The debate over whether abortion should be a legal option has long divided people around the world. Split into two groups, pro-choice and pro-life, the two sides frequently clash in protests.
Proponents of legal abortion believe abortion is a safe medical procedure that protects lives, while abortion bans endanger pregnant people not seeking abortions, and deny bodily autonomy, creating wide-ranging repercussions.
Opponents of legal abortion believe abortion is murder because life begins at conception, that abortion creates a culture in which life is disposable, and that increased access to birth control, health insurance, and sexual education would make abortion unnecessary.
Abortion techniques were developed as early as 1550 BC, when the Egyptian medical text Ebers Papyrus suggested that the vaginal insertion of plant fiber covered with honey and crushed dates could induce an abortion. Abortion was an accepted practice in ancient Greece and Rome. Greek philosopher Aristotle (384–322 B.C) wrote that “when couples have children in excess, let abortion be procured before sense and life have begun.” In the latter days of the Roman Empire, abortion was not considered homicide, but a crime against a husband who would be deprived of a potential child.
Throughout much of Western history, abortion was not considered a criminal act as long as it was performed before “quickening” (the first detectable movement of the fetus, which can occur between 13-25 weeks of pregnancy). American states derived their initial abortion statutes from British common law, which followed this principle. Until at least the early-1800s, abortion procedures and methods were legal and openly advertised throughout the United States. Abortion was unregulated, however, and often not only unsafe, but potentially fatal.
In 1821, Connecticut became the first US state to criminalize abortion. The state banned the selling of an abortion-inducing poison, but it did not punish those who took the poison. Legal consequences began in 1845 when New York criminalized a woman’s participation in her abortion, whether it took place before or after “quickening.” In the mid-1800s, early pro-life advocate Dr. Horatio Robinson Storer (1830-1922) convinced the American Medical Association to join him in campaigning for the outlawing of abortion nationwide. By the early 1900s, most states had banned abortion. By 1965, all 50 states had outlawed abortion, with some exceptions varying by state.
The motivation behind these early abortion laws has been disputed. Some writers argue that the laws were not aimed at preserving the lives of unborn children, but rather were intended to protect women from unsafe abortion procedures, or to allow the medical profession to take over responsibility for women’s health from untrained practitioners. Others say that pro-life concerns were already prevalent and were a major influence behind the efforts to ban abortion.
Roe v. Wade
Federal action on abortion didn’t occur until Roe v. Wade, which declared most state anti-abortion laws unconstitutional. The US Supreme Court’s 7-2 decision established rules based on a pregnancy trimester framework, banning legislative interference in the first trimester of pregnancy (0-12 weeks), allowing states to regulate abortion during the second trimester (weeks 13-28) “in ways that are reasonably related to maternal health,” and allowing a state to “regulate, and even proscribe” abortion during the third trimester (weeks 29-40) “in promoting its interest in the potentiality of human life,” unless an abortion is required to preserve the life or health of the mother. The decision also allowed states to prohibit abortions performed by anyone who is not a state-licensed physician.
The initial Roe v. Wade lawsuit was filed at the Dallas federal district courthouse on Mar. 3, 1970 by pregnant Texas resident Norma McCorvey, named in court documents as “Jane Roe.” Henry Wade, Dallas County District Attorney from 1951 to 1987, was the named defendant. McCorvey was seeking to end her pregnancy, but abortion was illegal in Texas except to save the mother’s life. McCorvey said the pregnancy was the result of rape, but she later retracted that claim, admitting she lied in the hope of increasing her chances of procuring an abortion. The baby was eventually delivered and given up for adoption. McCorvey later abandoned her support of abortion rights, becoming a pro-life activist and an evangelical Christian in 1995. She then converted to Catholicism and took part in silent prayer vigils outside abortion clinics. In the 2020 documentary, AKA Jane Roe, McCorvey claimed anti-abortion activists paid her to support their cause.
Hyde Amendment & Mexico City Policy
Immediately following Roe v. Wade, pro-life proponents pushed for federal legislation that would restrict abortion. In 1976, Congress passed the appropriations bill for the Departments of Labor, Health, Education, and Welfare (now the Department of Health and Human Services) which included an amendment ending Medicaid funding for abortions. Known as the “Hyde Amendment,” this provision banning federal funding for abortions has been renewed with various revisions every year since its inception.
At the Aug. 1984 United Nations International Conference on Population held in Mexico City, Mexico, President Ronald Reagan announced the Mexico City Policy, which restricted all non-governmental organizations funded by the US Agency for International Development (USAID) from performing or promoting abortion services. President Bill Clinton rescinded the policy (Jan. 22, 1993); President George W. Bush reenacted it (Jan. 22, 2001); President Barack Obama again rescinded it (Jan. 23, 2009); President Donald Trump again reinstated it (Jan. 23, 2017); and President Biden revoked it once again (Jan. 28, 2021).
Planned Parenthood v. Casey
On June 29, 1992 the US Supreme Court case Planned Parenthood of Southeastern Pennsylvania v. Casey (5-4) upheld the constitutional right to have an abortion, but it abandoned the “rigid trimester framework” outlined in Roe v. Wade and adopted a less restrictive standard for state regulations. The decision allowed states to impose waiting periods before an abortion can be obtained, allowed some legislative interference in the first trimester in the interests’ of health, and permitted parental consent requirements for minors seeking abortions. The Court ruled that none of these conditions imposed an “undue burden” upon those seeking abortions, but some pro-choice advocates warned that Roe v. Wade had been significantly weakened and that states would limit abortion access.
Federal Regulation Post Casey
On Nov. 5, 2003, after passing in the US House of Representatives (281-142) and the US Senate (64-34), the Partial-Birth Abortion Ban Act of 2003 was signed into law by President George W. Bush. This federal legislation banned physicians from providing intact dilation and extraction (also called a “partial-birth” abortion outside of the medical profession), a late-term (after 21 weeks gestation) method which accounted for 0.17% of abortion procedures in 2000. The act defines a “partial-birth abortion” as “an abortion in which the provider deliberately and intentionally vaginally delivers a living fetus until… the entire fetal head is outside the body of the mother, or… any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus.” Pro-choice advocates challenged the constitutionality of the Partial-Birth Abortion Ban Act of 2003; however, the Apr. 18, 2007 US Supreme Court case Gonzales v. Carhart/Gonzales v. Planned Parenthood upheld the act, ruling 5-4 that it did not impose “an undue burden on a woman’s right to abortion.”
The topic of abortion was raised during the 2009-2010 US Congress health care debate. Some pro-life advocates said the Patient Protection and Affordable Care Act would allow federal funding for abortions, a claim denied by abortion rights supporters. To ensure passage of the bill, President Obama signed an executive order “to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services,” re-affirming Hyde Amendment restrictions and extending them to cover the newly created health insurance exchanges.
In Mar. 2017, the Department of Health and Human Services announced that all federally-funded shelters housing undocumented unaccompanied minors are henceforth prohibited from taking “any action that facilitates” access to abortion. The American Civil Liberties Union (ACLU) challenged this decision in Garza v. Hargan, and on Mar. 30, 2018 the US District Court for the District of Columbia issued an injunction, ruling that the federal government must not interfere or obstruct any “unaccompanied immigrant minor children who are or will be in the legal custody of the federal government” from having an abortion while the case is being heard.
State restrictions on abortion access increased sharply after the 2010 midterm elections, in which Republicans gained at least 675 state legislative seats, the biggest gain made by any party in state legislatures since 1938. Between Roe v. Wade and Dec. 31, 2021, 1,338 new abortion restrictions were passed by states. 44% of those were passed after 2011, and the most (108) were passed in 2021.
Most abortion restrictions were passed prior to the US Supreme Court overturning Roe v. Wade on June 24, 2022. Those restrictions may no longer apply in states where “trigger laws” were also in effect, which ban abortion without the federal constitutional protection of Roe v. Wade.
Fetal pain laws or 20-week bans
These laws typically ban abortion at or after 20 weeks of gestation on the theory that a fetus can feel pain at that time. On Apr. 13, 2010, Nebraska’s Republican Governor Dave Heineman signed the first law in the United States to restrict abortions based on fetal pain. After Nebraska’s law was passed, several other states enacted similar laws. On Mar. 6, 2013, Idaho’s fetal pain law was the first to be struck down by a federal court.
These laws require people seeking an abortion to get an ultrasound, which is frequently accompanied by a detailed description of the fetus’ heart, limbs, and organs. While other states had passed laws requiring an ultrasound before having an abortion, on Apr. 27, 2010, the Oklahoma legislature passed the first law requiring that the patient watch the monitor and listen to a detailed description of the fetus. However, the law was struck down by the Supreme Court in 2013. Many states have laws regulating the provision of ultrasound by abortion providers; three of these states (LA, TX, WI) require the abortion provider to display and describe the image to the pregnant patient.
Criminalization of abortions based on the sex or race of a fetus
This type of law was first enacted in Arizona on Mar. 29, 2011. The bill, signed into law by Republican Governor Jan Brewer, was opposed by Democrats, who said there was little evidence that sex- or race-selection abortions were taking place in the state. As of June 2018, eight states (AZ, AR, KS, NC, ND, OK, PA, SD) ban sex-selection abortions; Arizona is the sole state to ban race-selection abortions.
Fetal abnormality laws
These laws ban abortions in cases of fetal abnormality even if the fetus will die before or shortly after birth. Enacted in 2013, North Dakota is the only state to ban abortions in cases of fetal abnormality.
“Fetal heartbeat” laws or six-week bans
This type of law outlaws abortions as early as six weeks after the last menstrual period, when an electrical impulse, often called a “fetal heartbeat,” can first be detected. In Mar. 2013, North Dakota enacted a “fetal heartbeat” law. A federal appeals court struck down the law in 2015, noting that the law “violates Supreme Court precedent establishing that abortion is legal until a fetus is viable outside of the womb, usually about 24 weeks into pregnancy.”In 2018, the governors of Mississippi and Iowa signed into law similarly restrictive abortion laws banning abortion at 15-weeks and 6-weeks respectively; both laws were put on hold by federal judges pending appeals. On Sep. 1, 2021, the most restrictive “fetal heartbeat” law to date went into effect in Texas after the US Supreme Court refused in a 5-4 vote to block the law. The law bars abortions after six weeks, has no exceptions for rape or incest, and has only a narrow exception for the health of the mother. Further, the law bars state officials from enforcing the law, instead deputizing private citizens who may bring a $10,000 lawsuit (plus legal fees) against anyone they suspect of performing or “aiding and abetting” an abortion, making the law more difficult to challenge in court.
Admitting privileges and surgical center standards laws
These laws require that doctors who perform abortions have admitting privileges in local hospitals, and these laws require abortion clinics to have the same building standards as ambulatory surgical centers. Despite an 11-hour filibuster from State Senator Wendy Davis, the Texas legislature passed a law in 2013 that added admitting privileges and surgical center requirements. The number of clinics providing abortion services fell from 42 to 19 over the next two years. On June 27, 2016, the US Supreme Court struck down the Texas law. Writing for the majority, Justice Stephen Breyer said: “neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes… each violates the Federal Constitution.” A similar law passed in Arkansas in 2015 requires abortion providers using pills to induce abortion in the first nine weeks of pregnancy (medication abortions) to have admitting privileges at local hospitals. On June 29, 2020, in a 5-4 ruling, the Supreme Court struck down a Louisiana admitting privilege law similar to the Texas law struck down in 2016.
These laws are abortion bans that were written to stop all or nearly all abortions if Roe v. Wade were overturned (as it was in June 2022). During the 2018 midterm elections, voters in Alabama and West Virginia voted in favor of constitutional amendments that would restrict access to abortion if Roe v. Wade were to be overturned by the Supreme Court. As of Apr. 1, 2019, six states had trigger laws that would ban all or nearly all abortions and an additional five states had trigger laws that were blocked by courts but could be put in effect when Roe v. Wade was overturned in June 2022. By Apr. 4, 2022, the Guttmacher Institute reported 13 states with trigger laws.
Roe v. Wade protection laws
This type of law codifies the right to abortion within the state constitution or legal code and are meant to be a state-level protection against Roe v. Wade being overturned by the US Supreme Court. In 2017, Oregon enacted the Reproductive Health Equity Act that would keep abortion legal even if the Supreme Court overturned Roe v. Wade (as it did in June 2022). As of Apr. 1, 2019, nine other states have laws that will keep abortion legal prior to fetal viability.As of Apr. 4, 2022 the Guttmacher Institute reported 16 states with laws to protect abortion access.
Laws designed to challenge Roe v. Wade in court
These laws were passed by several states in 2019 and typically combined six-week bans with other restrictive measures such as allowing no exceptions for rape or incest and including felony penalties for doctors who perform abortions. Alabama passed the most restrictive of these laws to date on May 16, 2019. Alabama State Representative Terri Collins (R) stated, “This bill is about challenging Roe v. Wade and protecting the lives of the unborn, because an unborn baby is a person who deserves love and protection.” Elizabeth Nash, MPP, Senior States Issue Manager at the Guttmacher Institute, stated, “There’s a real momentum around banning abortion at the state level and it’s stemming from the shift in the U.S. Supreme Court” with the addition of conservative Associate Justices Neil Gorsuch and Brett Kavanaugh. These measures proved successful when Roe v. Wade was overturned in June 2022.
Pandemic restrictions were put in place by at least seven states by Apr. 9, 2020, including Alabama, Indiana, Iowa, Mississippi, Ohio, Oklahoma, and Texas. Each state listed abortion as a nonessential medical procedure during the COVID-19 pandemic, which banned abortion. The states contend they were freeing up medical personnel to deal with the pandemic, while abortions rights supporters argued that the states were already hostile to abortion rights and were using the pandemic as an excuse to enact a ban that could last beyond the pandemic. Federal judges blocked the bans at least in part in most of the states.
Civil lawsuit abortion restrictions
This type of law was first put into place in Texas. The Texas Heartbeat Act made performing abortions illegal if a doctor could detect a “fetal heartbeat,” or around six weeks. While the law is technically a “fetal heartbeat law,” the enforcement of the law is left to private citizens who may sue anyone who helps someone obtain an abortion from doctors to Uber drivers. The law was upheld by the US Supreme Court in Dec. 2021. Other states have since copied Texas’ law, including Idaho and Oklahoma and at least ten other states had such laws under consideration.
Protections against civil lawsuit abortion restrictions
In anticipation of Roe v. Wade being overturned by the Supreme Court, some states enacted laws that would protect health care providers and those seeking abortions from civil lawsuits started in another state. The laws were passed because some states authorized civil action against anyone seeking an abortion or anyone aiding a person seeking an abortion, even in another state. California, Connecticut, and Washington had passed such laws as of June 24, 2022.
Medication abortion restrictions
After Roe v. Wade was overturned in 2022, many legislators and activists turned their attentions to restricting abortion medications in states where abortion is not already completely banned or where an abortion ban is being challenged in court. Wyoming became the first state to completely ban the use of drugs for abortions (the state’s complete abortion ban has been in court) on Mar. 17, 2023.
“Abortion trafficking” restrictions
Idaho became the first (and, thus far, only) state to enact an “abortion trafficking” law (H.B. 242) on Apr. 5, 2023. The law states an abortion trafficker is “an adult who, with the intent to conceal an abortion from the parents or guardian of a pregnant, unemancipated minor, either procures an abortion… or obtains an abortion-inducing drug for the pregnant minor to use for an abortion by recruiting, harboring, or transporting the pregnant minor within this state commits the crime of abortion trafficking.” Idaho’s law allows for the “any female upon whom an abortion has been attempted or performed, the father of the preborn child, a grandparent of the preborn child, a sibling of the preborn child, or an aunt or uncle of the preborn child” to sue for damages from the medical professionals for “not less than twenty thousand dollars ($20,000),” as well as legal and attorney’s fees.
Roe v. Wade in 2022
On May 2, 2022, a US Supreme Court first draft majority opinion written by Justice Samuel Alito was leaked to and verified by Politico. The draft indicated the court would overturn Roe v. Wade and Planned Parenthood v. Casey. Alito wrote, “Roe was egregiously wrong from the start…. The inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions.” Justice Alito indicated the decisions to allow, regulate, or ban abortion lies with individual states. Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett were reported to have voted with Alito to overturn Roe and Casey, while Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan were writing dissents. How Chief Justice John Roberts would vote was unclear at the time of the leak.
On June 24, 2022, the US Supreme Court overturned Roe v. Wade and Planned Parenthood v. Casey in a 6-3 decision in Dobbs v. Jackson Women’s Health Organization, eliminating the federal constitutional right to abortion. Justice Samuel Alito wrote the majority opinion (the final copy of which was similar to the draft leaked in May), and was joined by Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney. Chief Justice John Roberts did not join the majority, but wrote a concurring opinion that would have upheld Mississippi’s 15-week ban, but would not have overturned Roe v. Wade. Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan dissented, writing: “With sorrow — for this Court, but more, for the many millions of American women who have today lost a fundamental constitutional protection — we dissent.”
Post-Roe and –Casey
On July 8, 2022, President Joe Biden signed “Executive Order on Protecting Access to Reproductive Healthcare Services.” The order directs Health and Human Services (HHS) to submit a report within 30 days on what actions HHS is taking to protect access to abortion and other reproductive services; states HHS will expand access to emergency contraception and long-acting reversible contraception as well as education about abortion; directs HHS to update physician responsibilities and protections guidance under the Emergency Medical Treatment and Labor Act; establishes an interagency reproductive health care access task force; collects private pro bono lawyers and organizations to provide legal representation to those seeking and providing abortions; directs the Federal Trade Commission and HHS to consider taking steps to protect patient privacy; and providing safety to those seeking and providing abortions.
In guidance issued by HHS Secretary Xavier Becerra on July 11, 2022, the Biden Administration “reaffirmed that it [the Emergency Medical Treatment and Active Labor Act (EMTALA)] protects providers when offering legally-mandated, life- or health-saving abortion services in emergency situations” and that, in emergency situations, “this federal law preempts state law restricting access to abortion in emergency situations.” On July 14, 2022, Texas sued the federal government, stating: “EMTALA does not mandate access to abortion or codify a right to an abortion as ‘stabilizing treatment’ for an ’emergency medical condition.’ The Abortion Mandate cites no other federal law that would authorize or require an abortion. No federal statute, including EMTALA, supersedes or preempts the States’ power to regulate or prohibit abortion.”
On July 13 2022, the Biden Administration issued clarifying guidance with examples of when pharmacies that receive federal assistance (including via Medicare and Medicaid payments) are not allowed to refuse to fill prescriptions for drugs that may end a pregnancy lest they violate federal civil rights laws. The examples of potential civil rights violations (discrimination on the basis of sex or disability specifically) include but are not limited to: refusing to fill mifepristone and misoprostol prescriptions for miscarriages; not stocking or filling prescriptions for misoprostol, which can be used for stomach ulcers, or methotrexate, which can be used for rheumatoid arthritis, because of their alternate uses in abortions; refusing to stock or fill a prescription for emergency contraception if the pharmacy also stocks other contraception including condoms.
On Aug. 23, 2022, US District Court Judge James Wesley Hendrix ruled that the HHS guidance about the EMTALA was “unauthorized.” Hendrix wrote: “That guidance goes well beyond EMTALA’s text, which protects both mothers and unborn children, is silent as to abortion, and preempts state law only when the two directly conflict. Since the statute is silent on the question, the Guidance cannot answer how doctors should weigh risks to both a mother and her unborn child. Nor can it, in doing so, create a conflict with state law where one does not exist.”
The following day, Aug. 24, 2022, US District Judge B. Lynn Winmill blocked an Idaho ban on emergency abortions. Winmill wrote the court was tasked with determining “whether Idaho’s criminal abortion statute conflicts with a small but important corner of federal legislation. It does.” The conflict between the Aug. 23 ruling and the Aug. 24 ruling could send abortion rights back to the US Supreme Court.
On Sep. 1, 2022, the Department of Veterans Affairs announced an interim final rule that the VA would provide abortions to veterans and VA beneficiaries in some cases, regardless of state laws. Abortions will be available if the life or health of the pregnant person is in danger and in cases of rape and incest.
Some prominent pro-choice organizations include Planned Parenthood, NARAL Pro-Choice America, the National Abortion Federation, the American Civil Liberties Union (ACLU), and the National Organization for Women. Although many pro-life positions derive from religious ideology, several mainstream faith groups support the pro-choice movement, such as the United Methodist Church, United Church of Christ, the Episcopal Church, Presbyterian Church (USA), and the Unitarian Universalist Association.
The 2020 Democratic Party Platform endorsed the pro-choice position, stating, “Democrats are committed to protecting and advancing reproductive health, rights, and justice. We believe unequivocally, like the majority of Americans, that every woman should be able to access high-quality reproductive health care services, including safe and legal abortion. We will repeal the Title X domestic gag rule and restore federal funding for Planned Parenthood, which provides vital preventive and reproductive health care for millions of people, especially low-income people, and people of color, and LGBTQ+ people, including in underserved areas.”
Some prominent pro-life organizations include The National Right to Life Committee, Pro-Life Action League, Operation Rescue, the Catholic Church, the Eastern Orthodox Church, Americans United for Life, the National Association of Evangelicals, Family Research Council, Christian Coalition of America, and the Church of Jesus Christ of Latter-Day Saints (Mormon Church).
The 2016 Republican Party Platform (which was not updated in 2020) opposed abortion, stating, “We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare… We will not fund or subsidize healthcare that includes abortion coverage… We thank and encourage providers of counseling, medical services, and adoption assistance for empowering women experiencing an unintended pregnancy to choose life.”
While “pro-choice” and “pro-life” have long been the mainstream terms, some prefer “pro-abortion” and “anti-abortion,” either to clarify or scorn the position of the opposing group.
A 2018 Marist Poll and Knights of Columbus survey found that 51% of Americans consider themselves to be pro-choice, and 44% consider themselves to be pro-life.
A 2017 Pew Research survey found that 57% of Americans say abortion should be legal in all or most cases, while 40% say it should be illegal in all or most cases.
Pew Research found that 69% of Americans – 84% of Democrats and 53% of Republicans – surveyed said “No, do not overturn” in response to the question “Would you like to see the Supreme Court completely overturn its Roe versus Wade decision, or not?”
A 2018 PPRI poll found that 45% of women and 42% of men agreed abortions should be covered by most health insurance plans.
A Sep. 22, 2021 Marquette Law School survey found 20% were in favor of overturning Roe v. Wade, 50% were opposed, and 29% said they didn’t have enough information. A 2021 Monmouth University poll reported 62% of Americans were in favor of leaving the Roe v. Wade ruling as is, while 31% supported the Supreme Court revisiting the ruling. And a 2021 Quinnipiac University survey found that 67% agreed with the Roe v. Wade ruling and 27% were opposed.
A June 2021 Gallup poll found 47% of Americans believed abortion to be morally acceptable, while 46% believed it not to be. 48% thought abortion should be legal “only under certain circumstances,” 32% “under any circumstances,” and 19% “illegal in all circumstances.” The majority of Americans opposed overturning Roe v. Wade (58%), while 32% are in favor of overturning the US Supreme Court decision. 56% oppose banning abortion after the 18th week of pregnancy, 58% oppose fetal heartbeat restrictions, and 57% oppose abortion bans if the fetus is found to have a genetic disease or disorder.
A June 2, 2022 Gallup poll found 58% of Americans are opposed to overturning Roe v. Wade, a steady majority seen since 1989. 35% would like to see the US Supreme Court ruling legalizing abortion nationwide overturned. There were, however, partisan divides: 80% of Democrats, 62% of independents and 31% of Republicans would keep Roe, while 58% of Republicans, 34% of independents and 15% of Democrats want the ruling reversed.
According to the same June 2, 2022 Gallup poll, 55% of Americans identified as “pro-choice,” the highest percentage since 1995. 39% identified as “pro-life,” and 5% were neither or unsure. For the first time in the history of the poll question (since 2001), 52% of Americans believe abortion is morally acceptable. 38% believed the procedure to be morally wrong, and 10% answered that it depended on the situation or they were unsure.
Contemporary Abortion Procedures
Surgical abortion (aka suction curettage or vacuum curettage) involves using a suction device to remove the contents of a uterus. Surgical abortion performed later in pregnancy (after 12-16 weeks) is called D&E (dilation and evacuation).
Medication abortion (also called the “abortion pill”), involves taking medications, usually mifepristone and misoprostol, within the first seven to nine weeks of pregnancy to induce an abortion.
In Dec. 2022, the FDA clarified that Plan B is a contraceptive and is not an abortion drug: the pill “will not work if you’re already pregnant, and will not affect an existing pregnancy.”
A US district judge ruled on July 13, 2020 that requiring in-person visits for abortions was unconstitutional during the COVID-19 (coronavirus) pandemic. The ruling allowed healthcare providers nationwide to mail mifepristone for the duration of the pandemic. The drug, when used in combination with misoprotosol, induces an abortion, and is the only drug the FDA requires to be administered in a medical setting, according to the ACLU.
On Dec. 16, 2021, the FDA permanently lifted the in-person requirements for mifepristone, which are available via telemedicine appointments and the mail. However, telemedicine appointments for abortions were banned in 19 states and six states had bans on mailing the pills in place at the time of the decision.
On Jan. 3, 2023, the FDA announced that certified pharmacies will be allowed to dispense the abortion medication mifepristone to people with a prescription, removing the requirement that only a healthcare provider may dispense the medication.
On Apr. 7, 2023, two federal district court judges issued conflicting preliminary injunctions (rulings issued before the case is heard) on medication abortion: one in Texas ordered the FDA to take mifepristone off the market, while the other in Washington ordered the FDA to maintain the status quo (which would mean keeping mifepristone on the market). The first injunction (Texas) was stayed by the judge pending appeal. On Apr. 12, 2023, 5th U.S. Circuit Court of Appeals issued a ruling on the Texas case allowing mifepristone to remain on the market while the case is heard, but restricting access: the drug may only be dispensed up to seven weeks of pregnancy instead of 10 and may not be dispensed through the mail. On Apr. 14, 2023, the U.S. Justice Department asked the U.S. Supreme Court to stay the Texas ruling and Associate Justice Samuel Alito placed a hold on the ruling until Wednesday, Apr. 19, 2023 and the full court stayed the injunction on Friday, Apr. 21, 2023. In the meantime, some Democratic-led states are stockpiling the drug in case new restrictions are put on mifepristone.
From Roe v. Wade through 2017, over 60 million legal abortions were estimated to have been performed in the United States – an average of about 1.4 million abortions per year. In 2014, 19% of pregnancies (excluding miscarriages) ended in abortion, and 1.5% of women aged 15-44 had an abortion. At 2014 abortion rates, one in twenty US women would have an abortion before age 20, one in five by 30, and about one in four by 45. 11% of women who had an abortion were teenagers, while most women who had abortions were in their 20s: 32% aged 20-24 and 27% aged 25-29.
The US abortion rate fell 29% between 1990 and 2005, from 27.4 to 19.4 abortions per 1,000 women of childbearing age, before leveling out from 2005-2008. Between 2008 and 2011, the abortion rate dropped again by 13% to its lowest point since 1973: 17 abortions for every 1,000 women; in 2014 the rate dropped another 14% to 15 abortions per 1,000 women. Pro-choice supporters credited an increased use of new birth control methods such as Mirena (an intra-uterine device that can last for several years) as one of the reasons for the decline. Pro-life groups credited an increase in anti-abortion laws at the state level amongst other factors, although abortion rates dropped faster than the national average in some states that had not enacted abortion restrictions, such as Illinois, where the rate dropped by 18%.
The number of abortion providers has been declining since 1984, after it reached a peak of 2,908 providers in 1982. There were 1,671 abortion providers in the United States in 2014, including 272 abortion clinics, 516 non-specialized clinics, 638 hospitals, and 245 physicians’ offices. 90% of US counties did not provide abortion services, with 39% of women living in those counties. Between 2011 and 2017, at least 126 clinics providing abortion services closed. Seven states (KY, MO, MS, ND, SD, WV, WY) had only one clinic left.
Pro-choice advocates believe increased clinic violence contributed to this downward trend in abortion providers. In 2016, 6% of abortion clinics reported losing staff members as a result of anti-abortion violence or harassment. According to the National Abortion Federation, a professional association of abortion practitioners, at least 229 arson attacks/bombings were committed against abortion providers between 1977 and 2017, with at least another 99 attempted arson attacks/bombings. Additionally, at least 11 abortion providers were murdered during that time and there were at least 26 attempted murders of clinic staff and physicians. Mainstream pro-life leaders and organizations have publicly denounced violence committed against abortion providers and clinics.
In 2017, abortion rates declined to an estimated 862,320 in the United States, or 13.5 abortions per 1,000 women between the ages of 15 and 44. Those rates represent a 7% drop since 2014, according to a Sep. 2019 Guttmacher Institute, and the lowest recorded rate since abortion was legalized in 1973.
The Centers for Disease Control and Prevention (CDC) reported 629,898 legal abortions in 2019 (the most recent data as of May 3, 2022). 92.7% of the abortions were performed at or before 13 weeks or gestation, 6.2% at 14–20 weeks, and less than 1.0% at or after 21 weeks’ gestation. 42.3% of all abortions were early medical abortions (at or before 9 weeks). The abortion ratio was 195 abortions per 1,000 live births.
In a 2022 report, the World Health Organization and the Guttmacher Institute found that between 36 to 47 abortions were performed per 1,000 women (ages 15-49) yearly in countries where abortion is broadly legal. In countries where abortion is banned, between 31 and 51 abortions were performed per 1,000 women (ages 15-49) yearly.
In the year after the U.S. Supreme Court ruled abortion was not a constitutionally guaranteed right in Dobbs v. Jackson Women’s Health Organization, abortion access dropped dramatically with 14 states outlawing the procedure entirely and another seven states imposing stricter laws. However, abortion procedures rose about 0.2% instead of decreasing as expected. In the two months before the Supreme Court ruling, there were 82,115 abortions per month. In the 12 months after the ruling, 82,298 abortions were performed on average per month. According to New York Times reporters Claire Cain Miller and Margot Sanger-Katz, the increase can be attributed to the “expansion of telemedicine for mail-order abortion pills, increased options and assistance for women who traveled, and a surge of publicity about ways to get abortions.” Additionally, 20 states increased abortion protections for both people seeking abortions and the health care providers who perform or assist abortions.
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