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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

Since May 15, 2023

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Thesis: The Dynamic Landscape of Abortion Law in the United States

Editor's note:

Victoria Higginbotham defended her thesis titled “The Dynamic Landscape of Abortion Law in the United States” in May 2018 in front of committee members Jane Maienschein, Carolina Abboud, and Alexis Abboud, earning her a Bachelor’s degree from Barrett, the Honors College. https://repository.asu.edu/items/48020

The Dynamic Landscape of Abortion Law in the United States explores the ways abortion laws have changed in the United States over the course of US history. Abortion laws in the US have historically been fluid, changing in ways both big and small. Those changes can occur after advances in science, changes in understanding, or changes in public opinion. And there have been various periods in the history of the US where tolerance abortion waxed or waned, and common law reflected those attitudes.

Roe v. Wade was a pivotal moment in the history of abortion law that accomplished much in the way of broadening women's access to abortions. But Roe v. Wade was not the beginning or the end of the fight for abortion rights in the US. There were legal abortions prior to Roe v. Wade and illegal abortions after. Roe v. Wade granted that women had a constitutional right to have an abortion but the ruling left the boundaries of that right somewhat undefined and most courtroom battles over abortion laws are fought over where a woman's right to an abortion ends and a States right to regulate and protect fetal life begin.

Much change has occurred in abortion laws over the past 50 years, this thesis tracks those changes principally through Supreme Court Cases, such as United States v. Milan Vuitch, Roe v. Wade, and Gonzales v. Planned Parenthood among others. The landscape of abortion law in the US continues to shift today, as recently as 2017 with Plowman v. FMCH cases were being heard in courts that wrought subtle yet important changes in abortion law.

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2018 Theses Master's

Abortion as a Human Right in the United States: Exploring the Role of CEDAW Cities in Challenging the Hyde Amendment

Pierson, Jessica

Women’s sexual and reproductive rights are foundational to gender equality. Having access to abortion care is fundamental to the full realization of a woman’s human rights. Anti-choice advocates consistently and successfully separate abortion from other basic health care that women need. At the same time, activists for gender equality often shy away from advocating for abortion care as part of their women’s rights agenda because of the political stigma that is associated with abortion. Although abortion is legal in the United States, anti-choice groups and conservative lawmakers have been successful in restricting the right to an abortion, particularly through legislation like the Hyde Amendment, which bans federal funds from covering abortion care for low-income women insured by the Medicaid program. U.S. constitutional law has upheld restrictions on abortion care, leaving a large portion of reproductive age women without the ability to exercise their constitutional right to an abortion. In contrast, international human rights mechanisms have had an impact on liberalizing national abortion laws by requiring that governments take affirmative action to ensure that women can access safe abortion care as a fundamental human right. While the international community is advancing abortion as a human right, several cities have aligned themselves with an international human rights framework by adopting the principles of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), an international women’s rights treaty that the U.S. has refused to ratify at the federal level. This research aimed to discover how these cities could utilize this human rights framework to advance abortion as a human right in their communities, particularly in states that follow the federal Hyde Amendment restrictions on abortion. The research was conducted through qualitative semi-structured interviews with local activists working to pass and implement CEDAW resolutions and ordinances, people working on the Cities for CEDAW (C4C) campaign, reproductive rights professionals, and a local abortion fund. This thesis found that framing reproductive health as a human right is a paradigm shift toward destigmatizing abortion. This thesis concludes that the local CEDAW resolutions and ordinances have the power to influence state policies involving abortion. Furthermore, local CEDAW activists can instigate a political shift by embracing and utilizing the jurisprudence, General Comments, and Concluding Observations identified by the United Nations CEDAW Committee regarding abortion as a human right. The negative human rights impact of the Hyde Amendment, although law of the land, can be challenged by activists through advocacy around passing and implementing local CEDAW ordinances and resolutions.

Geographic Areas

• United States
• Human rights
• Abortion--Law and legislation
• Women's health services
• Constitutional law
• United Nations. Committee on the Elimination of Discrimination Against Women
• Convention on the Elimination of All Forms of Discrimination against Women (1979 December 18)

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Home > School, College, or Department > Honors > Honors Theses > 1183

University Honors Theses

An exploration of the wide-reaching effects of the repeal of roe v. wade on women's access to abortion.

Mitchell J. Foster , Portland State University Follow

First Advisor

Christopher Shortell

Date of Award

Spring 6-16-2022

Document Type

Degree name.

Bachelor of Science (B.S.) in Political Science and University Honors

Political Science

Abortion -- Government policy -- United States -- History, Abortion services -- United States -- History, Reproductive rights -- United States, Civil rights -- United States

10.15760/honors.1223

Since 1973, the federal government, through the Supreme Court of the United States, has acted to protect, the rights of women in their ability to choose to have an abortion without excessive governmental restriction. This thesis analyzes how and why access to abortion will shift in the face of the Supreme Court's overturning of Roe v. Wade (1973), likely to occur this June. This thesis begins with an in-depth description of how and why abortion became illegal, how and why abortion became legal, and how the opposition has developed against legal abortion. Through the last few decades, though especially in the last few years, most states have signed into law statutes that greatly limit a woman's access to abortion, and several have signed into law statutes that will act to ban abortion in nearly all cases if Roe is repealed. This thesis examines what precisely state law, as well as lasting precedents, put forth by the Supreme Court in other cases related to abortion, and the response of the other branches of the federal government to the issue of abortion will mean for a woman's access to abortion throughout the United States. I found, in the course of this project, that access to abortion will shift most substantially in states which do not, by constitutional interpretation or statute, protect one's fundamental right to acquire an abortion. This shift will, also, be felt most by impoverished persons, as these persons are less likely to be able to travel for abortions.

In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/ This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).

Persistent Identifier

https://archives.pdx.edu/ds/psu/37695

Recommended Citation

Foster, Mitchell J., "An Exploration of the Wide-Reaching Effects of The Repeal of Roe v. Wade on Women's Access to Abortion" (2022). University Honors Theses. Paper 1183. https://doi.org/10.15760/honors.1223

Since May 23, 2022

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Abortion Argumentative Essay: Definitive Guide

Academic writing

Abortion remains a debatable issue even today, especially in countries like the USA, where a controversial ban was upheld in 13 states at the point this article was written. That’s why an essay on abortion has become one of the most popular tasks in schools, colleges, and universities. When writing this kind of essay, students learn to express their opinion, find and draw arguments and examples, and conduct research.

It’s very easy to speculate on topics like this. However, this makes it harder to find credible and peer-reviewed information on the topic that isn’t merely someone’s opinion. If you were assigned this kind of academic task, do not lose heart. In this article, we will provide you with all the tips and tricks for writing about abortion.

Where to begin?

Conversations about abortion are always emotional. Complex stories, difficult decisions, bitter moments, and terrible diagnoses make this topic hard to cover. Some young people may be shocked by this assignment, while others would be happy to express their opinion on the matter.

One way or another, this topic doesn't leave anyone indifferent. However, it shouldn’t have an effect on the way you approach the research and writing process. What should you remember when working on an argumentative essay about abortion?

• Don’t let your emotions take over. As this is an academic paper, you have to stay impartial and operate with facts. The topic is indeed sore and burning, causing thousands of scandals on the Internet, but you are writing it for school, not a Quora thread.
• Try to balance your opinions. There are always two sides to one story, even if the story is so fragile. You need to present an issue from different angles. This is what your tutors seek to teach you.
• Be tolerant and mind your language. It is very important not to hurt anybody with the choice of words in your essay. So make sure you avoid any possible rough words. It is important to respect people with polar opinions, especially when it comes to academic writing. 
• Use facts, not claims. Your essay cannot be based solely on your personal ideas – your conclusions should be derived from facts. Roe v. Wade case, WHO or Mayo Clinic information, and CDC are some of the sources you can rely on.

Speaking of Outline

An argumentative essay on abortion outline is a must-have even for experienced writers. In general, each essay, irrespective of its kind or topic, has a strict outline. It may be brief or extended, but the major parts are always the same:

• Introduction. This is a relatively short paragraph that starts with a hook and presents the background information on the topic. It should end with a thesis statement telling your reader what your main goal or idea is.
• Body. This section usually consists of 2-4 paragraphs. Each one has its own structure: main argument + facts to support it + small conclusion and transition into the next paragraph.
• Conclusion. In this part, your task is to summarize all your thoughts and come to a general conclusive idea. You may have to restate some info from the body and your thesis statement and add a couple of conclusive statements without introducing new facts.

Why is it important to create an outline?

• You will structure your ideas. We bet you’ve got lots on your mind. Writing them down and seeing how one can flow logically into the other will help you create a consistent paper. Naturally, you will have to abandon some of the ideas if they don’t fit the overall narrative you’re building.
• You can get some inspiration. While creating your outline, which usually consists of some brief ideas, you can come up with many more to research. Some will add to your current ones or replace them with better options.
• You will find the most suitable sources. Argumentative essay writing requires you to use solid facts and trustworthy arguments built on them. When the topic is as controversial as abortion, these arguments should be taken from up-to-date, reliable sources. With an outline, you will see if you have enough to back up your ideas.
• You will write your text as professionals do. Most expert writers start with outlines to write the text faster and make it generally better. As you will have your ideas structured, the general flow of thoughts will be clear. And, of course, it will influence your overall grade positively.

Abortion Essay Introduction

The introduction is perhaps the most important part of the whole essay. In this relatively small part, you will have to present the issue under consideration and state your opinion on it. Here is a typical introduction outline:

• The first sentence is a hook grabbing readers' attention.
• A few sentences that go after elaborate on the hook. They give your readers some background and explain your research.
• The last sentence is a thesis statement showing the key idea you are building your text around.

Before writing an abortion essay intro, first thing first, you will need to define your position. If you are in favor of this procedure, what exactly made you think so? If you are an opponent of abortion, determine how to argue your position. In both cases, you may research the point of view in medicine, history, ethics, and other fields.

When writing an introduction, remember:

• Never repeat your title. First of all, it looks too obvious; secondly, it may be boring for your reader right from the start. Your first sentence should be a well-crafted hook. The topic of abortion worries many people, so it’s your chance to catch your audience’s attention with some facts or shocking figures.
• Do not make it too long. Your task here is to engage your audience and let them know what they are about to learn. The rest of the information will be disclosed in the main part. Nobody likes long introductions, so keep it short but informative.
• Pay due attention to the thesis statement. This is the central sentence of your introduction. A thesis statement in your abortion intro paragraph should show that you have a well-supported position and are ready to argue it. Therefore, it has to be strong and convey your idea as clearly as possible. We advise you to make several options for the thesis statement and choose the strongest one.

Hooks for an Abortion Essay

Writing a hook is a good way to catch the attention of your audience, as this is usually the first sentence in an essay. How to start an essay about abortion? You can begin with some shocking fact, question, statistics, or even a quote. However, always make sure that this piece is taken from a trusted resource.

Here are some examples of hooks you can use in your paper:

• As of July 1, 2022, 13 states banned abortion, depriving millions of women of control of their bodies.
• According to WHO, 125,000 abortions take place every day worldwide.
• Is abortion a woman’s right or a crime?
• Since 1994, more than 40 countries have liberalized their abortion laws.
• Around 48% of all abortions are unsafe, and 8% of them lead to women’s death.
• The right to an abortion is one of the reproductive and basic rights of a woman.
• Abortion is as old as the world itself – women have resorted to this method since ancient times.
• Only 60% of women in the world live in countries where pregnancy termination is allowed.

Body Paragraphs: Pros and Cons of Abortion

The body is the biggest part of your paper. Here, you have a chance to make your voice concerning the abortion issue heard. Not sure where to start? Facts about abortion pros and cons should give you a basic understanding of which direction to move in.

First things first, let’s review some brief tips for you on how to write the best essay body if you have already made up your mind.

Make a draft

It’s always a good idea to have a rough draft of your writing. Follow the outline and don’t bother with the word choice, grammar, or sentence structure much at first. You can polish it all later, as the initial draft will not likely be your final. You may see some omissions in your arguments, lack of factual basis, or repetitiveness that can be eliminated in the next versions.

Trust only reliable sources

This part of an essay includes loads of factual information, and you should be very careful with it. Otherwise, your paper may look unprofessional and cost you precious points. Never rely on sources like Wikipedia or tabloids – they lack veracity and preciseness.

Edit rigorously

It’s best to do it the next day after you finish writing so that you can spot even the smallest mistakes. Remember, this is the most important part of your paper, so it has to be flawless. You can also use editing tools like Grammarly.

Determine your weak points

Since you are writing an argumentative essay, your ideas should be backed up by strong facts so that you sound convincing. Sometimes it happens that one argument looks weaker than the other. Your task is to find it and strengthen it with more or better facts.

Add an opposing view

Sometimes, it’s not enough to present only one side of the discussion. Showing one of the common views from the opposing side might actually help you strengthen your main idea. Besides, making an attempt at refuting it with alternative facts can show your teacher or professor that you’ve researched and analyzed all viewpoints, not just the one you stand by.

If you have chosen a side but are struggling to find the arguments for or against it, we have complied abortion pro and cons list for you. You can use both sets if you are writing an abortion summary essay covering all the stances.

Why Should Abortion Be Legal

If you stick to the opinion that abortion is just a medical procedure, which should be a basic health care need for each woman, you will definitely want to write the pros of abortion essay. Here is some important information and a list of pros about abortion for you to use:

• Since the fetus is a set of cells – not an individual, it’s up to a pregnant woman to make a decision concerning her body. Only she can decide whether she wants to keep the pregnancy or have an abortion. The abortion ban is a violation of a woman’s right to have control over her own body.
• The fact that women and girls do not have access to effective contraception and safe abortion services has serious consequences for their own health and the health of their families.
• The criminalization of abortion usually leads to an increase in the number of clandestine abortions. Many years ago, fetuses were disposed of with improvised means, which included knitting needles and half-straightened metal hangers. 13% of women’s deaths are the result of unsafe abortions.
• Many women live in a difficult financial situation and cannot support their children financially. Having access to safe abortion takes this burden off their shoulders. This will also not decrease their quality of life as the birth and childcare would.
• In countries where abortion is prohibited, there is a phenomenon of abortion tourism to other countries where it can be done without obstacles. Giving access to this procedure can make the lives of women much easier.
• Women should not put their lives or health in danger because of the laws that were adopted by other people.
• Girls and women who do not have proper sex education may not understand pregnancy as a concept or determine that they are pregnant early on. Instead of educating them and giving them a choice, an abortion ban forces them to become mothers and expects them to be fit parents despite not knowing much about reproduction.
• There are women who have genetic disorders or severe mental health issues that will affect their children if they're born. Giving them an option to terminate ensures that there won't be a child with a low quality of life and that the woman will not have to suffer through pregnancy, birth, and raising a child with her condition.
• Being pro-choice is about the freedom to make decisions about your body so that women who are for termination can do it safely, and those who are against it can choose not to do it. It is an inclusive option that caters to everyone.
• Women and girls who were raped or abused by their partner, caregiver, or stranger and chose to terminate the pregnancy can now be imprisoned for longer than their abusers. This implies that the system values the life of a fetus with no or primitive brain function over the life of a living woman.
• People who lived in times when artificial termination of pregnancy was scarcely available remember clandestine abortions and how traumatic they were, not only for the physical but also for the mental health of women. Indeed, traditionally, in many countries, large families were a norm. However, the times have changed, and supervised abortion is a safe and accessible procedure these days. A ban on abortion will simply push humanity away from the achievements of the civilized world.

Types of abortion

There are 2 main types of abortions that can be performed at different pregnancy stages and for different reasons:

• Medical abortion. It is performed by taking a specially prescribed pill. It does not require any special manipulations and can even be done at home (however, after a doctor’s visit and under supervision). It is considered very safe and is usually done during the very first weeks of pregnancy.
• Surgical abortion. This is a medical operation that is done with the help of a suction tube. It then removes the fetus and any related material. Anesthesia is used for this procedure, and therefore, it can only be done in a hospital. The maximum time allowed for surgical abortion is determined in each country specifically.

Cases when abortion is needed

Center for Reproductive Rights singles out the following situations when abortion is required:

• When there is a risk to the life or physical/mental health of a pregnant woman.
• When a pregnant woman has social or economic reasons for it.
• Upon the woman's request.
• If a pregnant woman is mentally or cognitively disabled.
• In case of rape and/or incest.
• If there were congenital anomalies detected in the fetus.

Countries and their abortion laws

• Countries where abortion is legalized in any case: Australia, Albania, Bosnia and Herzegovina, Belgium, Canada, Denmark, Sweden, France, Germany, Greece, Italy, Hungary, the Netherlands, Norway, Ukraine, Moldova, Latvia, Lithuania, etc.
• Countries where abortion is completely prohibited: Angola, Venezuela, Egypt, Indonesia, Iraq, Lebanon, Nicaragua, Oman, Paraguay, Palau, Jamaica, Laos, Haiti, Honduras, Andorra, Aruba, El Salvador, Dominican Republic, Sierra Leone, Senegal, etc.
• Countries where abortion is allowed for medical reasons: Afghanistan, Israel, Argentina, Nigeria, Bangladesh, Bolivia, Ghana, Israel, Morocco, Mexico, Bahamas, Central African Republic, Ecuador, Ghana, Algeria, Monaco, Pakistan, Poland, etc. 
• Countries where abortion is allowed for both medical and socioeconomic reasons: England, India, Spain, Luxembourg, Japan, Finland, Taiwan, Zambia, Iceland, Fiji, Cyprus, Barbados, Belize, etc.

Why Abortion Should Be Banned

Essays against abortions are popular in educational institutions since we all know that many people – many minds. So if you don’t want to support this procedure in your essay, here are some facts that may help you to argument why abortion is wrong:

• Abortion at an early age is especially dangerous because a young woman with an unstable hormonal system may no longer be able to have children throughout her life. Termination of pregnancy disrupts the hormonal development of the body.
• Health complications caused by abortion can occur many years after the procedure. Even if a woman feels fine in the short run, the situation may change in the future.
• Abortion clearly has a negative effect on reproductive function. Artificial dilation of the cervix during an abortion leads to weak uterus tonus, which can cause a miscarriage during the next pregnancy.
• Evidence shows that surgical termination of pregnancy significantly increases the risk of breast cancer.
• In December 1996, the session of the Council of Europe on bioethics concluded that a fetus is considered a human being on the 14th day after conception.

You are free to use each of these arguments for essays against abortions. Remember that each claim should not be supported by emotions but by facts, figures, and so on.

Health complications after abortion

One way or another, abortion is extremely stressful for a woman’s body. Apart from that, it can even lead to various health problems in the future. You can also cover them in your cons of an abortion essay:

• Continuation of pregnancy. If the dose of the drug is calculated by the doctor in the wrong way, the pregnancy will progress.
• Uterine bleeding, which requires immediate surgical intervention.
• Severe nausea or even vomiting occurs as a result of a sharp change in the hormonal background.
• Severe stomach pain. Medical abortion causes miscarriage and, as a result, strong contractions of the uterus.
• High blood pressure and allergic reactions to medicines.
• Depression or other mental problems after a difficult procedure.

Abortion Essay Conclusion

After you have finished working on the previous sections of your paper, you will have to end it with a strong conclusion. The last impression is no less important than the first one. Here is how you can make it perfect in your conclusion paragraph on abortion:

• It should be concise. The conclusion cannot be as long as your essay body and should not add anything that cannot be derived from the main section. Reiterate the key ideas, combine some of them, and end the paragraph with something for the readers to think about.
• It cannot repeat already stated information. Restate your thesis statement in completely other words and summarize your main points. Do not repeat anything word for word – rephrase and shorten the information instead.
• It should include a call to action or a cliffhanger. Writing experts believe that a rhetorical question works really great for an argumentative essay. Another good strategy is to leave your readers with some curious ideas to ponder upon.

Abortion Facts for Essay

Abortion is a topic that concerns most modern women. Thousands of books, research papers, and articles on abortion are written across the world. Even though pregnancy termination has become much safer and less stigmatized with time, it still worries millions. What can you cover in your paper so that it can really stand out among others? You may want to add some shocking abortion statistics and facts:

• 40-50 million abortions are done in the world every year (approximately 125,000 per day).
• According to UN statistics, women have 25 million unsafe abortions each year. Most of them (97%) are performed in the countries of Africa, Asia, and Latin America. 14% of them are especially unsafe because they are done by people without any medical knowledge.
• Since 2017, the United States has shown the highest abortion rate in the last 30 years.
• The biggest number of abortion procedures happen in the countries where they are officially banned. The lowest rate is demonstrated in the countries with high income and free access to contraception.
• Women in low-income regions are three times more susceptible to unplanned pregnancies than those in developed countries.
• In Argentina, more than 38,000 women face dreadful health consequences after unsafe abortions.
• The highest teen abortion rates in the world are seen in 3 countries: England, Wales, and Sweden.
• Only 31% of teenagers decide to terminate their pregnancy. However, the rate of early pregnancies is getting lower each year.
• Approximately 13 million children are born to mothers under the age of 20 each year.
• 5% of women of reproductive age live in countries where abortions are prohibited.

We hope that this abortion information was useful for you, and you can use some of these facts for your own argumentative essay. If you find some additional facts, make sure that they are not manipulative and are taken from official medical resources.

Abortion Essay Topics

Do you feel like you are lost in the abundance of information? Don’t know what topic to choose among the thousands available online? Check our short list of the best abortion argumentative essay topics:

• Why should abortion be legalized essay
• Abortion: a murder or a basic human right?
• Why we should all support abortion rights
• Is the abortion ban in the US a good initiative?
• The moral aspect of teen abortions
• Can the abortion ban solve birth control problems?
• Should all countries allow abortion?
• What consequences can abortion have in the long run?
• Is denying abortion sexist?
• Why is abortion a human right?
• Are there any ethical implications of abortion?
• Do you consider abortion a crime?
• Should women face charges for terminating a pregnancy?

Want to come up with your own? Here is how to create good titles for abortion essays:

• Write down the first associations. It can be something that swirls around in your head and comes to the surface when you think about the topic. These won’t necessarily be well-written headlines, but each word or phrase can be the first link in the chain of ideas that leads you to the best option.
• Irony and puns are not always a good idea. Especially when it comes to such difficult topics as abortion. Therefore, in your efforts to be original, remain sensitive to the issue you want to discuss.
• Never make a quote as your headline. First, a wordy quote makes the headline long. Secondly, readers do not understand whose words are given in the headline. Therefore, it may confuse them right from the start. If you have found a great quote, you can use it as your hook, but don’t forget to mention its author.
• Try to briefly summarize what is said in the essay. What is the focus of your paper? If the essence of your argumentative essay can be reduced to one sentence, it can be used as a title, paraphrased, or shortened.
• Write your title after you have finished your text. Before you just start writing, you might not yet have a catchy phrase in mind to use as a title. Don’t let it keep you from working on your essay – it might come along as you write.

Abortion Essay Example

We know that it is always easier to learn from a good example. For this reason, our writing experts have complied a detailed abortion essay outline for you. For your convenience, we have created two options with different opinions.

Topic: Why should abortion be legal?

Introduction – hook + thesis statement + short background information

Essay hook: More than 59% of women in the world do not have access to safe abortions, which leads to dreading health consequences or even death.

Thesis statement: Since banning abortions does not decrease their rates but only makes them unsafe, it is not logical to ban abortions.

Body – each paragraph should be devoted to one argument

Argument 1: Woman’s body – women’s rules. + example: basic human rights.

Argument 2: Banning abortion will only lead to more women’s death. + example: cases of Polish women.

Argument 3: Only women should decide on abortion. + example: many abortion laws are made by male politicians who lack knowledge and first-hand experience in pregnancies.

Conclusion – restated thesis statement + generalized conclusive statements + cliffhanger

Restated thesis: The abortion ban makes pregnancy terminations unsafe without decreasing the number of abortions, making it dangerous for women.

Cliffhanger: After all, who are we to decide a woman’s fate?

Topic: Why should abortion be banned?

Essay hook: Each year, over 40 million new babies are never born because their mothers decide to have an abortion.

Thesis statement: Abortions on request should be banned because we cannot decide for the baby whether it should live or die.

Argument 1: A fetus is considered a person almost as soon as it is conceived. Killing it should be regarded as murder. + example: Abortion bans in countries such as Poland, Egypt, etc.

Argument 2: Interrupting a baby’s life is morally wrong. + example: The Bible, the session of the Council of Europe on bioethics decision in 1996, etc.

Argument 3: Abortion may put the reproductive health of a woman at risk. + example: negative consequences of abortion.

Restated thesis: Women should not be allowed to have abortions without serious reason because a baby’s life is as priceless as their own.

Cliffhanger: Why is killing an adult considered a crime while killing an unborn baby is not?

Examples of Essays on Abortion

There are many great abortion essays examples on the Web. You can easily find an argumentative essay on abortion in pdf and save it as an example. Many students and scholars upload their pieces to specialized websites so that others can read them and continue the discussion in their own texts.

In a free argumentative essay on abortion, you can look at the structure of the paper, choice of the arguments, depth of research, and so on. Reading scientific papers on abortion or essays of famous activists is also a good idea. Here are the works of famous authors discussing abortion.

A Defense of Abortion by Judith Jarvis Thomson

Published in 1971, this essay by an American philosopher considers the moral permissibility of abortion. It is considered the most debated and famous essay on this topic, and it’s definitely worth reading no matter what your stance is.

Abortion and Infanticide by Michael Tooley

It was written in 1972 by an American philosopher known for his work in the field of metaphysics. In this essay, the author considers whether fetuses and infants have the same rights. Even though this work is quite complex, it presents some really interesting ideas on the matter.

Some Biological Insights into Abortion by Garret Hardin

This article by American ecologist Garret Hardin, who had focused on the issue of overpopulation during his scholarly activities, presents some insights into abortion from a scientific point of view. He also touches on non-biological issues, such as moral and economic. This essay will be of great interest to those who support the pro-choice stance.

H4 Hidden in Plain View: An Overview of Abortion in Rural Illinois and Around the Globe by Heather McIlvaine-Newsad 

In this study, McIlvaine-Newsad has researched the phenomenon of abortion since prehistoric times. She also finds an obvious link between the rate of abortions and the specifics of each individual country. Overall, this scientific work published in 2014 is extremely interesting and useful for those who want to base their essay on factual information.

H4 Reproduction, Politics, and John Irving’s The Cider House Rules: Women’s Rights or “Fetal Rights”? by Helena Wahlström

In her article of 2013, Wahlström considers John Irving’s novel The Cider House Rules published in 1985 and is regarded as a revolutionary work for that time, as it acknowledges abortion mostly as a political problem. This article will be a great option for those who want to investigate the roots of the abortion debate.

FAQs On Abortion Argumentative Essay

• Is abortion immoral?

This question is impossible to answer correctly because each person independently determines their own moral framework. One group of people will say that abortion is a woman’s right because only she has power over her body and can make decisions about it. Another group will argue that the embryo is also a person and has the right to birth and life.

In general, the attitude towards abortion is determined based on the political and religious views of each person. Religious people generally believe that abortion is immoral because it is murder, while secular people see it as a normal medical procedure. For example, in the US, the ban on abortion was introduced in red states where the vast majority have conservative views, while blue liberal states do not support this law. Overall, it’s up to a person to decide whether they consider abortion immoral based on their own values and beliefs.

• Is abortion legal?

The answer to this question depends on the country in which you live. There are countries in which pregnancy termination is a common medical procedure and is performed at the woman's request. There are also states in which there must be a serious reason for abortion: medical, social, or economic. Finally, there are nations in which abortion is prohibited and criminalized. For example, in Jamaica, a woman can get life imprisonment for abortion, while in Kenya, a medical worker who volunteers to perform an abortion can be imprisoned for up to 14 years.

• Is abortion safe?

In general, modern medicine has reached such a level that abortion has become a common (albeit difficult from various points of view) medical procedure. There are several types of abortion, as well as many medical devices and means that ensure the maximum safety of the pregnancy termination. Like all other medical procedures, abortion can have various consequences and complications.

Abortions – whether safe or not - exist in all countries of the world. The thing is that more than half of them are dangerous because women have them in unsuitable conditions and without professional help. Only universal access to abortion in all parts of the world can make it absolutely safe. In such a case, it will be performed only after a thorough assessment and under the control of a medical professional who can mitigate the potential risks.

• How safe is abortion?

If we do not talk about the ethical side of the issue related to abortion, it still has some risks. In fact, any medical procedure has them to a greater or lesser extent.

The effectiveness of the safe method in a medical setting is 80-99%. An illegal abortion (for example, the one without special indications after 12 weeks) can lead to a patient’s death, and the person who performed it will be criminally liable in this case.

Doctors do not have universal advice for all pregnant women on whether it is worth making this decision or not. However, many of them still tend to believe that any contraception - even one that may have negative side effects - is better than abortion. That’s why spreading awareness on means of contraception and free access to it is vital.

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Key facts about the abortion debate in America

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

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

• Religion & Abortion

Carrie Blazina is a former digital producer at Pew Research Center .

Cultural Issues and the 2024 Election

Support for legal abortion is widespread in many places, especially in europe, public opinion on abortion, americans overwhelmingly say access to ivf is a good thing, broad public support for legal abortion persists 2 years after dobbs, most popular.

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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

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( 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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[1] Christina San Fillipo is a Law and Society graduate of Ramapo College of New Jersey

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Factors Influencing Abortion Decision-Making Processes among Young Women

Mónica frederico.

1 International Centre for Reproductive Health (ICRH), Ghent University, 9000 Gent, Belgium; [email protected]

2 Centro de Estudos Africanos, Universidade Eduardo Mondlane, C. P. 1993, Maputo, Mozambique; [email protected]

Kristien Michielsen

Carlos arnaldo, peter decat.

3 Department of Family Medicine and primary health care, Ghent University, 9000 Gent, Belgium; [email protected]

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective : The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods : A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results : The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions : Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique.

1. Introduction

Abortion among adolescents and youth is a major public health issue, especially in developing countries. Estimates indicate that 2.2 million unplanned pregnancies and 25% (2.5 million) unsafe abortions occur each year, in sub-Saharan Africa, among adolescents [ 1 ]. In 2008, of the 43.8 million induced abortions, 21.6 million were estimated to be unsafe, and nearly all of them (98%) took place in developing countries, with 41% (8.7 million) being performed on women aged 15 to 24 [ 2 ].

The consequences of abortion, especially unsafe abortion, are well documented and include physical complications (e.g., sepsis, hemorrhage, genital trauma), and even death [ 3 , 4 , 5 , 6 ]. The physical complications are more severe among adolescents than older women and increase the risk of morbidity and mortality [ 6 , 7 ]. However, the detrimental effects of unsafe abortion are not limited to the individual but also affect the entire healthcare system, with the treatment of complications consuming a significant share of resources (e.g., including hospital beds, blood supply, drugs) [ 5 , 8 ].

The decision if and how to terminate a pregnancy is influenced by a variety of factors at different levels [ 9 ]. At the individual level these factors include: their marital status, whether they were the victim of rape or incest [ 10 , 11 ], their economic independence and their education level [ 10 , 12 ]. Interpersonally factors include support from one’s partner and parental support [ 12 ]. Societal determinants include social norms, religion [ 9 , 13 ], the stigma of premarital and extra-marital sex [ 14 ], adolescents’ status, and autonomy within society [ 12 ]. At the organizational level, the existence of sex education [ 10 , 14 ], the health care system, and abortion laws influence the decisions if and where to have an abortion.

Those factors are related to power and (gender) inequalities. They limit young women’s autonomy and make them vulnerable to pressure. Additionally, the situation is exacerbated when there is a lack of clarity and information on abortion status, despite the existence of a progressive law in this regard.

For example, Mozambican law has allowed abortion if the woman’s health is at risk since the 1980s [ 15 , 16 , 17 , 18 ]. In 2014, a new abortion law was established that broadened the scope of the original law: women are now also allowed to terminate their pregnancy: (1) if they requested it and it is performed during the first 12 weeks; (2) in the first 16 weeks if it was the result of rape or incest, or (3) in the first 24 weeks if the mother’s physical or mental health was in danger or in cases of fetus disease or anomaly. Women younger than 16 or psychically incapable of deciding need parental consent [ 19 , 20 ].

Notwithstanding the progressive abortion laws in Mozambique, hospital-based studies report that unsafe abortion remains one of the main causes of maternal death in Mozambique [ 3 ]. However, hospital cases are only a small share of unsafe abortions in the country. Many women undergo an abortion in illegal and unsafe circumstances for a variety of reasons [ 3 ], such as legal restrictions, the fear of stigma [ 21 , 22 , 23 ], and a lack of knowledge of the availability of abortion services [ 3 , 9 , 23 ].

According to the 2011 Mozambican Demographic Health Survey (DHS), at least 4.5% of all adolescents reported having terminated a pregnancy [ 24 ]. Unpublished data from the records of Mozambican Association for Family Development (AMODEFA) which has a clinic that offers sexual and reproductive health services, including safe abortion, indicate that from 2010 to 2016 a total of 70,895 women had an induced abortion in this clinic, of which 43% were aged 15 to 24. Of the 1500 women that had an induced abortion in the AMODEFA clinic in the first three months of 2017, 27.9% were also in this age group [ 25 ]. These data show the high demand for (safe) abortion among young women.

For all this described above, Mozambique is an interesting place to study this decision-making process; given the changing legal framework, women may have to navigate gray areas in terms of legality, safety, and access when seeking abortion, which is stigmatized but necessary for the health, well-being, and social position of many young women.

The objective of this study is to explore the individual, interpersonal and environmental factors behind the abortion decision-making process. This entails both the decision to have an abortion and the decision on how to have the abortion. By examining fourteen stories of young women with an episode of induced abortion, we contribute to the documentation of the circumstances around the abortion decision making, and also to inform the policymakers on complexity of this issue for, which in turn can contribute to improve the strategies designed to reduce the cases of maternal morbidity and mortality in Mozambique.

2. Materials and Methods

This is an exploratory study using in-depth interview to explore factors related to abortion decision-making in a changing context. As research on this topic is limited, we opted for a qualitative research framework that aims to identify factors influencing this decision-making process.

2.1. Location of the Study

The study was conducted in two Mozambican cities, Maputo and Quelimane. These cities were selected because they registered more abortions than other cities in the same region. According to the 2014 data from the Direcção Nacional de Planificação, 629 and 698 women, respectively, were admitted to the hospital due to induced abortion complications in Maputo and Quelimane [ 26 ]. Furthermore, the two differ radically in terms of culture, with Maputo in the South being patrilineal and Quelimane in the Central Region matrilineal, which could influence the abortion decision-making process. The fieldwork took place between July–August 2016 and January–February 2017.

2.2. Data Collection

The data were collected through in-depth interviews, asking participants about their experiences with induced abortion and what motivated them to get an abortion. To approach and recruit participants ( Figure 1 ), we used the information collected during a cross-sectional survey with women in the reproductive age (15–49), These women were selected randomly applying multistage cluster based on household registers. The survey was designed to understand women’s sexual and reproductive health and included filter questions that allowed us to identify participants who had undergone an abortion. The information sheet and informed consent form for this household survey included information about a possible follow-up study.

The process of recruitment of the participants.

Participants who were within the age-range 15–24 years and who reported having had an abortion were contacted by phone. In this contact, the researcher (MF) introduced herself, reminded the participant of the study she took part in, explained the follow-up study and asked whether she was willing to participate in this. If she did, an appointment was made at a convenient location. Before each interview, we explained to each participant why she was invited to the second interview. Participants were also informed of interview procedures, confidentiality and anonymity in the management of the data, and the possibility to withdraw from the interview at any time. In total 14, young women (15–24) agreed to participate: nine in Maputo and five in Quelimane. Six of them were interviewed twice to explore further aspects that remained unclear after the first interview. The interviews were conducted in Portuguese.

To start the interview, the participant was invited to tell her life history from puberty until the moment when the abortion occurred. During the conversation, we used probing questions to elicit more details. Gradually, we added questions related to the abortion and factors that influenced the decision process. The main questions were related to the pregnancy history, abortion decision-making, and help-seeking behaviour. The guideline was adapted from WHO tools [ 27 , 28 ]. Before the implementation of the guideline, it was discussed first with another Mozambican researcher to see how they fell regarding the question. After those questions were revised or removed from the guideline.

2.3. Data Analysis

The analysis consisted of three steps: transcription, reading, and codification with NVivo version 11(QSR International Pty Ltd., Doncaster, Australia). After an initial reading, one of the authors (MF) developed a coding tree on factors determining the decision-making. A structured thematic analysis was used to make inferences and elicit key emerging themes from the text-based data [ 29 , 30 ]. The coding tree was based on the ecological model, which is a comprehensive framework that emphasizes the interaction between, and interdependence of factors within and across all levels of a health problem since it considers that the behaviour affects and is affected by multiple levels of influence [ 31 , 32 ].

Next, the codes and the classification were discussed among the researchers (Mónica Frederico, Kristien Michielsen, Carlos Arnaldo and Peter Decat). Finally, the data was interpreted, and conclusions were drawn [ 33 ].

2.4. Ethical Consideration

Before the implementation of this research, we obtained ethical approval from the Institutional Committee of the Faculty of Medicine and Nacional Bioethical Committee for Health (IRB00002657). We also asked for the institutional approval of the Minister of Health and authorities at the provincial and community levels. The participants gave their informed consent after the objectives and interview procedures had been explained to them. The participants were informed that they might be contacted and invited, within six months, to participate in another interview.

2.5. Concepts

The providers are the people who carried out the abortion procedure. These may be categorized into skilled and unskilled providers: the former refers to a professional (i.e., nurse or doctor) offering abortion services to a client, while the latter is someone without any medical training. Another concept that requires further explanation is the legal procedure. This corresponds to a set of steps to be followed to comply with the law [ 19 , 20 ]. Specifically, this means that a committee should authorize the induced abortion and an identification document should be available, as well as an informed consent form from the pregnant woman. If the woman is a minor, consent is given by her legal guardian. An ultrasound exam is required to determine the gestational age.

3.1. Characteristics of the Participants

The characteristics of the interviewees are summarized in Table 1 . The 14 participants were aged 17 to 24 years. Eight had completed secondary school, four had achieved the second level of primary school, and two were university students. Almost all (13) were Christian. Five participants were studying, eight were unemployed, and one was working. The median age of their first sexual intercourse was 15.5 years. Participants reported living with one or both parents (12), with their uncle (1) or alone (1). They lived in suburban areas of Maputo and Quelimane, which are slums with poor living conditions. In these areas, most households earn their income through small businesses that also involve child labour (e.g., selling food or drinks).

Socio-demographic characteristics and abortion procedure.

Among the participants, five reported more than one pregnancy. One interviewee first had a stillbirth and then two abortions. Another woman gave birth to a girl and afterward terminated two pregnancies. Two interviewees reported two pregnancies, the first of which was brought to full term and the second one terminated. One woman first had an abortion and afterward gave birth to a child. In short, 14 interviewees in total reported on the experiences and decision-making of 16 abortions. One participant stated that the pregnancy was the consequence of rape. Of the 16 reported abortions, seven were performed after the new law came into force at the end of 2014, and nine were carried out before this time.

3.2. Abortions Stories

In this study, 12 abortions were done by skilled providers and two by unskilled providers. The unskilled providers were a mother and a husband, respectively. None of the cases, whose abortion was done by a skilled provider, included in this study followed the legal procedure.

In the analysis of the interviews, we studied the personal, interpersonal and environmental factors that influenced six different types of abortion stories, see Table 2 : (1) an abortion was performed because the pregnancy was unwanted; (2) an abortion was carried out although the pregnancy was wanted; (3) the abortion was done by an unskilled provider at home; (4) an abortion was carried out by a skilled provider outside the hospital; (5) a particular abortion procedure (medical or chirurgical) was chosen, and (6) the legal procedure was not followed in the hospital. Factors influencing the choice for a particular technical procedure were also examined.

Summary of induced abortion stories. (We changed the table format, please confirm.)

* The result of rape; ** Seven participants; *** six participants.

3.3. Abortion Following an Unwanted Pregnancy

In the stories about unwanted pregnancies, mostly personal factors were mentioned as reasons, with some interviewees stating that they felt unable to be a mother at the time of the pregnancy: “ (It) was at the time that I was taking pills that I got pregnant, and I induced abortion because I was not prepared (for motherhood). ” (24 years)

Some had had a bad experience in the past: “ Maybe I would be abandoned and it would be the same. (Sigh)... I learned with my first pregnancy. ” (23 years)

Also, the existence of another child was mentioned as a reason to have an abortion: “ I got pregnant when I was 20, and I had a baby. When I became pregnant again, my daughter was a child, and I could not have another child. ” (23 years)

For other participants, studies were the main reason why the pregnancy was not wanted: “ He was informed about it, and he said that I should keep it. However, as I wanted to continue my studies, I told him no, no (I) do not. ” (17 years)

At the interpersonal level, a lack of support from the partner was often mentioned as a reason for not wanting the baby: “ He said that he recognizes the paternity, but it is not to keep that pregnancy. ” (22 years)

Women frequently mentioned environmental circumstances related to their poor socio-economic situation: “ I am staying at Mom's house; it is not okay to still be having babies there.” (23 years)

“ At home, we do not have any resources to take care of this child! ” (20 years)

3.4. Abortion Following a Wanted Pregnancy

In these cases, the decision to abort the pregnancy was not made by the woman herself but imposed by others or by the circumstances.

Some participants reported that their parents/family had decided what had to be done: “ They decided while I was at school. If (it) was my decision I would keep it because I wanted it. ” (18 years).

Other young women indicated the refusal of paternity as a reason to terminate the pregnancy.

“ Because my son’s father did not accept the (second) pregnancy. There was a time, we argued with each other, and we terminated the relationship. Later, we started dating again, and I got pregnant. He said it was not possible. ” (21 years)

“ (he) impregnated me and after that, he dumped me, (smiles)… I went to him, and I said that I was pregnant. He said eee: I do not know, that is not my child. ” (20 years).

Some women told the interviewers that they were convinced by their boyfriend to have an abortion: “ I talked to him, and he said okay we are going to have an abortion and I accepted. ” (22 years)

Others mentioned their partner’s indecision and changing attitude as a reason to get an abortion, even though they did want the baby:

“ I told him I was pregnant. First, he said to keep it. (Next) He was different. Sometimes he was calling me, and other times not. I understood that he did not want me. ” (20 years)

The fear of being excluded from their family due to their pregnancy was another reason reported by participants: “ So I went to talk with my older sister, and she said eee, you must abort because daddy will kick you out of our home. ” (20 years)

“ As I am an orphan, and I live with my uncle, they were going to kick me out. No one would assist me. ” (20 years)

3.5. Location of the Abortion: Home-Based Versus Hospital-Based

Two young women reported having had the abortion at home by an unskilled provider. It seems that these unskilled providers than the women (i.e. family members, partner) made the decisions.

“ It was mammy and my sister (who provided the induced abortion services). My sister knows these things. ” (18 years)

“ He (the father of the child) came to my house and took me back to his house. It was that moment when I aborted. ” (21 years)

Of the 16 abortions, seven were performed through health services, by a skilled provider. For some of them, the choice for a health service was influenced by the fact of knowing someone at the health facility.

“ I went to talk to her (friend), and she said that “I have an aunt who works at the hospital, she can help you. Just take money”. ” (20 years)

“ I Already knew who could induce it (abortion). No, I knew that person. I went to the hospital, and I talked to her, (and) she helped me. ” (22 years)

Other participants went to the health facility, but due to the lack of money to pay for an abortion at the facilities they sought help out of the health facility: “ They charged us money that we did not have. The ladies did not want to negotiate anything. I think they wanted 1200 mt (17.1 euros) if I am not wrong. He had a job, but he (boyfriend) did not have that amount of money. ” (22 years)

Some participants reported that they had an abortion outside regular facilities because the health provider recommended going to his house: “ She (mother) was the one who accompanied me. She is the one who knows the doctor. We went to the central hospital, but he (the doctor) was very busy, and he told us to go to his house. ” (17 years)

Others reported the fear of signing a document as a reason to seek help outside of official channels: “ I heard that to induce abortion at the hospital it is necessary for an adult to sign a consent form. I was afraid because I did not know who could accompany me. Because at that time I only wanted to hide it from others. ” (22 years).

3.6. Abortion Procedure

The women were not able to explain why a particular abortion procedure (i.e., pills or aspiration, curettage) was used. It appears that they were not given the opportunity to choose and that they submitted themselves to the procedure proposed by the provider.

“ The abortion was done here at home. They just went to the pharmacy, bought pills and gave them to me. ” (18 years)

3.7. Legal Procedure

None of those treated at the hospital stated that legal procedures were followed. They also mentioned that they had to pay without receiving any official receipt.

“ First we got there and talked to a servant (a helper of the hospital). The servant asked for money for a refreshment so he could talk to a doctor. After we spoke (with servant), he went to the doctor, and the doctor came, and we arranged everything with him. ” (22 years)

“ We went to the health center, and we talked to those doctors or nurses I mean, they said that they could provide that service. It was 1200 mt (17.1 euros), and they were going to deal with everything. They did not give us the chance to sign a document and follow those procedures. ” (20 years)

4. Discussion

The objective of this study was to describe abortion procedures and to explore factors influencing the abortion decision-making process among young women in Maputo and Quelimane.

The study pointed out determinants at the personal, interpersonal and environmental level. Analysing the results, we were confronted with four recurring factors that negatively impacted on the decision-making process: (1) women’s lack of autonomy to make their own decisions regarding the termination of the pregnancy, (2) their general lack of knowledge, (3) the poor availability of local abortion services, and (4) the overpowering influence of providers on the decisions made.

The first factor involves women’s lack of autonomy. In our study, most women indicate that decisions regarding the termination of a pregnancy are mostly taken by others, sometimes against their will. Parents, family members, partners, and providers decide what should happen. As shown in the literature, this lack of autonomy in abortion decision-making is linked to power and gender inequality [ 34 , 35 , 36 , 37 , 38 ]. On the one hand, power reflects the degree to which individuals or groups can impose their will on others, with or without the consent of those others [ 34 , 37 , 38 ]. In this case, the power of the parent/family is observed when they, directly or indirectly, influence their daughters to induce an abortion, for instance by threatening to kick them out of their home. On the other hand, gender inequality is also a factor. This refers to the power imbalance between men and women and is reflected by cases in which the partner makes the decision to terminate the pregnancy [ 38 ]. Besides this, the contextual environment of male chauvinism in Mozambique also makes it more socially acceptable for men to reject responsibility for a pregnancy [ 34 , 35 , 37 , 39 , 40 ]. Finally, women’s economic dependence makes them more vulnerable, dependent and subordinated. For economic reasons, women, have no other choice but to obey and follow the family or partner’s decisions. Closely linked with women’s lack of autonomy is their lack of knowledge. Interviewees report that they do not know where abortion services are provided. They are not acquainted with the legal procedures and do not know their sexual rights. This lack of knowledge among women contributes to the high prevalence of pregnancy termination outside of health facilities and not in accordance with legal procedures.

Our participants often report that abortion services are absent at a local level, as has also been pointed out by Ngwena [ 41 ]. This is a particular problem in Mozambique. Not all tertiary or quaternary health facilities are authorized to perform abortions. The fact that only some tertiary and quaternary facilities are allowed to do so creates a shortage of abortion centres to cover the demand. In fact, only people with a certain level of education and a sufficiently large social network have access to legal and proper abortion procedures.

Finally, our study shows that providers mostly decide on the location, the methods used and the legality of abortion procedures. Patients are highly dependent on the health providers’ commitment, professionality and accuracy and the selected procedures are not mutually decided by the provider and the patient. Providers often do not refer the client to the reference health facility or do not inform them of the legal procedures, creating a gap between law and practice that stimulates illegal and unsafe procedures. The reasons for this are unclear. It might be due to a lack of knowledge among health providers too, and, perhaps, provider saw here an opportunity to supplement the low salary [ 42 ]. Participants who seek help at the health facility they do so contacting the provider in particular, as indication given by someone.

This corroborates with studies conducted by Ngwena [ 41 , 43 ], Doran et al. [ 44 ], Pickles [ 45 ], Mantshi [ 46 ], and Ngwena [ 47 ], which pointed out the obstacles related to the availability of services and providers’ attitudes towards safe abortion, although the law grants the population this right [ 41 , 43 , 44 , 45 , 46 , 47 ]. As Ngwena [ 41 , 43 ] argues, the liberalization of abortion laws is not always put into practice and abortion rights merely exist on paper. Braam’ study [ 48 ] therefore highlights the necessity of clarifying and informing women and providers of the current legislation and ensuring that abortion services are available in all circumstances described in the law.

Finally, despite cultural differences between Maputo and Quelimane, the result did not suggest differences between two areas studied regarding factors influencing the decision to terminate and how the abortion is done. However, the Figure 1 suggests that there was trend to have more participants from Maputo reporting abortion episode in her life than Quelimane. This difference maybe be because Maputo is much more multicultural and the people of this city have more access to information that gives them the opportunity to learn about matter of reproductive health including abortion, than Quelimane. So, due to this there is trend decrease the taboo relation to abortion in Maputo than in Quelimane.

These abortion stories illustrate the lack of autonomy in decision-making process given the power and gender inequalities between adults and young women, and also between man and women . They also show the lack of knowledge not only on the availability of abortion services at some health facilities, as well as, on the new law on abortion. All these lacks that women have are reinforced by poor availability of abortion services and the fact that the providers we not taking their role to help those women, as it is exposed in the next sections.

This study interviewed young women who had an induced abortion at some point in their lives (15 years up to their age at interview date). As such, it does not provide any information on the factors behind the decisions of those who did not terminate their pregnancy.

The results presented in this paper only reflect the perceptions of the young women who had an induced abortion, not those of their parents or partners. The paper is based on qualitative data that provides insights into factors influencing abortion decision-making. Since the sample included in the study is not representative for the population of young women in Mozambique, the results cannot be generalized.

5. Conclusions

Based on the results of the study, we recommend the following measures to improve the abortion decision-making process among young women:

First, strategies should be implemented to increase women's autonomy in decision-making: The study highlighted that gender and power inequalities obstructed young women to make their decision with autonomy. We reiterate the Chandra-Mouli and colleges [ 49 ] message. There is a need to address gender and power inequalities. Addressing gender inequality, and promotion of more equitable power relations leads to improved health outcomes. The interventions to promote gender-equitable and power relationships, as well as human rights, need to be central to all future programming and policies [ 49 ].

Second, patients and the whole population should be better informed about national abortion laws, the recommended and legal procedures and the location of abortion services, since, despite the decision to terminate pregnancy resulted to the imposition, if they were well informed on that, maybe they could be decide on safe and legal abortion, avoiding double autonomy deprivation. At the same time, providers must be informed about the status of national abortion laws. Additionally, they should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.

Third, the number of health facilities providing abortions services should be increased, particularly in remote areas.

Finally, health providers should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.

The abortion decision-making by young women is an important topic because it refers the decision made during the transitional period from childhood to adulthood. The decision may have life-long consequences, compromising the individual health, career, psychological well-being, and social acceptance. This paper, on abortion decision-making, calls attention to some attitudes that lead to the illegality of abortion despite it was done at a health facility.

Acknowledgments

Authors gratefully acknowledge the support, contribution, and comments from all those who collaborated direct or indirectly, especially Olivier Degomme, Eunice Remane Jethá, Emilia Gonçalves, Cátia Taibo, Beatriz Chongo, Hélio Maúngue and Rehana Capruchand.

Author Contributions

All authors contributed significantly to the manuscript. Mónica Frederico collected data and developed the first analysis. The themes were intensively discussed with Kristien Michielsen, Carlos Arnaldo and Peter Decat. The subsequent versions of the article were written with the active participation of all authors.

Conflicts of Interest

The authors declare no conflicts of interest.

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

Chapter: 5 conclusions, 5 conclusions.

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

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

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

___________________

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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