counseling before an abortion is performed” (Guttmacher Institute, 2019a). The legal basis of mandatory counseling laws lies upon the principle of informed consent. This principle is the idea that patients “have the right to receive accurate and unbiased medical information from their health care provider so that they can make an informed decision about their treatment” (Medoff, 2009). Mandatory counseling laws in states make it a requirement for physicians to read a “’script’ to any patient seeking an abortion” (Rose, 2006, p. 105). These scripts are specific to each state, which are left to approve of the information they wish to include. While the counseling information may vary state-to-state in terms of what exactly must be included, each have the same general idea: to warn women who are seeking an abortion of the possible complications, side effects, and other options.

To stay in accordance with the idea of providing unbiased and objective information, states must also counsel women about options other than abortion, and the possible effects associated with them. For example, North Carolina’s “Woman’s Right to Know Act” states that physicians must inform the woman that she “has other alternatives to abortion, including keeping the baby or placing the baby for adoption.” The act also requires abortion providers to provide patients with printed materials that detail the possible complications and effects of abortion, “as well as the medical risks associated with carrying an unborn child to term” (Stam, 2012, pp. 18–20).

The issue with this counseling is that not all the information distributed is necessarily accurate and may “dissuade women from having an abortion by giving them biased medical information … that is deliberately inaccurate and false” (Medoff, 2009).

One piece of information included in the counseling materials of several states is the idea that “abortion is detrimental to a woman’s mental health” (Medoff, 2009). While this may be the case for some women who receive abortions, it is not true for all. This topic is considered further below.

Other information that is commonplace in counseling materials is that abortions are linked to future medical issues within women. In 6 out of the 34 states that include mention of medical issues, the emphasis is on the correlation between abortion and breast cancer, and 22 out of 34 include information about infertility (Guttmacher Institute, 2019a). However, research has shown that the claims being made are not necessarily accurate. Among the 6 states that discuss breast cancer, 5 “inaccurately assert a link between abortion and an increased risk of breast cancer” (Guttmacher Institute, 2019a). Furthermore, in 1996, The National Cancer Institute stated that after doing research, they found “no evidence of a direct relationship between breast cancer and either induced or spontaneous abortion” (Medoff, 2009). Regarding infertility, there is research showing that “vacuum” abortions, which are “the most common method used in over 90% of all abortions – poses no long-term risk of infertility” (Medoff, 2009). In 4 of the 22 states that discuss infertility, the risk is inaccurately portrayed (Guttmacher Institute, 2019a). The distribution of this inaccurate information may scare women away from having an abortion, fearing they will have serious health complications in the future.

In 13 out of the 34 states, the mandatory counseling information tells women that the fetus is able to feel pain during the procedure of the abortion (Guttmacher Institute, 2019a). However, not every state provides the same facts. In South Dakota, women are told that the fetus feels pain no matter how far along the pregnancy may be. In Texas, women are told the fetus can feel pain as early as 12 weeks, while women in Arkansas and Georgia are told it is 20 weeks (Medoff, 2009). However, research has shown “that the necessary physical structures to perceive pain develop between 23 and 30 weeks’ gestation” (Gold & Nash, 2007). This disagreement between states clearly shows how inaccurate the information being distributed to women may be.

Aside from possibly dissuading women from getting an abortion by providing potential complications and side effects, the counseling information can also be laced with bias language meant to do the same. For example, in 2003, Texas passed a law entitled “Woman’s Right to Know Act,” which required abortion patients be given a twenty-three-pages long booklet discussing all of the possible risks listed above. However, the booklet refers to the fetus as an “unborn child,” using word choice to place personhood on the fetus (Rose, 2006, p. 106). It also “speaks at length about the euphoria of giving birth,” while barely touching on the possible issue of post-partum depression if the woman chooses to have the child (Rose, 2006, p. 106). The subtle use of language and emphasis on happy childbirth shows that the state favors the idea of carrying the fetus to term rather than letting the woman have an abortion.

Waiting Periods

Following the mandatory counseling, as of March 1, 2019, 27 out of these 34 states require that there be a waiting period of at least 24 hours until the woman can receive the abortion (Guttmacher Institute, 2019a). In these cases, women are required to visit the physician twice: once to be counseled, and second to undergo the procedure after the waiting period is complete. While this may be a minor inconvenience for some women, it can be quite major for others. For example, if a woman has traveled a far distance to receive the abortion, there are extra costs involved, whether that be money for gasoline, public transportation fees, and/or paying to stay in a hotel. By forcing these women to visit the physician twice, the money they are spending increases, whether that be by a few dollars for a couple of more gallons of gasoline in their car or by a few hundred dollars for an extra night in a hotel room. While the waiting period may be a helpful time for some women to read and further inform themselves on the procedure they are about to receive, it may be a burden for others who have already confirmed their decision and cannot afford these extra costs (Rose, 2006, p. 106).  

Minor Consent or Notification

As of March 1 2019, 37 states in the nation require the involvement of a minor’s parent when deciding to have an abortion. In 11 of these 37 only require parental notification, while 21 require parental consent (Guttmacher Institute, 2019b). Among the many barriers put on access to abortion, “parental involvement laws have some of the highest public support” (Rose, 2006, p. 107). A large portion of this support comes from the idea that minor’s may be too immature to make this life-altering decision on their own and require the potentially important input of their parents (Rose, 2006, p. 107).

In an attempt to avoid the laws requiring them to involve their parent, some young girls travel across state lines to receive the procedure in a state that does not have these laws. If that is not a possibility, other girls turn to unsafe illegal procedures to terminate their pregnancy (Rose, 2006, p. 107). One specific example of this is Becky Bell, a seventeen-year-old girl from Indianapolis. In 1988, afraid to inform her parents that she was pregnant, Becky sought out an illegal abortion (Lewin, 1991). During the procedure, unsanitary instruments were used, which resulted in the young girl contracting a bodily infection. Within one week, Becky’s veins collapsed, her heart stopped, and she died (Rose, 2006, p. 107). This case became an example of the potential issues with the forced involvement of parents.

While parental involvement laws may seem rational, they pay no attention to the possible circumstances within each minor’s situation. For a young girl who has an open and close relationship with her parents, these laws may not pose an issue. Oppositely, for a young girl who has a distant, unhealthy, and/or violent relationship with her parents, such as Becky Bell, these laws may be extremely problematic. In a 1991 study that looked at reasons why minors seeking abortions did not want to inform their parents, the most common reasons listed “were wanting to preserve their relationship with their parents and wanting to protect the parents from stress and conflict” (Henshaw & Kost, 1992). These reasons may be especially true in a household where the pregnancy is the result of a friend/family rape, which would put much stress on the family relationships. Due to these possible issues, 36 out of the 37 states with parental involvement laws “include a judicial bypass procedure, which allows a minor to obtain approval from a court” (Guttmacher Institute, 2019b). This procedure, if approved, grants a minor the ability to receive an abortion without involving a parent.

Current Federal Administration

Election of Donald Trump

Although states have been able to place these barriers limiting the access to abortion within their borders, the rights granted in Roe v. Wade have continued to hold steady in federal law. However, more recently, there has been fear of a perceived threat to these rights. This fear began with the election of President Donald Trump in November 2016. When elected, Trump vowed “to nominate socially conservative Supreme Court Justices, withhold federal funding from Planned Parenthood, and sign legislation banning abortion after 20 weeks of pregnancy” (Reinhard, 2016). Although Trump has not signed any legislation doing so, he has indeed followed through on the first two promises.

Nomination of Socially Conservative Supreme Court Justice Brett Kavanaugh

In 2018, President Donald Trump nominated Judge Brett Kavanaugh to become a Justice on the United States Supreme Court. Since this nomination, Kavanaugh has been elected to the Supreme Court, replacing Justice Anthony Kennedy, who “protected [ Roe v. Wade ] as the court’s swing vote on abortion” (Bassett, 2018). By replacing Kennedy, Kavanaugh creates “a solid conservative majority on the court,” which could potentially threaten Roe , given his standpoint on the issue of abortion (Gershman, 2018). Although Kavanaugh has not spoken directly about his views on the Supreme Court decision of Roe v. Wade , he has spoken about “the government’s ‘permissible interests’ in ‘favoring fetal life’ and ‘refraining from facilitating abortion,’” indicating his opinions on the subject lean toward a pro-life viewpoint (Bassett, 2018). However, despite the possible personal opinions of Kavanaugh, he has stated that he believes Roe v. Wade is a “settled law” (Gershman, 2018). While there was no further explanation on what exactly Kavanaugh meant by those words, a logical interpretation would mean that “he believes the precedent is too deeply embedded in the fabric of the law to be re-examined” (Gershman, 2018). This would mean that Kavanaugh himself is not even confident in the fact that the Supreme Court could overturn the landmark decision.  

Trigger Laws

Although the possibility of Roe v. Wade being overturned is questionable, some states have “trigger laws” set up in the event that it does happen. These laws are blatant state bans put on abortion, but are presently unconstitutional, therefore, unenforceable. The point of these laws is to have statutes set in place, ready to “become enforceable without further legislative action” the moment Roe v. Wade gets overturned, if ever (Rose, 2006, p. 102). The states that have put these laws in place are Mississippi, Louisiana, North Dakota, and South Dakota (Gershman, 2018).  

Gag Rules Withholding Federal Funding from Planned Parenthood

  When getting elected, President Trump also promised to withhold federal funding from Planned Parenthood. In February 2019, the Trump administration announced, “that it will bar organizations that provide abortion referrals from receiving federal family planning money” (Belluck, 2019). This new legislation is a form of a “gag rule,” which “prohibit those working in state-run health care facilities from even speaking of abortions as an option with patients” (Rose, 2006, p. 109). In this specific federal rule, “clinics will be able to talk to patients about abortion, but not where they can get one” (Belluck, 2019). This means that organizations meant to help women, such as Planned Parenthood, could potentially lose millions of dollars in funding (Belluck, 2019). As of this writing a federal court in Washington state issued a nationwide injunction that stops the rule from taking effect while various lawsuits are pending (Barbash, 2019).

Trump Reinstatement of Global Gag Rule

Aside from being present within the United States, every recent Republican Administration has enforced such gag rules internationally. “The United States is the largest donor of international family planning money, which is dispersed through the United States Agency for International Development.” This agency “funds international non-governmental organizations (NGOs) in contraceptives, training, technical assistance, and other family planning needs.” However, in 1984, the Reagan Administration instituted a global gag rule, which mandated that any NGO “that performed or promoted abortion services” were no longer “eligible for USAID funding,” even if abortion was legal in their jurisdiction. When the Clinton Administration came into power, this global gag rule was overturned. This back-and-forth has continued ever since, with the Bush Administration reinstating the global gag rule, and then the Obama Administration overturning it (Gezinski, 2012, pp. 839–840). Predictably, President Trump reinstated it – on his first day in office. This global gag rule is a large setback for many countries in the developing world, where NGOs are a primary source for women’s health care. For example, in some parts of Africa, these clinics “offer HIV/AIDS prevention and treatment, maternal health, and counseling on sexual violence like genital mutilation.” This rule also cuts funding for the International sector of Planned Parenthood (Quackenbush, 2018). By cutting funding to NGOs around the world, the global gag rule can have serious effects on a woman’s ability to get proper health care.

III. Possible Effects After Having an Abortion or Being Denied an Abortion

Before being able to fully understand the potential effects of an abortion, one should know exactly what the abortion process consists of. There are multiple different kinds of abortion procedures a woman can receive that vary in methods and depend on how far along the pregnancy is. By being fully educated on the details of the actual procedure, individuals are able to understand the issues surrounding abortion on a more comprehensive level. The following paragraphs will go through the vital specifics of each procedure.

Receiving an Abortion: How is it Done?  

First Trimester Abortions

“In the United States, most abortions (88 percent) are performed during the first trimester,” which includes the first twelve weeks of pregnancy. Currently, there are two different forms of first-trimester abortions: a medication abortion or an aspiration abortion. A woman is able to choose which one she wishes to receive. As of 2011, aspiration abortion is more commonly used than medication abortion, but the interest for the latter continues to rise. If a medication abortion fails, an aspiration abortion is necessary to abort the fetus (Boston Women’s Health Book Collective, 2011, pp. 324–328).

“In a medication abortion, the pregnancy is interrupted and expelled over the course of a few days using medicines.” While in the presence of the doctor, a woman swallows a pill containing a drug called mifepristone. Later, when at home, the woman takes another drug, misoprostol, either by inserting it vaginally or letting is dissolve inside her mouth. The abortion begins a few hours later, consisting of heavy bleeding and cramping. To ensure the abortion worked, the woman must go back to the doctor one week later for a follow-up appointment. In 95 to 98 percent of cases, this method is effective. However, if it fails, the woman must then undergo an aspiration abortion (Boston Women’s Health Book Collective, 2011, pp. 324–326).

In an aspiration abortion, also known as surgical or vacuum abortion, “suction is used to remove the pregnancy.” A thin tube, called a cannula, is “inserted into the uterus and connected to a source of suction, either an electric pump or a handheld syringe,” which then removes the fetus from the woman. Unlike medical abortions, aspiration abortions only take 5-10 minutes to complete and do not require a follow-up appointment with the doctor unless the woman is experiencing problems (Boston Women’s Health Book Collective, 2011, pp. 324–328).

Second and Third Trimester Abortions

When Do They Happen?

“In the United States, about 12 percent of all abortions take place after the first trimester” (Boston Women’s Health Book Collective, 2011, p. 332). Women enter the second trimester of pregnancy at week 12, and the third trimester at week 28 (Boston Women’s Health Book Collective, 2011, p. 332; Cha, 2015). The Centers for Disease Control and Prevention reported that in 2015, only “about 1.3 percent of abortions were performed at or greater than 21 weeks of gestation.” This means that within the aforementioned 12 percent, almost all of these abortions are done during the beginning and middle of the second trimester. In the rare cases where women seek abortions in their third trimesters, the reasons are serious and based on “an absence of fetal viability,” and/or risks to the mother’s health or life (Cha, 2015).

Procedure Details

For second and third trimester abortions, the procedures differ from those in the first trimester. Currently, there are two different methods used to abort a fetus after the first trimester: dilation and evacuation (D&E), and induction abortion (Boston Women’s Health Book Collective, 2011, p. 332).

In a D&E procedure, the fetal and placental tissues are removed by using a combination of instruments and suction. This method is more commonly used, and quite similar to the aspiration abortions performed during the first trimester. However, due to the fact that the pregnancy is further along, the woman’s cervix must “be opened wider to allow the larger pregnancy tissue to pass, which requires the clinician to soften and dilate the cervix ahead of time.” This can take anywhere from a few hours to two days and can be done either by the use of instruments (osmotic dilators), or drugs (misprostol). The earlier a woman is in her pregnancy, the less time this portion of the abortion takes. After the cervix is prepared, “the clinician removes the pregnancy (fetal and placental tissue) with vacuum aspiration, forceps, and a curette (a small, spoonlike instrument)” (Boston Women’s Health Book Collective, 2011, pp. 332–333).

“After a certain point in pregnancy (usually around twenty-four weeks), a D&E can no longer be performed and the only option is an induction abortion.” In an induced abortion, a woman is given drugs that induce labor. The drugs that are used can vary depending on the circumstances of the situation, and can either be inserted into the vagina, be given through an intravenous line, or injected into the woman’s abdomen. These drugs cause contractions of the uterus, thus sending the woman into labor. The fetus and placenta are then ‘delivered,’ expelling the pregnancy. This method “usually takes place in specialized facilities or hospitals,” and takes more time than D&E’s. Due to this, and the fact that it forces women to endure the mental and physical stress of labor, induction abortion is less commonly chosen than D&E. However, in a case where the pregnancy being ended is wanted, this method allows the woman to deliver and hold the fetus, and say good-bye (Boston Women’s Health Book Collective, 2011, pp. 332–334).  

Reasons Why Women May Get an Abortion

Despite the possible attempts by state law to limit a woman’s ability to get an abortion, the medical procedure is still performed across the nation. While the specific reasoning behind every abortion is different in each individual situation, in many cases, there are common themes of reasoning.

In 2004, a study was done by the Guttmacher Institute to explore the reasons why a woman may seek an abortion. In the study, over 1200 abortion patients at 11 providers completed a survey that asked questions regarding their reasoning. The first portion of the survey was open ended, asking the woman to briefly explain why she was choosing to get an abortion at that time. If there were multiple reasons, she was asked to give them in order from most to least important. After that, there were specific reasons listed that the woman had to confirm whether or not were applicable to her. There were three large reasons listed that then provided even more specific sub-reasons underneath. These three included: “having a baby would dramatically change my life,” “can’t afford a baby now,” and “don’t want to be a single mother or having relationship problems” (Finer et al., 2005, p. 113). Under “having a baby would dramatically change my life,” the sub-reasons for why it would do so were because it would interfere with the patient’s education and/or career, and/or because she already had other dependents in her life (Finer et al., 2005, p. 113). Under “can’t afford a baby now,” a few sub-reasons for lack of funds were because the woman was unemployed, could not leave her job to care for the child, and/or could not even afford the basic necessities of life (Finer et al., 2005, p. 113). Under “don’t want to be a single mother or having relationship problems,” a couple sub-reasons were because the woman was unsure about her current relationship, or because she was not in a relationship at the moment (Finer et al., 2005, p. 113). After the breakdown of these three large reasons, there were various others listed, including: “have completed my childbearing,” “don’t want people to know I had sex,” “don’t feel mature enough to raise a child,” “victim of rape,” and “result of incest” (Finer et al., 2005, p. 113). Finally, the questionnaire provided a space where the woman could write in her own reasons that were not listed or did not qualify within the given categories. The results showed that most women identified with reasons that fell within the three large ones, with 74% of respondents feeling that “having a baby would dramatically change [their] life,” 73% saying they “[could not] afford a baby [at the moment],” and 48% “[citing] relationship problems or a desire to avoid single motherhood” (Finer et al., 2005, p. 113). This study provided many possible reasons as to why a woman may seek an abortion.

In 2013, a similar study was published by BioMed Central Women’s Health that examined the reasons why women get abortions. This study looked at the data collected during the Turnaway Study , which was done to evaluate “the health and socioeconomic consequences of receiving or being denied an abortion in the US” (Biggs et al., 2013, p. 1). Although the premise of the Turnaway Study was not to focus on the reasons why women wanted an abortion, those who participated were required to give their reasoning. This 2013 study took those women’s answers and analyzed them. The sample for this study was “954 women from 30 abortion facilities across the US,” who were questioned between 2008 and 2010 (Biggs et al., 2013, p. 1). Many of the reason’s women mentioned in this study overlapped with those given during the 2004 study, falling under the general concepts of financial instability, partner-related issues, and inconvenient timing. However, some women delved into other reasons motivating their decision. Out of all the respondents, 12% had health-related reasons regarding either herself, the fetus, or both. One woman explained that the medication she had been taking for her bipolar disorder was known to cause birth defects and felt it would be considered child abuse to bring a baby into the world knowing that it may have life-altering defects. Five percent of respondents mentioned reasons that included family members. One woman was scared her family would not accept that she would be having a biracial child, while another stated that her dad wanted her to finish school before having a child (Biggs et al., 2013, pp. 7–8). The 2013 study differed from the 2004 study in the fact that the women were only given open ended questions to answer, rather than checking off possible reasons from a provided list. This emphasis on personal words helped yield answers that reflected how each woman’s reasoning is specific to her own life and situation.

It is important to note that every woman and situation is different. While these studies show a plethora of reasons why women decide to get abortions, the circumstances surrounding every single abortion are personal to the individual(s) involved. The range of reasons can include physical and mental health issues, economic needs, and/or fear of social stigma.  

Potential Physical, Sociological, and Psychological Effects of Abortions

A hypothetical woman who wanted an abortion did it. She jumped through all the hoops: she was granted the fundamental right to receive one by the federal government, came to the educated and reasonable decision that she wanted one, overcame any legal barriers her state instituted on the matter, and was able to get the abortion she sought out to get. Now what? Does the life-altering procedure she just underwent truly alter her life? Or does she return to her regular weekly schedule, viewing the abortion as a minor inconvenience in her life?

The general consensus on this matter is contradicting. When speaking about physical, sociological, and psychological health, some research states that there are no effects on women who receive an abortion, while other research state that they are indeed affected. That is because “both opponents and advocates could easily prove their case by picking and choosing from a wide range of contradictory evidence” (Arthur, 1997, p. 7).  

Physical Effects

After receiving an abortion, there is research concluding that women may suffer from possible physical health effects in the future. The effects that will be discussed below are increased risk of breast cancer and future reproductive health issues.

Breast Cancer

One health risk that has been linked to abortion is an increased risk to breast cancer. According to biologist and endocrinologist Joel Brind, Ph.D., as stated in an article published in Human Life Review :

Breast lobules, which are the lactational apparatus of the breast, remain in their immature Type 1 and 2 states unless they are stimulated by a pregnancy. The pregnancy signals the mother’s body to send estrogen (a potential carcinogen) to her breasts, and the lobules begin to multiply. This multiplication continues until the thirty-second week of pregnancy, when the milk cells are fully mature. If a woman has an abortion or delivers prematurely before the thirty-second week, cancer is more likely to develop in the immature cells. Mature milk cells are much less prone to becoming cancerous (Adamek, 2017, p. 28).

Many other health professionals agree upon this statement and have offered further medical information. One comprehensive review that looked at the link between breast cancer and induced abortion stated that “it is only after 32 weeks’ gestation that elevated levels of pregnancy hormones allow sufficient maturation of cancer-resistant breast tissue to occur” (Lanfranchi & Fagan, 2014, p. 5).  After carrying a pregnancy to full-term, “only about 10 to 30 percent of a mother’s breast tissue remains susceptible to forming cancer,” and this risk decreases another 10 percent with each subsequent pregnancy (Lanfranchi & Fagan, 2014, p. 6).

Future Reproductive Health

Another physical health risk that has been linked to abortion is the risk of future reproductive health issues. Although occurring in less than 1% of cases, after an abortion, there is a possibility that a woman can develop an upper genital tract infection. The upper genital tract involves the pelvis and fallopian tubes, which are important parts of a woman’s reproductive system. Serious infections can cause major issues to these, including chronic pelvic pain and damage to the fallopian tubes. This damage can consequentially lead to future issues, such as infertility and ectopic pregnancy (Boston Women’s Health Book Collective, 2011, p. 318; Lohr et al., 2014, p. 4).

Physical Health: Opposing Views

Despite these statements, there have been dissenting opinions on the idea that induced abortions and breast cancer are linked. “In February 2003, the National Cancer Institute (NCI) convened a workshop of over 100 of the world’s leading experts who study pregnancy and breast cancer risk” (National Cancer Institute, 2003). The conclusion of this workshop was that having an abortion “does not increase a woman’s subsequent risk of developing breast cancer” (National Cancer Institute, 2003). The NCI is a part of the National Institutes of Health under the United States Department of Health and Human Services, and states on the website homepage that it is “the nation’s leader in cancer research.” Due to the fact that it is an organization under the federal government, one can assume that the research they publish is trustworthy. This disagreement upon health professionals makes it hard for women to know the true risk. The scientific facts of the development of breasts points to a clear correlation between abortion and breast cancer, but the highly respected National Cancer Institute dissents from that idea. Similarly, in regard to the possible development of an upper genital tract infection, it is difficult for women to measure the possible risk. The fact that it happens in only 1% of cases is promising, but women are left unsure of whether or not they will end up falling into that small percentage until they actually undergo the abortion procedure.

Sociological Effects

Social Norms and Stigmas

Within every society, there are certain human behaviors that become normalized over time. These behaviors, also known as “social norms,” can include essentially anything about a person, such as how they speak or dress, their mannerisms, or traits of their personality. A stigma can be described as “an attribute that is deeply discrediting that negatively changes the identity of an individual to a tainted, discounted one” (Kumar et al., 2009, p. 626). Stigmas are created and reproduced through a social process. In a 2001 Annual Review of Sociology , Link and Phelan describe this process:

In the first component, people distinguish and label human differences. In the second, dominant cultural beliefs link labelled persons to undesirable characteristics – to negative stereotypes. In the third, labelled persons are placed in distinct categories so as to accomplish some degree of separation of ‘us’ from ‘them’. In the fourth, labelled persons experience status loss and discrimination that lead to unequal outcomes (2001, p. 367).

Throughout history, worldwide, societies have constructed and enforced stereotypical social norms on women as a whole. Some of the most widely held stereotypes are based around the fact that women bear children. Female sexuality can be seen “solely for procreation,” and becoming a mother viewed as being natural and inevitable (Kumar et al., 2009, p. 628). Due to this, societal norms may expect women to be instinctually warm, kind, caring, and nurturing. Therefore, when a woman wishes to end a pregnancy by receiving an abortion, she is challenging these “assumptions about the ‘essential nature’ of women” by using “her agency to deem a potential life unwanted and then [acting] to end that potential life” (Kumar et al., 2009, p. 628). By terminating a fetus, which would eventually develop into a baby, a woman getting an abortion deviates from the assumption that she should be naturally maternal. Instead, she may be labelled with opposite stereotypes, seen as being heartless, promiscuous, and/or selfish. Consequentially, for those who accept these social norms about women, abortion can be seen as a stigmatized act (Kumar et al., 2009, pp. 628–629).

Stigma Causes Underreporting, Which Perpetuates Further Stigma

Over the past several decades, surveys have been an essential way for researchers to gather data on topics they are studying. However, “the usefulness of surveys in studying highly personal or sensitive individual characteristics” has been questioned (Jagannathan, 2001, p. 1825). This may include topics that involve things that are typically regarded as private matters, such as mental health, income, and/or sexual behavior. Personal topics like these can easily have some type of stigma attached to them if a person deviates from any type of social norm within the matter. Survey data involving these topics may be inaccurate if people refuse to participate, even if they are affected by the topic, in fear of being a social deviant. As previously mentioned, abortion is a controversial issue in society that has been stigmatized. Therefore, women who have gotten abortions may feel a social pressure to stay silent, making “it challenging to know the true prevalence of abortion in a given community” (Kumar et al., 2009, p. 629). Studies that have specifically looked at the underreporting of abortions have stated that “only 35% to 60% of abortions are reported in surveys” (Jagannathan, 2001, p. 1825). The social construction of deviance in regard to abortion creates an ongoing cycle of silence about the topic. This cycle is demonstrated in the following chart, provided by Kumar (2009, p. 629):

Figure 2: Cycle of Stigmatization in Society

This chart shows how “silence and fear of social exclusion keeps women” from speaking openly about abortion, “thus sustaining the negative stereotype” (Kumar et al., 2009, p. 630). Underreporting of the issue makes it seem uncommon, which makes it a deviant from social norms. Those who do not behave in accordance with social norms are typically outcasted or discriminated against, making women who get abortions fear stigmatization and not report it, consequentially creating inaccurate data due to underreporting. This then brings the issue back to the beginning of the cycle (Kumar et al., 2009, pp. 629–630).

Psychological Effects

Similar to the physical health effects linked with abortion, the idea that there are mental health consequences after receiving the procedure is a topic of controversy. However, the issue with psychological compared to physical is the fact that every individual is different, and every mind works in unique ways. Physical effects are a matter of science and fact, while psychological effects rely on the unpredictability of the human brain. There is research concluding that after receiving an abortion, women may suffer from possible mental health effects. The effects that will be discussed below are “post-abortion syndrome,” anxiety/panic disorders, and depression.

Post-Abortion Syndrome

The largest source of controversy within the discussion of abortion and possible mental health effects stems from the concept of “post-abortion syndrome.” The idea behind this syndrome is that abortion can cause women “severe and long-lasting guilt, depression, rage, and social and sexual dysfunction,” and can be categorized under post-traumatic-stress-disorder (Arthur, 1997, p. 7). However, this so-called syndrome is “not recognized in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association” (Robinson et al., 2009, p. 269).  

Anxiety/Panic Disorders and Depression

Over the years, studies have been done that concur with the idea that abortion is linked to post-abortion syndrome and further mental health problems. Research has stated that most panic disorders in adults form in the six months following a major stressful life event. Therefore, if women view the abortion they received as a traumatic life event, it “may trigger a psychological .. process that culminates in an anxiety disorder” (Coleman et al., 2009, p. 775). Aside from anxiety disorders, a 2009 study found:

Women who have aborted are at a higher risk for a variety of mental health problems including anxiety (panic attacks, panic disorder, agoraphobia, PTSD), mood (bipolar disorder, major depression with and without hierarchy), and substance abuse disorders when compared to women without a history of abortion (Coleman et al., 2009, p. 775).

When looking specifically at anxiety and depression, the study found that among women who had abortions, the risk for panic disorders increased by 111%, and the risk for depression increased by 45% (Coleman et al., 2009, p. 773).

Furthermore, in 2011, “a comprehensive review and analysis of 22 of the world’s best large studies of abortion’s impact on women’s mental health” concluded that “women who had undergone an abortion experienced an 81 percent greater risk of mental health problems” (Adamek, 2017, p. 32).

Psychological Effects: Opposing Views

Despite the studies claiming that women who get abortions are at a higher risk for mental health issues, there is also research that opposes this view.

One study examined 442 women over a two-year period to assess their mental health after receiving an abortion. Those who participated were evaluated one hour before the abortion, and then one hour, one month, and two years after. The study assessed the women for “preabortion and postabortion depression and self-esteem, postabortion emotions, decision satisfaction, perceived harm and benefit, and posttraumatic stress disorder.” The results concluded that two years after receiving their abortion, 72% of the women were satisfied with the decision they made, and 69% would make the same decision again. From pre-abortion to post-abortion, depression decreased, self-esteem increased, and some women reported feeling a sense of relief more than any negative emotions (Major et al., 2000). Further research has agreed with this, stating that “although there may be sensations of regret, sadness, or guilt,” more frequently, women “report feeling relief and happiness” following their abortion (Adler et al., 1990, p. 41). It is important to note that “feelings” do not translate into true psychological issues. For example, a woman may feel a sense of sadness following the procedure, but that does not imply she is clinically depressed.

Link Between Socio- and Psycho-

When looking at whether abortion has a psychological effect on women, it is important to note the intersectionality between sociology and psychology. As discussed above, culturally developed societal norms and stigmas influence individuals to behave and think certain ways. Therefore, the way abortion is socially accepted within a certain group may have an impact on the psychological effects a woman experiences after getting the procedure. If a woman belongs to a community where there are stereotypes put on women, and stigma surrounding abortion, she may have a poor view of herself afterwards. “Women may feel that they are selfish or immoral because they perceive themselves to be defying familial expectations, cultural norms or ideas of motherhood” (Kumar et al., 2009, p. 633). In comparison, if women are part of a community that shows support for their personal decision, they “may experience less grief and anxiety than those who were unsupported by their communities or the larger environment” (Kumar et al., 2009, p. 632). This interrelationship shows how important it is to be socially accepted within society, and how being outcasted may cause real psychological issues within human beings.

Trauma from Unwanted Pregnancy

When looking at the possible realness of “post-abortion syndrome,” it is essential to look more deeply at the root of the issue. This syndrome claims that abortion is an event so traumatic that it may lead to serious psychological effects for women. However, this poses the question: is the abortion the traumatic life event triggering psychological issues, or is it the unwanted pregnancy?

In 2008, the American Psychological Association’s Task Force on Mental Health and Abortion published a report that “concluded ‘that among women who have a single, legal, first-trimester abortion of an unplanned pregnancy … the relative risks of mental health problems are no greater than risks among women who deliver an unplanned pregnancy” (Kaplan, 2009). Furthermore, one study concluded that abortion patients who “had no intention to become pregnant” were significantly less depressed than women whose pregnancy was wanted and “viewed as personally meaningful by the woman” (Adler et al., 1990, p. 42). These research findings indicate the possibility that it is the unplanned/unwanted pregnancy that raises the risk of psychological issues, rather than the actual abortion.  

Abortion is Not Always an Option

Making the choice to get an abortion is a huge decision. Women are forced to decide whether they want to alter their lives by going through pregnancy and bringing a child into the world, or if they want to terminate the fetus and risk the possible side effects. However, for some women, the burden of this choice is not the only difficult part about the situation. Depending on circumstances, even if a woman wants to get an abortion, the likelihood of getting one may be close to impossible. As discussed above, states have been able to pass statutes within their borders that make it difficult for a woman to get an abortion. These legislative barriers include zoning laws, mandatory counseling, waiting periods, and minor consent or notification. On top of these legal obstacles put in place by the state, there may be additional conditions that cause prevention of the procedure. Two large circumstances that may play into a woman’s decision are her geographical location and her financial situation.

Reasons Why Women May Not Be Able to Get an Abortion

Zoning laws and access to abortion providers  .

One large obstacle for women who wish to receive an abortion is the ability to access a provider. As discussed above, some local governments attempt to block abortion providers from residing in an area by using zoning laws, applicable under the police powers given to each state. The use of these zoning ordinances to limit providers can make it extremely difficult for women who want to get an abortion to be able to find a place to receive the procedure within a reasonable geographical range.

A couple current examples of the use of these zoning laws to limit access to abortion providers can be seen in Manassas, Virginia, and San Antonio, Texas. In 2015, both the city’s made amendments to their zoning codes that consequentially affected the access to abortion providers.

In Manassas, Virginia, the amendment “[requires] medical care facilities, including abortion clinics, to obtain a special use permit that would be granted only after a period of public comment and City Council approval.” This means that any new clinics trying to open in Manassas would need to obtain the permit, as well as any current clinics that want to relocate or make expanding renovations. Due to the fact that the city’s council is predominantly Republican, the need for their approval may cause a possible barrier for abortion providers (Stein, 2015).

In San Antonio, Texas, a bill was passed in 2013 that required “all facilities that provide abortion services [to] meet the standards of an [ambulatory surgical center] in order to remain in operation.” Then, in 2015, a zoning code amendment was passed that put restrictions on where these centers can be built. Under the new amendment, ASC’s cannot be built in C-1 areas – a level of classified area for commercial use – “without permission from the Zoning Committee and the City Council, both of which will then have to vote on each individual case.” Similar to the amendment made in Manassas, Virginia, these San Antonio zoning laws “effectively [target] any future abortion providers in the city (Cato, 2015).

Access to Abortion Providers

“Most abortions are provided by freestanding clinics,” and “fewer than 5 percent of abortions are performed in hospitals” (Boston Women’s Health Book Collective, 2011, p. 317). As of 2008, only 610 hospitals in the US perform abortions, and 87% of counties do not have an abortion provider. This means that for the women who want an abortion but do not live in that small thirteen-percent that have providers, they must travel outside of their local community to get one. Large organizations such as Planned Parenthood and The National Abortion Federation provide resources for women to help find the closest abortion providers (Boston Women’s Health Book Collective, 2011, pp. 317–318).

Financial Situation and Cost of Abortion

Just like anything in life, the abortion procedure has a cost. According to Planned Parenthood, an abortion can cost anywhere between zero and almost a thousand dollars. Whether it is performed in a clinic or hospital, and is paid for by the patient, insurance, or government funding, someone is paying for it in the end. However, the price tag of the procedure is not one-size-fits-all. The cost of an abortion varies on many factors, including where the procedure is taking place or how far along a woman’s pregnancy is.

Another factor is the type of abortion a woman decides to get, as discussed above. Due to the fact that these abortions include various differences: where they take place (home vs. doctor’s office), what is used (medication vs. instruments), and follow-up care, the cost of the type a woman gets may vary. Further, if a woman has to get an aspiration abortion after the failure of a medication abortion, she is forced to pay for both.

A few final factors that involve the cost of an abortion are whether or not a woman has health insurance and her overall financial situation, which will be further discussed below (Emily @ Planned Parenthood, 2014).

Cost of Abortion: Health Insurance, Income, and Funding

A large factor that plays into the cost of the procedure is whether or not the patient has health insurance. This factor is different from the rest because it does not determine the actual cost of the procedure, but rather how the procedure will be paid for. If she does have health insurance, it may cover some or all of the costs of the abortion. The patient must call her insurance provider to find out about her coverage. If she does not have health insurance, or chooses not to use it to maintain privacy, the patient must pay out of pocket (Emily @ Planned Parenthood, 2014). Depending on her income and/or financial situation, this factor may be debilitating to the woman seeking the abortion and completely prevent her ability to get one. Simply put, if you cannot pay for a service, you cannot receive a service.

One source, The National Network of Abortion Funds, provides a website where women can search their location and find different organizations that may help them with the costs of their abortion (Boston Women’s Health Book Collective, 2011, p. 320). On the “About” page of their website, the NNAF states that some of their member organizations “work with clinics to help pay for [women’s] abortions[s].” Other member organizations offer to help with different factors that may cost the woman, such as childcare, transportation, and/or a place to stay if they had to travel for the abortion ( About: What are Abortion Funds , n.d.).

In some states, the government may offer financial assistance to women through “Medicaid programs [that] use state funds to provide abortion coverage.” However, “twenty state Medicaid programs do not fund abortion under any circumstances.” As mentioned above, the Hyde Amendment prohibits state Medicaid programs to use federal funds to help pay for abortions. This barrier contributes to a lack of funding, which in turn hurts poor women who are desperately searching for a way to pay for the procedure (Boston Women’s Health Book Collective, 2011, pp. 341–342).

Furthermore, if the domestic gag rule takes effect, this will affect the range of choices for women without other health insurance. As discussed above, the Trump Administration announced in February 2019 “that it will bar organizations that provide abortion referrals from receiving federal family planning money” (Belluck, 2019). This gag rule affects places such as Planned Parenthood, which provides many reproductive health services to women who cannot afford health insurance.

Relation Between Geographical Location and Financial Situation

Individually, the possible geographical and financial obstacles of receiving an abortion are difficult to deal with. However, for some women, the issues may intersect. Take for example a woman who is financially struggling and must travel over 30 miles to reach the nearest clinic that performs abortions. Not only must this woman travel a far distance to undergo the procedure, but she is also forced to worry about all the costs associated with it. First, there is the cost of the actual abortion. Then, there are the travel costs to get to the clinic and back home, whether it be gas money or public transportation fees. If she has children and does not want to bring them with her, there is the possible cost of childcare while absent. If her state has a mandatory waiting period, she is forced to pay these transportation and childcare fees a second time when going back to the clinic to get the procedure. If she gets a medication abortion and requires a follow-up appointment a week later, she has to pay them a third time. On top of all of this, there is the cost of her time. The time it takes for her to travel the far distance, possibly multiple times, is time she could have spent at her job making the money she desperately needs.  

Physical, Sociological, and Psychological Effects on Women Denied Abortions

For women who seek an abortion but cannot receive one due to factors mentioned above, there may be certain physical, sociological, and/or psychological effects.

For women who are unable to get an abortion, the physical effect is obvious: pregnancy. If cannot abort the fetus inside of her, she is forced to continue the pregnancy, and carry the child inside of her until it is delivered. According to a website powered by the American Academy of Family Physicians, being pregnant comes with many physical effects. These effects include, but are not limited to, tiredness, nausea, frequent urination, lightheadedness, heartburn, and vaginal discharge and bleeding ( Changes in Your Body During Pregnancy , 2009). Two of the largest, and most obvious, physical changes with pregnancy are belly and breast growth. As the fetus develops into a fully functioning baby, it grows, causing a woman’s uterus and belly to grow in size as well. Breasts also physically change during pregnancy to allow a woman to breastfeed her child once born, as discussed earlier.

Episiotomies

In addition to pregnancy, the actual delivery of a child may bear its own physical effects on a woman’s body. One of the most common of these effects is the use of an episiotomy during childbirth. “An episiotomy is a surgical enlargement of the vagina by means of an incision in the perineum, the skin and muscles between the rectum and vagina.” This is done “as the baby’s head is crowning,” in order to “enlarge the vagina so that forceps [can] be inserted high into the pelvis, thereby assisting in the birth of the baby.” Aside from the physical incision made to the body, episiotomies may lead to further physical effects, such as postpartum pain, infection at the site of the incision, problems with having intercourse, and vaginal swelling. One article published in 1995 stated that “The American College of Obstetricians and Gynecologists (ACOG) estimates that as many as 90 percent of women giving birth to their first child in a hospital will have an episiotomy.” Although this number may have changed throughout the years, this statistic shows how significant episiotomies have been within the last twenty years (Griffin, 1995).  

Financial Instability

One factor that may motivate a woman to seek an abortion is her current financial situation. In a 2004 study discussed above, 73% of participants listed “can’t afford a baby now” as their reason for abortion, with sub-reasons including that the woman was unemployed, could not leave her job to care for the child, and/or could not even afford the basic necessities of life (Finer et al., 2005, p. 113). While many women identify with these reasons, not all are able to receive the abortion they want. In these cases, the intense burden of financial instability becomes a possible reality, with the newly added cost of raising a child. While there is the option of giving the child up for adoption, that is not the right choice for every woman.

One study published in 2018 looked at the socioeconomic outcomes of women who were denied wanted abortions compared to women who were able to get them. Similar to the study discussed earlier, done by BioMed Central Women’s Health, this study looked at data collected during the Turnaway Study . After analyzing the collected data, it was determined that women who were unable to get the abortion they sought were more likely to “experience economic hardship and insecurity lasting years” (Foster et al., 2018, p. 407). More specifically, compared to women who were able to receive a wanted abortion, women who were unable were “more likely to be in poverty for 4 years after denial,” and “less likely to be employed full time” six months after denial (Foster et al., 2018, p. 407). These results are an example of how following through with an unintended pregnancy as a result of being unable to receive an abortion can have a negative sociological impact a woman, pushing them into severe financial struggle.

Welfare Stigma

As discussed earlier, when something deviates from the widely accepted social norms and stereotypes within society, it is stigmatized, creating further stereotypes. One of the generally accepted ideas about America is that it is a land full of equal opportunity for everyone. “Most Americans believe that anyone can succeed [through] hard work, and that those at the bottom of the social heap have not tried enough to make it.” Due to this, being impoverished and receiving help from public assistance programs has become a stigmatized act. This is especially true in the case of women who face financial struggles as a result of unintended pregnancy. People who are impoverished due to a physical or mental disability are less stigmatized than those whose financial dependency on the government results from something that is perceived as a “personal failure, such as [being an] unwed mother.” These stigmas further perpetuate stereotypes on poor people and women as whole groups (Goodban, 1985, pp. 403–404).

One study aimed to further examine this social stigma, interviewing one hundred black single mothers who were getting assistance from public programs. The women were asked a variety of questions about being on welfare, such as why they were on it and their feelings surrounding it. Many of the women “believed that they were on welfare for temporary, uncontrollable reasons having to do with their situation, rather than personal characteristics.” Out of the one hundred women, “sixty-one said they were sometimes ashamed of their welfare status” (Goodban, 1985, pp. 414–418). The results of this study exemplify the severity of stigma and stereotypes within society.

Psychological Effects  

Postpartum Depression

One of the most well-known psychological effects of giving birth to a child is postpartum depression. This form of depression is experienced by women in “the postpartum period, which is increasingly viewed as up to 1 year after childbirth” (O’Hara, 2009, p. 1258). Furthermore, women who give birth to a child resulting from an unintended pregnancy have a possible higher risk of developing postpartum depression compared to women who gave birth to a child that was planned and wanted. One study in North Carolina analyzed a group of 550 women who were 12 months postpartum for the possibility of depression. This group included a mixture of women whose pregnancies were intended (64%) and women whose pregnancies were unintended (36%). The results concluded that “depression was more common among women with unintended pregnancy [12%] than women with intended pregnancy [3%]” (Mercier et al., 2013, pp. 1116–1118). Although every individual is different, the possibility of developing postpartum depression is a real consequence that may affect women who give birth to a child. These results imply that this fact may be especially true for women whose pregnancies were unwanted and/or unintended, which can include women who wanted to get an abortion but were unable to. Postpartum depression has also been linked to further psychological, such as suicidal ideation and self-harm (Coker et al., 2017).

When looking at whether being unable to get an abortion has a psychological effect on women, it is important to note the intersectionality between sociology and psychology. Social norms and stereotypes within society can cause people to become outcasted if they do not act in accordance.

As discussed above, being impoverished and receiving help from government programs is stigmatized in American society. In the study that examined one hundred black single mothers on welfare, over half of the participants admitted to sometimes being ashamed of their status. This shame stemmed from the feeling that “they could not seem to succeed no matter how hard they tried, and [were] stigmatized by a society that devalues the poor.” Consequentially, this shame and guilt resulted in a handful of the participants experiencing low self-esteem (Goodban, 1985, p. 418). All of these feelings circle back to the socially normative belief in America that poor people do not work hard and accept government handouts, and that is why they are poor. Aside from guilt and low self-esteem, low socioeconomic status has also been linked as a risk factor for postpartum depression in women who gave birth (O’Hara, 2009, p. 1261).

When comparing women who receive a wanted abortion to women who do not receive a wanted abortion, it is important to note that both may suffer from physical, sociological, and psychological effects. A summary of the effects that were discussed can be found below.

Figure 3: Possible Effects of Receiving and Not Receiving a Wanted Abortion

IV. Conclusion

Abortion is an issue that has been relevant for over two hundred years. Before and during most of the 1800s, certain abortions were legal, and not uncommon. However, a woman was only allowed to seek an abortion before “quickening,” which was when she could feel the fetus moving. Before this, a fetus was not equivalated with a human life. Women who wished to abort their fetus were given certain drugs that would induce the process, and if those failed, a woman could visit a medical practitioner to remove the fetus.

Although abortions done before quickening were legal, they were not an entirely safe practice, and often ended in women dying. As a result, in the 1820s-40s, states began passing various laws in an attempt to control the procedure, which included outlawing the abortion inducing drugs (Connecticut, Missouri, and Illinois), the instruments used in the procedure (Missouri), or the actual procedure itself (Maine).

Within the late 1840s-50s, the American Medical Association was founded and began a crusade against abortion, headed by Dr. Horatio Storer. The Association, made up of licensed physicians, aimed to tarnish society’s view of abortion by painting it as a dangerous and immoral procedure. This anti-abortion movement gained traction, and the social shift towards the nonacceptance of abortion began to reflect in state laws. Beginning in the 1860s, states began passing legislation to criminalize the procedure of abortion and continued to do so throughout the early-to-mid-1900s.

In 1873, Congress went even deeper into the issue of women’s reproductive health and outlawed the importation and distribution of any information or drug that aimed to prevent conception with the passing of the Comstock Law. However, with much help from the feminist movements fighting for contraception, this was later declared unconstitutional by the Supreme Court in Griswold v. Connecticut in 1965 (married persons), and then Eisenstadt v. Baird in 1972 ( single persons).

In 1973, the Supreme Court struck down all state laws criminalizing abortion with the landmark case of Roe v. Wade , which made the procedure federally legal. Despite seeming like a victory for reproductive health, this federal ruling only set a legislative basis for states. Within their own borders, states are responsible for the abortion statutes, and can create certain barriers making it hard for women to obtain an abortion. These barriers include zoning laws to limit the areas where abortion providers can reside, mandatory counseling and/or waiting periods for women who want an abortion, and parental consent or notification requirements for minors. These state barriers are all federally legal under the 1989 ruling of Planned Parenthood of Southeastern Pennsylvania v. Casey. Some states even went as far as to implement “trigger laws” that will automatically ban abortion if Roe v. Wade ever gets overturned.

On top of these state-by-state barriers, there are also federal barriers that prevent women easy access to an abortion. In 1976, the Hyde Amendment was passed to prevent federal funds from being used by state Medicaid programs to help low-income people get abortions, and it is still in effect today. When President Trump took office, he re-implemented a global “gag rule” that prevents any international non-governmental organizations that perform or promote abortion services from receiving funding from the United States Agency for International Development. In 2019, the Trump Administration implemented a “gag rule” within the US, barring organizations that provide abortion referrals from receiving federal funds. However, despite the possible attempts by state and federal law to limit a woman’s ability to get an abortion, the medical procedure is still performed across the nation.

In the end, each individual’s story is different. Your circumstances are different, your reasoning is different, your journey is different, and your aftermath is different. All of the research in the world cannot predict how a woman is going to be affected by either receiving an abortion or being unable to receive an abortion. The most common reasons and effects of these two situations can be summarized in the tables below.

Figure 4: Common Reasons Why a Woman May Want to Receive an Abortion vs. Common Reasons Why a Woman May Not Be Able to Receive an Abortion

Cases Cites :

Eisenstadt v. Baird , 405 U.S. 438 (1972).  

Griswold v. Connecticut , 381 U.S. 479 (1965).

Roe v. Wade , 410 U.S. 113 (1973)  

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Some Cautionary     Evidence. American Journal of Public Health , 91 (11), 1825–1831.

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Kumar, A., Hessini, L., & Mitchell, E. M. H. (2009). Conceptualising Abortion Stigma. Culture, Health & Sexuality , 11 (6), 625–639. https://doi.org/10.1080/13691050902842741

Lanfranchi, A. E., & Fagan, P. (2014). Breast Cancer and Induced Abortion: A comprehensive review of breast development and pathophysiology, the epidemiologic literature, and proposal for creation of databanks to elucidate all breast cancer risk factors. Issues in Law & Medicine , 29 (1), 3–133.

Lewin, T. (1991, October 27). In Debate on Abortion, 2 Girls Make It Real. The New York Times . https://www.nytimes.com/1991/10/27/us/in-debate-on-abortion-2-girls-make-it-real.html

Link, B., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology , 27 , 363–385.

Lohr, P. A., Fjerstad, M., DeSilva, U., & Lyus, R. (2014). Abortion. BMJ: British Medical Journal , 348 . JSTOR. https://www.jstor.org/stable/26511467

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Major, B., Cozzarelli, C., Cooper, M. L., Zubek, J., Richards, C., Wilhite, M., & Gramzow, R. H. (2000). Psychological responses of women after first-trimester abortion. Archives of General Psychiatry , 57 (8), 777–784. https://doi.org/10.1001/archpsyc.57.8.777

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Argumentative Essay Outline on Abortion

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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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Statement: Reproductive rights are women’s rights and human rights

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Reproductive rights are integral to women’s rights, a fact that is upheld by international agreements and reflected in law in different parts of the world.

To be able to exercise their human rights and make essential decisions, women need to be able to decide freely and responsibly on the number and spacing of their children and to have access to information, education, and services.

When safe and legal access to abortion is restricted, women are forced to resort to less-safe methods, too often with damaging or disastrous results—especially for women who are affected by poverty or marginalization, including minority women.

The ability of women to control what happens to their own bodies is also associated with the roles women are able to play in society, whether as a member of the family, the workforce, or government.

UN Women remains steadfast in our determination to ensure that the rights of women and girls are fully observed and enjoyed worldwide, and we look forward to continued evidence-based engagement with our partners everywhere in support of rapid progress towards universal enjoyment of universal rights.

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Reproductive rights in America

What abortion politics has to do with new rights for pregnant workers.

Selena Simmons-Duffin

Employers are required to make accommodations for pregnant women and new moms like time off for doctor's appointments. Thomas Trutschel/Photothek via Getty Images hide caption

Employers are required to make accommodations for pregnant women and new moms like time off for doctor's appointments.

This week, attorneys general from 17 Republican-led states sued the Equal Employment Opportunity Commission over something they say is an "abortion accommodation mandate."

Here are four things to know about the latest battle in the war over abortion between Republican-led states and the Biden administration.

1. The law in question is about protections for pregnant workers.

First, a little background: In 2015, a survey found that nearly 1 in 4 women went back to work just two weeks after giving birth.

It took about ten years for a bill protecting pregnant workers to get through Congress, and in 2022, not long after Roe v. Wade was overturned, the Pregnant Workers Fairness Act passed with bipartisan support. The law requires employers with at least 15 employees to accommodate workers who are pregnant with things like extra bathroom breaks, time off for prenatal appointments, a chair for sitting during a shift. It also says employers have to accommodate workers after they give birth.

Even though lawmakers from both parties think pregnancy protections are a good thing, abortion politics have overshadowed the news of those new rights. It all comes down to one line in the law and the word "abortion" in the regulation.

The law says employers should make "reasonable accommodations" for pregnant workers during and after "pregnancy, childbirth and related medical conditions." The new rule EEOC put out to implement the law includes abortion in a lengthy list of "related medical conditions," along with everything from ectopic pregnancy to anxiety to varicose veins.

2. Abortion entered the chat and about 100,000 people chimed in on the regulations.

Political and religious groups that oppose abortion rights took notice of the inclusion of "abortion" in the list of related medical conditions, as did the lead Republican co-sponsor of the law , Sen. Bill Cassidy of Louisiana. Some 54,000 people commented on the proposed rule objecting to the inclusion of abortion, according to the EEOC's analysis in the final rule, while 40,000 people commented in support of abortion's inclusion. (The agency noted that most of these were nearly identical "form comments" driven by advocacy groups).

In the end, "abortion" remained on the list. In its analysis, the agency explained that abortion's inclusion is consistent with longstanding interpretation of civil rights laws and courts' rulings. In the final rule, the EEOC says the law "does not require any employee to have – or not to have – an abortion, does not require taxpayers to pay for any abortions, and does not compel health care providers to provide any abortions." The rule also notes that unpaid time off for appointments is the most likely accommodation that would be sought by workers having abortions.

3. The lawsuit + the politics of the lawsuit

Within days of the rule being published in the Federal Register , a coalition of 17 Republican-led states filed suit. "The implications of mandating abortion accommodations are immense: covered employers would be required to support and devote resources, including by providing extra leave time, to assist employees' decision to terminate fetal life," the lawsuit reads .

The lawsuit was filed on Thursday in federal court in Eastern Arkansas. The plaintiffs ask the court to put a hold on the effective date of the final rule pending judicial review, and to temporarily block the enforcement of – and ultimately vacate – the rule's "abortion-accommodation mandate."

Arkansas and Tennessee are the two states leading the lawsuit. In a statement , Arkansas Attorney General Tim Griffin said: "This is yet another attempt by the Biden administration to force through administrative fiat what it cannot get passed through Congress."

Griffin said the rule is a "radical interpretation" of the new pregnancy protection law that would leave employers subject to federal lawsuits if they don't give employees time off for abortions, even if abortions are illegal in those states. "The PWFA was meant to protect pregnancies, not end them," he said.

Women's advocates see the politics of the lawsuit as well. "It's no coincidence that this organized, partisan effort is occurring in states that have some of the highest maternal mortality rates in the country," Jocelyn Frye of the National Partnership for Women & Families wrote in a statement . "Any attempt to dismantle these protections will have serious consequences for women's health, working families, and the ability for women to thrive in the workplace."

Greer Donley is a law professor at the University of Pittsburgh who submitted a comment on the proposed regulation defending the inclusion of abortion. She points out that this is the latest in a string of legal challenges from anti-abortion groups fighting the Biden administration's efforts to protect abortion using federal agencies.

"You can really see this in a suite of [abortion] lawsuits – including the two that were heard in the Supreme Court this term, one involving the FDA's regulation of mifepristone and one involving the Biden administration's interpretation of EMTALA ," she observes, and guesses a legal challenge will also come in response to the newly announced privacy protections for patients who've had abortions. "You have a Supreme Court that is overwhelmingly anti-abortion and overwhelmingly anti-administrative state – those two things in tandem are not a good thing for the Biden administration."

4. In the meantime, pregnant workers have new rights.

At the moment, until a judge says otherwise, the new protections for pregnant workers are already in effect. The EEOC has a guide for pregnant workers about their new rights under the law and how to file charges against their employers. It's also holding trainings for human resource professionals on how to comply with the law.

Complaints have already started to roll in. In a statement to NPR, EEOC spokesperson Victor Chen wrote that in the first three months that the law was in effect, the agency received nearly 200 charges alleging a violation of the Pregnant Workers Fairness Act, which works out to nearly two a day.

• Abortion rights
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On Emergency Abortion Access, Justices Seem Sharply Divided

The case, which could reverberate beyond Idaho to over a dozen other states with abortion bans, is the second time in less than a month that the justices have heard an abortion case.

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Pam Belluck

5 takeaways from the Supreme Court argument on Idaho’s abortion ban.

The abortion case before the Supreme Court on Wednesday featured vigorous questioning and comments, particularly by the three liberal justices. At issue is whether Idaho’s near-total ban on abortion is so strict that it violates a federal law requiring emergency care for any patient, including providing abortions for pregnant women in dire situations.

A ruling could reverberate beyond Idaho, to at least half a dozen other states that have similarly restrictive bans.

The implications of the case could also extend beyond abortion, including whether states can legally restrict other types of emergency medical care and whether the federal law opens the door for claims of fetal personhood.

Here are some takeaways:

The case centers on whether Idaho’s abortion ban violates federal law.

Idaho’s ban allows abortion to save the life of a pregnant woman, but not to prevent her health from deteriorating. The federal government says it therefore violates the Emergency Medical Treatment and Labor Act, or EMTALA, which was enacted nearly 40 years ago.

EMTALA says that when a patient goes to an emergency room with an urgent medical issue, hospitals must either provide treatment to stabilize the patient or transfer the patient to a medical facility that can, regardless of the patient’s ability to pay. It says that if a state law conflicts with the federal law, the federal law takes precedence.

A lawyer representing Idaho, Joshua Turner, told the Supreme Court that the state does not believe its abortion ban conflicts with the federal law. He said the ban allows emergency departments to provide abortions if a pregnant woman has a medical problem that is likely to lead to her death, not just if she is facing imminent death.

The three liberal justices strongly objected to Mr. Turner’s interpretation and pointed out situations in which women in critical situations would be denied abortions under Idaho’s ban. When Justice Sonia Sotomayor asked if the ban would prevent abortion in a situation where a woman would otherwise lose an organ or have serious medical complications, Mr. Turner acknowledged that it would. “Yes, Idaho law does say that abortions in that case aren’t allowed,” he said.

The real-world consequences of Idaho’s ban for abortion and other medical care were apparent.

Solicitor General Elizabeth B. Prelogar, representing the federal government, said Idaho’s abortion ban, which was allowed to take effect this year, had significant consequences for pregnant women and emergency room doctors.

“Today, doctors in Idaho and the women in Idaho are in an impossible position,” she said. “If a woman comes to an emergency room facing a grave threat to her health, but she isn’t yet facing death, doctors either have to delay treatment and allow her condition to materially deteriorate or they’re airlifting her out of the state so she can get the emergency care that she needs.”

Justice Samuel A. Alito Jr., one of the most conservative justices, asserted that the federal government and the liberal justices were giving hypothetical examples. But Justice Elena Kagan, a liberal, noted that the hospital with the most advanced emergency room services in Idaho had needed to transfer six women to other states for emergency abortions so far this year.

There was also discussion about potential consequences for other types of medical care if Idaho’s ban was allowed to stand. Justice Sotomayor said that would allow states to pass laws saying “don’t treat diabetics with insulin, treat them only with pills,” contradicting the best medical judgment of a doctor who “looks at a juvenile diabetic and says, ‘Without insulin, they’re going to get seriously ill.’”

Conservative justices raised questions about fetal rights.

Justice Alito, in particular, focused on the fact that EMTALA includes several mentions of the phrase “unborn child.”

“Doesn’t that tell us something?” he asked. He suggested that it meant that “the hospital must try to eliminate any immediate threat to the child,” and that “performing an abortion is antithetical to that duty.”

That was an argument that supports efforts by abortion opponents to establish “fetal personhood” rights and declare that life begins at conception. Idaho’s lawyer, Mr. Turner, said on Wednesday that “there are two patients to consider” when pregnant women seek emergency room care.

The federal government has pointed out that three of the four mentions of “unborn child” in EMTALA refer only to when a woman in labor might be transferred to another hospital.

Ms. Prelogar described the intent of the fourth reference to “unborn child,” which was added to the law later. She said it referred to situations in which a pregnant woman goes to an emergency room and her pregnancy is in danger but her own health is not currently at risk. In that case, the law would require hospitals to do what they could to save the pregnancy. That would not be a situation where an abortion would be provided, she said.

Ms. Prelogar also emphasized that usually in the kinds of pregnancy emergencies in which an abortion is typically required, there is no possibility for a live birth. “In many of these cases, the very same pregnancy complication means the fetus can’t survive regardless,” she said. “There’s not going to be any way to sustain that pregnancy.”

In such cases, she said, “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. It stacks tragedy upon tragedy.”

The U.S. government disputed conservative claims that the federal law allows abortion for mental health emergencies.

Mr. Turner said that EMTALA would allow emergency rooms to provide abortions for pregnant women who are experiencing depression and other mental health issues. Abortion opponents have said that this could be used as a loophole to allow many patients to obtain abortions despite state bans.

Justice Amy Coney Barrett, another conservative, expressed some skepticism about Idaho’s claim. Justice Alito pressed the solicitor general about it.

“Let me be very clear about our position,” Ms. Prelogar replied. “That could never lead to pregnancy termination because that is not the accepted standard of practice to treat any mental health emergency.”

She said antipsychotic drugs and other psychiatric treatments would be administered to such patients. The treatment would not be abortion, she said, because “that won’t do anything to address the underlying brain chemistry issue that’s causing the mental health emergency in the first place.”

The federal emergency care law doesn’t require doctors who are morally opposed to abortion to provide them, the government said.

Justice Barrett and Chief Justice John G. Roberts Jr. asked if EMTALA’s requirement for emergency medical care prevented emergency room doctors or hospitals with moral or religious objections from opting out of providing abortions.

The solicitor general said that federal conscience protections take precedence. So individual doctors can invoke conscience rights to avoid providing abortions, Ms. Prelogar said. And although she said it would be rare for an entire hospital to invoke a moral objection to terminating pregnancies in the kinds of medical emergencies that EMTALA applies to, hospitals with such objections could opt out as well.

Aishvarya Kavi

Reporting from Washington

Protesters on both sides of the abortion debate clash outside the Supreme Court.

Chants of “Abortion is murder” and “Abortion is health care” rang through the air as protesters on both sides of the abortion debate dueled outside the Supreme Court on Wednesday morning.

More than a hundred people fanned out in front of the court as arguments began in a case that will determine the availability of abortions in emergency rooms in some 14 states with near-total abortion bans. Many favored a right to the procedure; markedly few were against it.

Only a dozen or so brandished signs that read “Emergency rooms are not abortion clinics” and “Abortion betrays women.” Rival protesters got in their faces with shouts and signs of their own, including one that read, “Emergency abortion is essential healthcare.” A large white banner proclaimed “SCOTUS is illegitimate.”

The case pits an Idaho law against a federal law requiring hospitals to provide emergency health care. The Idaho law bars doctors from providing abortions unless a woman’s life is in danger or in certain nonviable pregnancies.

Mylissa Farmer , 43, who the federal government found was denied necessary stabilizing care in Missouri and Kansas after her water broke at 17 weeks, told other demonstrators that the federal law should be upheld to protect women who faced complications like hers.

In an interview beforehand, Ms. Farmer said that the complications of her pregnancy prompted her involvement in politics and that the legal battles over reproductive rights have compounded her pain. “I just don’t want anyone else to go through what I did,” she said. “That’s why I’m speaking out, because it’s so wrong, and I don’t see any kind of light.”

Many opposing protesters emphasized that Idaho’s law was intended to protect women as well as children.

Bethany Janzen, the founder of Pro-Life Global, denounced the federal law, Emergency Medical Treatment and Labor Act, or EMTALA , saying what it would do is “essentially make our hospitals and emergency rooms abortion clinics.”

“It’s creepy to see men advocate for abortion,” one anti-abortion speaker, a woman, said into a microphone, prompting a group of men favoring abortion to break off and try to drown her out. Some included residents from the nearby George Washington University Hospital, wearing scrubs and lab coats.

Before arguments were even underway, more than a dozen women, representing the number of states where restrictive abortion bans are in effect , lay on the pavement, draped in sheets that were bloodied at the abdomen.

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Kate Zernike

Behind the language used during the argument is the goal of the anti-abortion movement.

On its face, the case argued before the Supreme Court on Wednesday was about whether doctors in Idaho have the obligation to provide abortions to women facing emergency risks to their lives.

But a difference in word choice by the justices and the lawyers revealed a more fundamental debate, one that goes straight to the ultimate goal of the anti-abortion movement.

The lawyer for Idaho and the conservative justices including Samuel A. Alito Jr., who wrote the majority opinion overturning Roe v. Wade, employed the term “unborn child,” a term used in the federal law at issue. The lawyer for the Biden administration tended to say “fetus.”

It was not merely a matter of semantics: Anti-abortion groups argue that life begins at conception. They have long pushed to establish so-called fetal personhood laws, granting fetuses the same legal rights and protections as any person, in the hopes that it would establish that abortion at any point in pregnancy is murder.

Roe v. Wade stood in their way for five decades, prohibiting states from banning abortion before fetal viability, or roughly 24 weeks. But since the Supreme Court overturned that decision in June 2022, laws establishing fetal personhood have taken effect in Georgia and other states. And anti-abortion lawmakers in Congress and in state legislatures have pushed other measures that establish fetal personhood through a variety of means: giving tax credits for fetuses, for example, or requiring child support payments beginning at conception.

Legal scholars warn that laws establishing fetal personhood would go farther than even existing abortion bans, ruling out all or most of the exceptions that those bans allow. If life begins at conception, that would include pregnancies that result from incest or rape.

Abortion rights groups and the American College of Obstetricians and Gynecologists use “embryo” when talking about pregnancies up to eight weeks after the start of a woman’s last menstrual period, and “fetus” to describe anything between that and delivery. (ACOG guidelines say: “Centering the language on a future state of a pregnancy is medically inaccurate.”)

Justice Alito relied on the language of fetal personhood in writing the decision overturning Roe , citing several 19th-century state laws referring to “unborn children.”

On Wednesday, he pressed the solicitor general repeatedly on the question of the “unborn child.” He noted that the federal law regulating emergency care — the law at issue in the Idaho case — uses the phrase several times. That, he said, suggests that the federal law means that “the hospital must try to eliminate any immediate threat to the child, but performing an abortion is antithetical to that duty.”

Elizabeth Prelogar, the solicitor general, replied that the law used that phrase to refer to cases in which the health of the pregnancy was in danger; the Idaho case concerns emergency health risks to the mother. The lawyer for Idaho, however, argued that doctors have to consider the life of the “unborn child” as much as the rights of the pregnant woman, even when she is facing an emergency risk to her health.

Anti-abortion lawmakers and groups have said that fetal personhood laws are the first step toward their ultimate goal of establishing constitutional protection for life beginning at conception.

But even many voters who oppose abortion in whole or in part have rejected attempts to establish fetal personhood. Voters rejected initiatives twice in South Dakota, in 2006 and 2008, and in Mississippi in 2011. Doctors in those states warned that establishing fetal personhood would criminalize IUDs and other methods of birth control. They also warned that they would have to stop doing in vitro fertilization, because disposing of unused fertilized eggs, or selectively eliminating implanted eggs, as many aspiring parents do, could result in murder charges.

Adam Liptak

What’s next: A decision will probably land in late June.

Now that the arguments are complete, the justices will cast tentative votes at a private conference in the coming days. The senior justice in the majority will then assign the majority opinion to a colleague, or perhaps keep it.

Draft opinions, almost certainly including concurrences and dissents, will then be prepared and exchanged.

The case was among the last to be argued this term, meaning that it would almost certainly not be decided until late June, when the term typically ends.

But there is even more reason to think that the decision will come then, or perhaps in early July, as the Supreme Court is facing a formidable backlog of pending decisions in major cases. Among them are ones on the fate and scope of the prosecution of former President Donald J. Trump for plotting to subvert the 2020 election, the First Amendment rights of social media companies and the power of administrative agencies.

The justices are also considering a second abortion case, on the availability of a commonly used pill to terminate pregnancies.

In an ordinary term, the two abortion cases would be among a small handful of blockbusters. This year, it will be one of many that are set to land, one after another, in a hectic few weeks in early summer.

Sheryl Gay Stolberg

Maternity care suffers as abortion laws drive obstetricians from red states.

One by one, doctors who handle high-risk pregnancies are disappearing from Idaho — part of a wave of obstetricians fleeing restrictive abortion laws and a hostile state legislature. Dr. Caitlin Gustafson, a family doctor who also delivers babies in the tiny mountain town of McCall, is among those left behind, facing a lonely and uncertain future.

When caring for patients with pregnancy complications, Dr. Gustafson seeks counsel from maternal-fetal medicine specialists in Boise, the state capital two hours away. But two of the experts she relied on as backup have packed up their young families and moved away, one to Minnesota and the other to Colorado.

Dr. Gustafson says those and other departures of labor and delivery doctors in the state have made a bad situation worse, depriving both patients and doctors of moral support and medical advice.

“I wanted to work in a small family town and deliver babies,” she said. “I was living my dream — until all of this.”

Idaho’s obstetrics exodus is not happening in isolation. Across the country, in red states like Texas , Oklahoma and Tennessee , obstetricians — including highly skilled doctors who specialize in handling complex and risky pregnancies — are leaving their practices. Some newly minted doctors are avoiding states like Idaho.

The departures may result in new maternity care deserts , or areas that lack any maternity care, and they are placing strains on physicians like Dr. Gustafson who are left behind. The effects are particularly pronounced in rural areas, where many hospitals are shuttering obstetrics units for economic reasons. Restrictive abortion laws, experts say, are making that problem much worse.

“This isn’t an issue about abortion,” said Dr. Stella Dantas, the president-elect of the American College of Obstetricians and Gynecologists. “This is an issue about access to comprehensive obstetric and gynecologic care. When you restrict access to care that is based in science, that everybody should have access to — that has a ripple effect.”

Idaho doctors operate under a web of abortion laws, including a 2020 “trigger law” that went into effect after the Supreme Court eliminated the constitutional right to abortion by overturning Roe v. Wade last year. Together, they create one of the strictest abortion bans in the nation. Doctors who primarily provide abortion care are not the only medical professionals affected; the laws are also impinging on doctors whose primary work is to care for expectant mothers and babies, and who may be called upon to terminate a pregnancy for complications or other reasons.

Zolan Kanno-Youngs

The Biden administration considers the federal EMTALA law key to preserving abortion access.

At the center of the case before the Supreme Court on Wednesday is a decades-old federal law that has been one of the primary ways President Biden has directly fought to preserve abortion rights since the fall of Roe.

After the Supreme Court overturned Roe v. Wade in 2022, and with it the national right to have an abortion, abortion rights supporters immediately pressed the White House over how it would use federal levers to protect those seeking abortions.

The Biden administration soon issued a memorandum saying EMTALA, which requires that all patients have emergency care, should also ensure hospitals provide abortions in cases in which the procedure would be necessary to stabilize a patient.

“If a physician believes that a pregnant patient presenting at an emergency department is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment,” the memo, by the Department of Health and Human Services, said.

Texas sued the federal government after the memo was issued, while the Idaho case before the Supreme Court was initiated by the Biden administration.

The Biden administration also told hospitals in Missouri and Kansas that they had not provided “necessary stabilizing care” required by EMTALA when they denied an abortion to Mylissa Farmer, whose water broke at 17 weeks’ gestation, less than halfway through the pregnancy. Even though she was told she could suffer severe infection and lose her uterus if her pregnancy was not aborted, doctors would not agree to the procedure. She was forced to travel to Illinois.

As it fights in court, the Biden administration has encouraged those in need of an abortion to better understand EMTALA.

Last May, the secretary of health and human services, Xavier Becerra, sent letters to hospitals across the nation reminding them they were obligated to abide by EMTALA when it comes to abortion care.

In January, the Department of Health and Human Services issued more guidance for patients experiencing pregnancy-related injuries to understand their rights under the law. The department also provided training materials to health care providers on the law.

The Justice Department has also said it is monitoring states’ efforts to punish those who cross state lines to receive abortion care.

Charlie Savage

A striking comment from Justice Kagan near the end encapsulated the critique of the Idaho law: “It’s become ‘transfer’ is the appropriate standard of care in Idaho, but it can’t be the right standard of care to force somebody onto a helicopter.”

The justices for the most part seemed divided along ideological lines. But the argument involved complicated and overlapping issues that could divide the court’s six-member conservative majority. Members of that group explored differing understandings of both the facts on the ground in Idaho and whether there is a meaningful gap between the requirements of the state's strict abortion law and the federal law requiring stabilizing care.

These oral arguments featured feisty comments by the justices, especially the three liberal justices. The arguments focused on a range of issues, including whether Idaho’s abortion ban violates the federal emergency care law.

Turner, the state’s lawyer, returns to the lectern for a brief rebuttal.

The solicitor general reminds the justices of a crucial point: In the kinds of pregnancy emergencies in which an abortion is typically required, there is no chance for a live birth. In most of those cases, including when a woman’s water has broken much too early, the pregnancy could not be viable and by making her wait for an abortion until she is on the brink of death, it is just causing additional suffering for the woman, the solicitor general says.

Tragically, in many of these cases, the pregnancy is lost. There’s not going to be any way to save that fetus because a woman who has PPROM at 17 weeks, there is no medical way to sustain the pregnancy to give the fetus a chance. So in that situation, 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. It just stacks tragedy upon tragedy.

Elizabeth Dias

The question of fetal personhood gets at deep questions that require social answers, not simply biological ones: Not just when does a human life begin, but also, when does responsibility for a life begin and end? We explored those questions in this article: When Does Life Begin?

Justice Alito raises the phrase “unborn child” in the federal emergency care law, suggesting it means “the hospital must try to eliminate any immediate threat to the child, but performing an abortion is antithetical to that duty.” The solicitor general says that the phrase “unborn child” refers to situations in which a pregnant woman goes to an emergency room and her pregnancy is in danger but her own health isn’t in danger. In that case, the law would require hospitals to do what it could to save the pregnancy.

This frank discussion about what can happen to pregnant women’s bodies — the dysfunction of their bodily systems, the loss of their reproductive organs and fertility, their other organs shutting down — shows the challenges anti-abortion activists face as their mission of ending abortion, once largely theoretical, has become utterly concrete for so many Americans.

There are now more than a hundred protesters outside the Supreme Court at competing rallies for and against abortion rights. Mylissa Farmer, a 43-year-old woman who was denied an abortion in Missouri and Kansas after her water broke at 17 weeks, is speaking in support of the federal law’s protections. “I just don’t want anyone else to go through what I did," she said. "That’s why I’m speaking out, because it’s so wrong, and I don’t see any kind of light.”

There are markedly fewer anti-abortion protesters, about a dozen, with signs with phrases including “Abortion betrays women.” But they are just as loud. “What this law would do is it essentially make our hospitals and emergency rooms abortion clinics,” Bethany Janzen, 30, said of the federal law. “And that’s a problem.”

We’ve heard very little about conscience exemptions until now; Solicitor General Elizabeth Prelogar says that the federal law “absolutely” protects doctors’ ability to refuse to provide an abortion if they object to providing abortions. Generally, she says, hospitals know objections in advance and have other staff on hand to provide care.

Solicitor General Elizabeth Prelogar tells Justice Alito that abortion would not be done to address mental health emergencies, a possibility that has been raised by abortion opponents. “Let me be very clear about our position,” the solicitor general said. “That could never lead to pregnancy termination because that is not the accepted standard of practice to treat any mental health emergency.”

In her opening, Solicitor General Elizabeth Prelogar emphasizes how Idaho’s abortion ban is playing out in the state. “Today, doctors in Idaho and the women in Idaho are in an impossible position,” she said. “If a woman comes to an emergency room facing a grave threat to her health, but she isn’t yet facing death, doctors either have to delay treatment and allow her condition to materially deteriorate or they’re airlifting her out of the state so she can get the emergency care that she needs.”

Today, doctors in Idaho and the women in Idaho are in an impossible position. If a woman comes to an emergency room facing a grave threat to her health, but she isn’t yet facing death, doctors either have to delay treatment and allow her condition to material — to materially deteriorate, or they’re airlifting her out of the state so she can get the emergency care that she needs. One hospital system in Idaho says that right now it’s having to transfer pregnant women in medical crisis out of the state about once every other week. That’s untenable, and EMTALA does not countenance it. None of petitioners’ interpretations fit with the text, and so they have tried to make this case be about the broader debate for access to abortion in cases of unwanted pregnancy. But that’s not what this case is about at all. Idaho’s ban on abortion is enforceable in virtually all of its applications, but in the narrow circumstances involving grave medical emergencies, Idaho cannot criminalize the essential care that EMTALA requires.

Solicitor General Elizabeth Prelogar, the Justice Department’s top appellate lawyer, will argue for the Biden administration. She will make a two-minute opening statement, face about a half-hour of questions in a free-for-all format and then one-by-one questions from the justices in order of seniority.

The Idaho lawyer argues that if the court upholds the requirement to provide abortions needed in a medical emergency, women could get abortions because they arrive in emergency rooms claiming that pregnancy is causing them severe mental distress. Anti-abortion activists have long been suspicious that any mental health exception provides a loophole that would turn emergency rooms into abortion clinics; some states have passed laws explicitly stating that there are no mental health exceptions to abortion restrictions.

Idaho’s lawyer is citing the language of “unborn child” in the federal law, saying that a fetus’s health needs to be considered equally with the life of a pregnant woman. The federal government says the references to “unborn child” in the law apply only to situations in which women are in labor and about to give birth, not to medical emergencies earlier in pregnancy when an abortion would be necessary to prevent serious health consequences for the pregnant woman.

Idaho’s argument for the “unborn child” assumes that life begins at conception. But even anti-abortion voters have been reluctant to affirm this, because the consequences can be so far-reaching. In Mississippi, for example, considered one of the most anti-abortion states in the country, voters rejected a 2011 ballot measure establishing “fetal personhood” after doctors warned they would be prosecuted for doing in vitro fertilization, because they destroy embryos that are not successfully implanted.

Idaho’s lawyer objects to Justice Kagan’s assertion that abortion is the standard of care in some medical conditions, saying there is no national standard of care. The American College of Obstetricians and Gynecologists, which the lawyer has cited, sides more with Justice Kagan.

In a statement urging the court to rule against the state, the group said: “In many of these emergency situations, the only way to treat or stabilize a patient is to end the pregnancy that is complicating or threatening their health. Because of this, EMTALA’s protections must cover abortion care so that access to lifesaving emergency care does not depend on a person’s zip code.”

Justice Sotomayor asks Idaho’s lawyer if it’s true that the state’s ban would prevent abortion in a situation where a woman would otherwise lose an organ or have serious medical complications. Idaho’s lawyer admits it would prevent abortion in those circumstances. “Yes, Idaho law does say that abortions in that case aren’t allowed,” he said.

“There is a difference between stabilizing a person who presents a serious medical condition requiring stabilization than a person who presents with a condition — quoting Idaho’s words — where there is a, poses a great risk of death to the pregnant women. You agree, there’s daylight between the two?” “We agree, and I think this is —” “And so there will be some women who present serious medical condition that the federal law would require to be treated who will not be treated under Idaho law. Potential loss of an organ or serious medical complications for the woman, they can’t perform those abortions?” “If that condition exists, yes, Idaho law does say that abortions in that case aren’t allowed.”

Justice Alito sympathizes with Idaho’s lawyer, saying it is unfair that other justices are presenting him with hypotheticals about what doctors might do in different situations. This highlights a dynamic that doctors have complained about since Roe v. Wade was overturned: uncertainty about what they can and can’t do when faced with a woman who might need an abortion has forced doctors to think like lawyers. And often the person making the decision is a lawyer for the hospital.

Justice Amy Coney Barrett, a conservative, seems frustrated by some of the hedged answers from Idaho’s lawyer.

Justice Kagan is recounting stories of women who will be left with serious health complications because their doctors could not treat them until the women faced immediate death. Women in several states with abortion bans, including Texas and Oklahoma, have sued to try to clarify what qualifies as a medical exception, saying they were left infertile because doctors had to wait until they faced certain death to give them abortions.

Abortion restrictions have changed the medical care in emergency rooms, too.

Two months after the Supreme Court overturned Roe v. Wade and the constitutional right to abortion, the medical consequences extend far beyond abortion clinics and women seeking to end unwanted pregnancies. Doctors who never thought of themselves as “abortionists,” to use the language of the court’s decision , say the criminalization of abortion is changing how they treat women who arrive in emergency rooms and on labor and delivery floors with wanted but complicated pregnancies.

During the 50 years of Roe, abortion became the standard of care in many medical situations. Now, laws ban it or make it unavailable in about half the states, usually with exceptions only for rape and incest or to save the life of the pregnant woman. While a few states have tried to specify conditions that qualify, the laws are generally vague and have failed to account for every possibility. With lawmakers attempting to regulate medical procedures, medical providers say they have to think like lawyers.

“A lot of us go into emergency medicine because of the imperative to take care of every patient — the person without housing and a C.E.O. — and we’re really proud of that ethical obligation to say, ‘Here’s the patient in front of me and I’m going to do everything I can for them,’” said Dr. Alison Haddock, an emergency physician in Houston and chair of the board of the American College of Emergency Physicians. Now, she said, “We’re no longer basing our judgment on the clinical needs of the woman, we’re basing it on what we understand the legal situation to be.”

Physicians would more typically talk to hospital lawyers about guardianship when caring for elderly or psychiatric patients, Dr. Haddock said. Now, when patients arrive with ectopic pregnancies, miscarriages or hemorrhaging — all situations where abortion has been established as standard care — the questions for the lawyers are more pressing: “Do we wait until the fetus is definitely dead, or is mostly dead good enough?” she asked. “If they’re telling us to wait for the condition to be fully emergent, how much bleeding is too much?”

“Having to consult a lawyer in an emergent situation is a whole new ballgame,” she said.

The Supreme Court said it was done with abortion. Its docket says otherwise.

When the Supreme Court overturned Roe v. Wade in 2022, eliminating the constitutional right to abortion, it made a kind of a promise. The majority opinion , written by Justice Samuel A. Alito Jr., said at least seven times that the ruling was an exercise in judicial modesty.

“The authority to regulate abortion must be returned to the people and their elected representatives,” he wrote, in a formulation that, with only small variations, was repeated throughout the opinion like a refrain.

The Supreme Court, Justice Alito said, was getting out of the business of deciding abortion cases.

Things have not turned out that way. In the space of just a month this spring, the court will have heard arguments in two important cases on access to abortions.

In March, the justices considered an effort to curtail a widely used abortion pill, part of the most common way to terminate pregnancies. If the court rules that the Food and Drug Administration acted unlawfully in approving the medication, people in states that continue to allow abortion would face major hurdles in obtaining it.

Put another way, the will of the people and their elected representatives in states that have decided to allow abortion would be thwarted.

Questions from the justices in March suggested that they would avoid the central issue in the case, ruling instead that the anti-abortion doctors and organizations who challenged the agency’s approval of the pill had not suffered the sort of direct injury that gave them standing to sue. Such a ruling would be a victory for proponents of abortion rights, but a provisional one, as other challenges could follow.

Wednesday’s argument illustrates a second way in which the Supreme Court cannot avoid abortion cases by returning the question to legislatures. That is because those bodies can be at odds, leaving it to the justices to resolve clashes.

The case concerns Idaho’s near-total ban on abortions , enacted by its Legislature, which the Biden administration said conflicted with a federal statute, enacted by Congress, that allowed for some exceptions.

Judge B. Lynn Winmill of the Federal District Court in Boise entered a preliminary injunction partly blocking the state law in 2022.

“It’s not about the bygone constitutional right to an abortion,” he wrote. “The court is called upon to address a far more modest issue — whether Idaho’s criminal abortion statute conflicts with a small but important corner of federal legislation. It does.”

Abbie VanSickle

The consequences of the court’s decision could reverberate beyond Idaho.

The case before the Supreme Court on Wednesday is the first time since the justices overturned Roe v. Wade that they will consider a state law criminalizing abortion.

The dispute pits a federal law aimed at emergency medical care in hospitals against an Idaho ban on abortion in nearly all cases, with narrow exceptions for the life of a woman, or instances of rape or incest.

The decision by the justices, which is expected by the end of the term in late June or early July, may have repercussions outside Idaho. A decision there could affect more than a dozen other states that have passed near-total bans on abortion since the court’s 2022 decision, Dobbs v. Jackson Women’s Health Organization .

Idaho’s abortion law is one of the most stringent in the country. But the state and those who have filed friend-of-the-court briefs in its support argue that the Biden administration’s approach is a thinly disguised way to circumvent the Supreme Court’s decision to overturn Roe v. Wade and to continue to allow access to abortion across the country.

A ruling for the Biden administration would most likely solidify the ability of doctors in emergency rooms, even those in states with strict anti-abortion laws, to provide abortions in cases where they believe the procedure is necessary to stabilize a woman’s health, whether or not her life is in danger.

A ruling for Idaho may spur other states to enact similarly strict measures. Many emergency room doctors and medical groups in the state have also voiced concern that siding with Idaho would also aggravate a growing shortage of doctors in the state. According to federal data, almost all counties there do not have enough primary care doctors , and the state ranks near the bottom in doctors per capita.

The federal law came about in part because of how pregnant women were treated in emergency rooms.

The abortion case before the Supreme Court on Wednesday centers on a federal law requiring emergency medical care for any urgent condition, but its specific mention of one condition — pregnancy — will matter most.

Lawyers for Idaho say the law’s language concerning a pregnant woman and “her unborn child” supports the state’s defense of its ban that outlaws most abortions unless women would otherwise die. One of Idaho’s claims is that the federal law requires hospitals to care for the “unborn child.”

The federal government says Idaho is misinterpreting that language and argues that Idaho’s ban violates the 1986 federal law: the Emergency Medical Treatment and Labor Act or EMTALA. The law requires that emergency departments provide stabilizing care not only to patients facing imminent death, but patients whose health would otherwise deteriorate. If emergency departments cannot provide care, they must transfer patients to hospitals that can.

EMTALA’s references to pregnancy were intended to address concerns at the time it was enacted. The law’s purpose was to prevent “patient dumping” — hospitals turning away people who could not pay or lacked health insurance.

At the time, private hospitals sometimes turned away seriously ill or injured patients who couldn’t pay , including victims of stabbings or shootings and people with severe infections or internal bleeding. In Texas, which enacted a state anti-dumping law a year before the federal one, a man with third-degree burns stumbled into a county hospital trailing a catheter and intravenous line inserted by a private hospital that had ejected him.

There were alarming cases involving pregnant women in labor jettisoned from private hospitals before their babies could be born. “It was sometimes so egregious to see how people came in,” Dr. Ron Anderson, then the chairman of the Texas board of health and chief executive of a county hospital in Dallas called Parkland Memorial, recounted in an oral history .

“I remember a young woman in labor who was sent to Parkland from another hospital — a religiously-affiliated hospital,” he said. “When she told them that she was so glad that they would still see her even though her husband had lost his job, they pushed her legs together, started an IV, and sent her to Parkland. She was crowning — the baby was coming any minute. She delivered in the hallway at Parkland.”

The federal law was originally titled “The Emergency Medical Treatment and Active Labor Act” because Congress was concerned about women who were about to give birth, said Sara Rosenbaum, a professor emerita of health law and policy at the George Washington University who has worked on and studied EMTALA since its inception. “Active” was removed from the title in 1989 because hospitals were sending away women in labor if their contractions were more than five minutes apart, she said.

Professor Rosenbaum said “labor and delivery really was a dominant issue” because childbirth was the main reason poor or uninsured pregnant women would go to emergency rooms. Abortion was legal under Roe v. Wade, and complications earlier in pregnancy that might require an abortion to stabilize a woman’s health were not specifically mentioned in the law, but were covered by the general language applying to all emergency medical conditions, she said.

EMTALA mentions “delivery” as one way to stabilize a woman in labor. It also says that risks to “the health of the unborn child” should be minimized when emergency departments decide whether to transfer laboring patients elsewhere.

Idaho cites that language in briefs, writing that “EMTALA requires hospitals to care for an unborn child” and that EMTALA “underscores the importance of caring for the unborn child while indicating that other specific treatments are not required.”

The federal government disputes that interpretation, writing in briefs that three of EMTALA’s four references to considering the health of an “unborn child” refer only to when a woman in labor might be transferred. The fourth reference was added later to require stabilizing care if a pregnant woman goes to an emergency room with an urgent problem that could impair her fetus, but not her own health, the federal government said.

But, it said, that did not eliminate a hospital’s obligation to provide abortions “when termination of the pregnancy is required to save the woman’s life or prevent serious harm to her health.”

What is EMTALA and what does it do?

One of the newest fronts in the abortion debate is a decades-old federal law requiring hospitals to guarantee patients a certain standard of emergency care.

At issue in the case the Supreme Court is hearing on Wednesday is whether Idaho’s near-total ban on abortions violates that law, the Emergency Medical Treatment and Labor Act, or EMTALA, and if it does, whether the state law can be followed instead of the federal law.

Here’s what to know:

What does the law do?

EMTALA (pronounced em-TAHL-uh) was passed by Congress in 1986 and signed by President Ronald Reagan, to address concerns that hospital emergency rooms were turning away patients, especially poor ones or those without insurance.

The law says that if a patient goes to an emergency room with an “emergency medical condition,” hospitals must either provide treatment to stabilize the patient or transfer the patient to a medical facility that can, regardless of the patient’s ability to pay. It applies to any hospital that receives Medicare funding and has an emergency department — most hospitals in the United States.

Hospitals that violate the law can face consequences including fines and exclusion from further Medicare funding.

What does that have to do with abortion?

The law does not mention abortion or name specific treatments for any emergency medical condition. It requires only that hospitals use accepted medical approaches for each patient. But soon after the Supreme Court overturned the national right to abortion in June 2022, the Biden administration issued a memorandum saying that EMTALA applies when abortion is necessary to stabilize a patient. Such cases could include a patient whose water breaks too early in the pregnancy or a patient experiencing severe pre-eclampsia.

“If a physician believes that a pregnant patient presenting at an emergency department is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment,” the memorandum said. “When a state law prohibits abortion and does not include an exception for the life of the pregnant person — or draws the exception more narrowly than EMTALA’s emergency medical condition definition — that state law is pre-empted.”

In its brief to the Supreme Court, Idaho said that the federal law “only requires hospitals to offer treatments that are ‘available,’” and that the state’s near-total ban made abortions unavailable in most circumstances. The brief also said that EMTALA requires that emergency departments stabilize both a pregnant woman and an “unborn child.”

The federal government argues that Idaho’s abortion ban violates EMTALA because its very limited exceptions allow abortions to prevent a pregnant woman’s imminent death, but not to prevent severe worsening of her health. EMTALA requires emergency departments to provide stabilizing care when not doing so could put a patient’s health in “serious jeopardy.”

In its brief, the government wrote: “EMTALA treats pregnancy termination the same as any other stabilizing care: It must be provided if, and only if, it is required to assure that no material deterioration of the individual’s condition is likely to occur.”

Abbie VanSickle contributed reporting.