Abortion

Abortion is an issue that has ethical, moral, and religious considerations for many people, making it a topic that impacts all of society. Read the overview below to gain a balanced understanding of the issue and explore the previews of opinion articles that showcase many perspectives on reproductive rights.

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Abortion Topic Overview

"Abortion" Opposing Viewpoints Online Collection, Gale, 2024.  

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Abortion is a medical or surgical procedure to deliberately end a pregnancy. In 1973 the US Supreme Court decision in Roe v. Wade ruled that the Constitution protects the right to an abortion prior to the viability of a fetus. Until the 2022 ruling in Dobbs v. Jackson Women's Health Organization, Roe v. Wade allowed a person living in any US state to exercise the right to an abortion at their own discretion through the end of the first trimester, around the twelfth week of pregnancy. States were allowed some power to regulate abortion access during the second and third trimesters. The Dobbs ruling, however, ended the federal protections for abortion rights and returned to the states the authority to determine abortion law.

In the decades between Roe and Dobbs, activists and policy makers in many states sought to change legal protections for reproductive rights. In 2020 lawmakers in twelve states tried to use the COVID-19 pandemic as justification to temporarily ban abortion as a "nonessential service." In 2021 several states introduced new restrictions on abortion, implementing over one hundred new abortion restrictions. Though the public has consistently indicated opposition to bans on abortion, several state legislatures passed bans in anticipation of the conservative Supreme Court majority overturning the nearly fifty-year-old Roe decision. Since the decision, new abortion laws have been passed across the country, some restricting and some easing access to abortion.

 

 Main Ideas

  • Abortion refers to a procedure to terminate a pregnancy. The term is typically applied to a planned medical or surgical procedure.
  • People who support legal access to abortion typically identify as pro-choice, while those who support bans and heavy restrictions identify as pro-life.
  • Medical abortions can take place during the first trimester of a pregnancy. In these procedures, the patient takes a combination of drugs to induce an abortion.
  • In 1973 the US Supreme Court ruled in Roe v. Wade that state laws banning abortion during the first trimester of pregnancy were unconstitutional. Reproductive rights advocates challenged subsequent restrictions placed on abortion in federal court.
  • Passed in 1976, the Hyde Amendment forbids the use of federal funds for abortions except under cases of rape, incest, or in which continuing the pregnancy would threaten the woman's health.
  • In 2022 the US Supreme Court ruled in Dobbs v. Jackson Women's Health Organization that the US Constitution did not guarantee the right to abortion. The decision overturned the court's previous ruling in Roe v. Wade.
  • After the Dobbs ruling, many states passed or implemented abortion bans or restrictions, despite continuing US public support for legal abortion. Bans have increased travel to obtain abortions to states where it remains legal and resulted in increased maternal and infant deaths in states where abortion was banned.

 

SUPPORT FOR AND OPPOSITION TO ABORTION

Opponents of abortion, who generally refer to themselves as pro-life, typically object to the practice for religious or ethical reasons, contending that the procedure amounts to the killing of what they consider to be a human life. Supporters of abortion rights, who typically identify as pro-choice, consider it an issue of human rights, asserting that individuals should be able to make medical decisions about their own bodies and lives. Both movements encompass a range of opinions on the subject. Some pro-life activists may condone abortions in cases of rape or incest, while others argue that all abortion is murder. Within the pro-choice movement, some activists contend that no restrictions should be placed on abortion, while others support laws requiring a waiting period before abortions can be performed or that minors obtain permission from their parents.

The majority of Americans oppose banning abortion altogether, with just 13 percent of respondents to a May 2022 Gallup poll indicating a belief that abortion should be illegal under all circumstances. However, the public has remained divided on the extent to which the government should be allowed to impose restrictions. A 2023 Pew Research Center poll found that 64 percent of US adults believed abortion should be legal in all or most cases, compared to 34 percent who said it should be prohibited in all or most cases. Poll results also showed a partisan divide on abortion that has widened over time, with almost 90 percent of Democrats believing abortion should be legal in all or most cases in 2022 compared to 21 percent of Republicans. According to an April 2023 report from the Pew Research Center, 54 percent of Americans said it would be very or somewhat easy to get an abortion in their area, compared to 65 percent in 2019. A further 34 percent of respondents told Pew it should be easier to have an abortion in their area, up from 26 percent in 2019.

After Roe was overturned, protest marches and demonstrations erupted across the United States and lasted for days, with some commentators noting the wide discrepancy between popular support for Roe and the court's rejection of it. While abortion has long been considered a feminist or women's rights issue, the protests highlighted its effects on all Americans regardless of gender. The Dobbs ruling removed precedents related to the right to privacy and the right to bodily autonomy, neither of which is specifically stated in the Constitution. However, these assumed rights have been foundational to rulings decriminalizing interracial marriage, contraception, nonprocreative sex, and same-sex marriage.

 

Surgical and Medical Abortions

Most abortions take place within the first trimester of pregnancy. The two types of abortion are surgical and medication. The most commonly performed surgical abortion procedure is suction abortion, also referred to as vacuum aspiration, which involves removing tissue from the uterus through a thin tube. The procedure is less invasive than surgeries at later stages of pregnancy, which require labor to be induced. First-trimester surgical abortions performed by trained medical professionals are among the safest and simplest forms of surgery. Data from the US Centers for Disease Control and Prevention (CDC) suggests that many fewer women die from legal abortions than from childbirth or many other common procedures, leading many medical experts to conclude that abortion is safer than giving birth in the United States.

Abortions achieved with drugs instead of surgery are called medication abortions and are considered safe and effective until between nine and eleven weeks after the last menstrual period. The most commonly used drugs for medication abortions in the United States are mifepristone and misoprostol, taken in sequence as prescribed by a health care provider. Patients first take mifepristone (previously called RU-486), which blocks the body's natural production of progesterone, an essential pregnancy hormone. The patient takes the second pill, misoprostol, two days later. This drug causes the uterus to contract and expel the embryo. Medication abortions are different from emergency contraception, a type of birth control pill used after unprotected sexual intercourse that prevents pregnancy.

The number of medication abortions surpassed the number of surgical abortions for the first time in 2020, accounting for an estimated 54 percent of all abortions that year, according to the Guttmacher Institute. In April 2021, due in part to COVID-19's impact on providing and accessing health care services, the US Food and Drug Administration (FDA) lifted a ban on dispensing abortion medication through the mail. The decision enabled patients to access abortion without risking COVID exposure and allowed abortion providers that operate online to mail pills to more states. The FDA made this change permanent in December 2021.

 

Roe V. Wade

Abortions were commonly performed in the United States at the time of its founding and were not restricted by law until Connecticut passed the first anti-abortion law in 1821. Until the Roe v. Wade ruling in 1973 there was no federal standard for abortion laws, which were left to the discretion of state legislatures. By 1967 forty-nine states and the District of Columbia had classified abortion as a felony crime in most cases. That same year, however, Colorado passed a law that allowed women to seek voluntary abortions. Several states followed Colorado in liberalizing their abortion laws. By 1973 laws prohibiting abortions had been repealed in four states and loosened in fourteen. In states where abortions were prohibited by law, women who wished to terminate their pregnancies sought out illegal abortions provided by health care workers who risked jeopardizing their careers or by individuals without the proper skills or tools to perform the procedure safely.

In Roe v. Wade, the Supreme Court ruled that restrictive abortion laws are unconstitutional and violate a woman's right to privacy, as implied by the due process clause of the Fourteenth Amendment. The court's decision also determined that an embryo or unviable fetus is not a person in the legal sense. The ruling established that the decision to terminate a pregnancy during the first trimester was the sole decision of the pregnant person and their physician but permitted state governments to regulate abortion during the second trimester. States could ban abortion after the fetus had reached viability, except in cases where the pregnant person's health is endangered. Viability refers to a fetus's ability to survive outside of the womb. The point at which viability is achieved during a pregnancy remains a topic of debate, though it is usually accepted as near the end of the second trimester, at around twenty-four weeks.

In Doe v. Bolton, a companion case to Roe v. Wade decided on the same day, the Supreme Court reaffirmed its decision in Roe v. Wade by prohibiting laws that require admission to a hospital, approval by a hospital abortion committee, a second and third medical opinion, or legal residence in a state before an abortion can be performed. The decision also extended the definition of what posed a health threat to the pregnant person when performing a post-viability abortion by allowing a health care provider to consider such factors as the woman's age and emotional and psychological health. These two court decisions contributed to a notable decrease in mortality rates among pregnant women.

After Roe, the Supreme Court heard several cases that challenged the ruling. In Planned Parenthood v. Danforth (1976), the court ruled against several restrictions imposed by Missouri's abortion laws, thus expanding access to abortion. One year later, however, the court ruled in Maher v. Roe that state governments could choose to deny public funds for an abortion, granting the government additional control over reproductive health care. The Maher v. Roe decision took advantage of the Hyde Amendment, legislation passed by Congress in 1976 that excluded abortion from the list of medical services provided and covered through Medicaid, the federal and state government program that subsidizes medical costs for patients with limited financial means.

 

CAMPAIGN TO OVERTURN ROE V. WADE

Responding first to a trend in the states toward liberalizing abortion laws and later to the court's decision in Roe v. Wade, activists founded several organizations in the late 1960s and 1970s, giving rise to a network of fervent pro-life groups. On the one-year anniversary of the Roe decision, approximately twenty thousand activists in Washington, DC, participated in the first March for Life, which became an annual event for anti-abortion activists. Activists also commonly hold public demonstrations outside abortion clinics, brandishing signs with disturbing images of fetuses and shouting condemnations toward people entering the buildings. In 1994 the Freedom of Access to Clinic Entrances (FACE) Act made blocking the entrances of places providing abortion counseling or services a federal offense punishable by fines and imprisonment.

Some anti-abortion activists have taken more extreme, surreptitious, or violent measures. Members of groups such as Project Veritas, for instance, have posed as patients and secretly filmed abortion providers, using the footage to create misinformation campaigns alleging unethical and criminal behavior. Anti-abortion groups also operate crisis pregnancy centers (CPCs), nonprofit organizations that seek to deter women from terminating unintended pregnancies. CPCs have been accused of using misleading and deceptive advertising and purposefully providing inaccurate information to stop individuals from accessing abortion services. Members of militant pro-life organizations such as Operation Rescue have committed acts of domestic terrorism, including the bombing of clinics and waging of aggressive harassment campaigns. Several doctors who provided abortions have been murdered by pro-life activists.

Meanwhile, in states where pro-life conservatives hold power, legislatures passed laws that placed additional regulations on abortion providers and had the effect of making abortion services more difficult to obtain. Some of these laws included provisions that required the examination rooms in which the procedure would be performed to be a certain size. Other laws required abortion providers and facilities to be affiliated with a hospital or located within a certain distance from a hospital. Pro-choice groups refer to these laws as Targeted Regulation (or Restriction) for Abortion Providers (TRAP) laws. The Supreme Court ruled against TRAP bills from Texas and Louisiana in Whole Woman's Health v. Hellerstedt (2016) and June Medical Services, LLC v. Russo (2020), determining that such requirements did not produce sufficient medical benefit to justify the imposition placed on women seeking abortions.

Many anti-abortion activists celebrated the election of President Donald Trump in 2016, as he had committed during his campaign to nominating pro-life judges. Anticipating a conservative majority in the Supreme Court, lawmakers in several states began advancing more restrictive anti-abortion legislation, including many laws intended to prohibit abortions before the end of the first trimester. For example, some states passed legislation outlawing abortion after a "fetal heartbeat" is detected. Reproductive health doctors consider this terminology misleading, as they describe the noise heard as the electrical activity of the ultrasound machine rather than a heartbeat produced by a functioning heart. Texas' "fetal heartbeat" law prohibited abortions after six weeks and relied on private citizens for enforcement by allowing anyone in any state to file a civil suit against any person who helps someone get an abortion in Texas. Out of fear of possible litigation, most providers in the state had ceased operations months before the Supreme Court issued its ruling in Dobbs.

In the courts, pro-life attorneys brought challenges to Roe in the hopes the Supreme Court would eventually strike it down, while pro-life activists built an organized pipeline of judicial nominees. In 1982 a group of conservatives and libertarians founded the Federalist Society as a professional network that would support and promote judges who shared a similar legal vision, including the overturning of Roe v. Wade. The Trump administration nominated several Federalist Society members as federal judges, including Supreme Court justices Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. As of 2023, six of the nine Supreme Court justices were members of the Federalist Society.

 

CRITICAL THINKING QUESTIONS

  • What factors do you think prevented federal lawmakers from adding a constitutional amendment or passing a federal law establishing a national standard regarding abortion rights?
  • Under what circumstances, if any, do you think state governments should restrict a person's access to abortion services? Explain your answer.
  • How has the Supreme Court's 2022 overturning of abortion rights affected abortion access in the country? What do you consider to be the most significant effect of those changes?

 

ABORTION RIGHTS POST-ROE

The Dobbs ruling, which denied that the Constitution ever recognized or implied a right to abortion in the US Constitution, has had a significant impact on abortion access throughout the country. In the late 2010s, in anticipation of a conservative majority on the court, lawmakers in some states began passing legislation to safeguard the right to legal and safe abortions in the event Roe v. Wade was overturned. In 2019, for example, New York passed the Reproductive Health Act, which removed several restrictions, decriminalized abortion, and limited government interference with the decisions of women and their health care providers. Before Roe's overturning, ten states—Alaska, Arizona, California, Florida, Kansas, Massachusetts, Minnesota, Montana, New Jersey, and New Mexico—had state constitutions protecting abortion rights. As of October 2023, twenty-two states had expanded or protected access to abortion, though the governments of some of these states were challenging those protections.

Before the Dobbs ruling, thirteen US states had passed trigger laws that would outlaw abortion in all or most cases, but not all went into effect immediately after the decision. Some triggered the beginning of a process to ban abortion, while others triggered the ban going into effect. Some laws were blocked from taking effect while lawsuits against them moved through the courts. In some states nearly all abortions became illegal, with some not allowing exceptions in instances of rape and incest or when continuing the pregnancy could be fatal.

President Joe Biden issued an executive order aimed at protecting reproductive rights in July 2022, following the Dobbs ruling. The order directed federal agencies, including the FDA and the Federal Trade Commission (FTC), to develop plans to protect patient privacy, safety, and security, as well as ensure access to comprehensive and reliable medical information and medical services, including abortion and contraception. Additionally, the order created a reproductive health care task force. Despite the sweeping intentions of the executive order, the Biden administration's ability to affect abortion rights remains limited without congressional action.

Since Dobbs, states have passed new laws either protecting or restricting abortion. State legislatures introduced 563 abortion restriction provisions, fifty of which were signed into law, and 369 abortion protection provisions, seventy-seven of which were passed. Six states also held ballot initiatives in which voters chose to protect abortion rights, reflecting the 64 percent majority of Americans who reported supporting abortion rights. As of October 2023, the Guttmacher Institute categorized six US states as "very protective" of abortion rights, with Oregon's laws identified as "most protective." An additional nine states, plus Washington, DC, had policies that protected the right to abortion but imposed some restrictions. Eight states were characterized as "restrictive" and three as "very restrictive." Fifteen states—Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, and West Virginia—had the "most restrictive" abortion policies, a significant increase from the five states with the designation in 2022.

One major point of contention between states is the ability of people to travel in order to access abortion. As of June 2023, twenty-five million people who can become pregnant had less access to legal abortion in their state than they did before the ruling, resulting in significant numbers of people traveling across state borders for the procedure. In response, so-called shield laws, which protect abortion patents and providers from prosecution in states where abortion is illegal, have been passed in fourteen states since Dobbs, bringing the total to fifteen states. In September 2023, lawmakers in Texas began passing measures restricting access to roadways for people on their way to an abortion appointment. In response to a federal rule allowing military personnel stationed in states where access to abortion is restricted to travel to states where abortion is legal, Senator Tommy Tuberville (R–AL) blocked the Senate from voting on military promotions, leaving several crucial high-level posts vacant for months. As of October 2023, despite pressure to relent from both sides of the aisle, Tuberville's blockade continued.

With the FDA allowing delivery of pills for medication abortion through the mail, pro-choice lawmakers and reproductive rights activists hoped that expanding access to medication abortion through telemedicine would mitigate some of the travel burden. However, in states where abortion is restricted, anti-abortion lawmakers began to explore ways of preventing the use of medication abortion. Despite a lack of medical or scientific evidence, several states passed legislation requiring doctors to inform patients that medical abortions can be interrupted or "reversed" by replacing the second pill with a dose of progesterone. Conservative states and legal groups have also pursued overturning the FDA's approval of mifepristone, one of the two drugs used in medication abortions. In April 2023 the Supreme Court ruled that mifepristone could continue to be prescribed while lawsuits continued.

In the year following Dobbs, the US maternal death rate, already the highest among industrialized countries, rose in states where abortion access was illegal or highly restricted. According to a January 2023 report by the Gender Equity Policy Institute, pregnant people in states where abortion is banned were up to three times more likely to die during pregnancy or labor or soon after than pregnant people in less restrictive states. Of these deaths, one in seven occurred in Texas. Babies were 30 percent likelier to die during their first month of life in states with abortion bans, and teen birth rates were twice as high in abortion restriction states.

The number of abortions performed in the United States increased after the Dobbs decision, according to the Guttmacher Institute, which found about 511,000 abortions performed between January and June 2023, compared to 465,000 in the same period of 2020. Less restrictive states bordering more restrictive states experienced most of the increase, with Illinois providers reporting a 69 percent increase and New Mexico reporting a 220 percent increase. States with total bans or six-week bans had an estimated 114,590 fewer abortions performed within their borders, according to the research group WeCount. Experts have raised concerns that the country's remaining abortion clinics are experiencing unsustainable demand for the procedure.

 

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