extended definition essay on abortion

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abortion , the expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation). An abortion may occur spontaneously, in which case it is also called a miscarriage , or it may be brought on purposefully, in which case it is often called an induced abortion.

Spontaneous abortions, or miscarriages, occur for many reasons, including disease, trauma, genetic defect, or biochemical incompatibility of mother and fetus. Occasionally a fetus dies in the uterus but fails to be expelled, a condition termed a missed abortion.

Induced abortions may be performed for reasons that fall into four general categories: to preserve the life or physical or mental well-being of the mother; to prevent the completion of a pregnancy that has resulted from rape or incest; to prevent the birth of a child with serious deformity, mental deficiency , or genetic abnormality; or to prevent a birth for social or economic reasons (such as the extreme youth of the pregnant female or the sorely strained resources of the family unit). By some definitions, abortions that are performed to preserve the well-being of the female or in cases of rape or incest are therapeutic, or justifiable, abortions.

Numerous medical techniques exist for performing abortions. During the first trimester (up to about 12 weeks after conception), endometrial aspiration , suction, or curettage may be used to remove the contents of the uterus. In endometrial aspiration, a thin flexible tube is inserted up the cervical canal (the neck of the womb) and then sucks out the lining of the uterus (the endometrium) by means of an electric pump.

In the related but slightly more onerous procedure known as dilatation and evacuation (also called suction curettage or vacuum curettage), the cervical canal is enlarged by the insertion of a series of metal dilators while the patient is under anesthesia , after which a rigid suction tube is inserted into the uterus to evacuate its contents. When, in place of suction, a thin metal tool called a curette is used to scrape (rather than vacuum out) the contents of the uterus, the procedure is called dilatation and curettage. When combined with dilatation, both evacuation and curettage can be used up to about the 16th week of pregnancy.

From 12 to 19 weeks the injection of a saline solution may be used to trigger uterine contractions; alternatively, the administration of prostaglandins by injection, suppository, or other method may be used to induce contractions, but these substances may cause severe side effects. Hysterotomy, the surgical removal of the uterine contents, may be used during the second trimester or later. In general, the more advanced the pregnancy, the greater the risk to the female of mortality or serious complications following an abortion.

In the late 20th century a new method of induced abortion was discovered that uses the drug RU-486 (mifepristone), an artificial steroid that is closely related to the contraceptive hormone norethnidrone. RU-486 works by blocking the action of the hormone progesterone, which is needed to support the development of a fertilized egg. When ingested within weeks of conception , RU-486 effectively triggers the menstrual cycle and flushes the fertilized egg out of the uterus. RU-486 is typically used in combination with another drug, misoprostol, which softens the cervix and induces uterine contractions. By 2020 the two-drug combination, commonly referred to as a “medication abortion” or the “abortion pill,” accounted for more than half of all abortions in the United States .

Whether and to what extent induced abortions should be permitted, encouraged, or severely repressed is a social issue that has divided theologians, philosophers, and legislators for centuries. Abortion was apparently a common and socially accepted method of family limitation in the Greco-Roman world. Although Christian theologians early and vehemently condemned abortion, the application of severe criminal sanctions to deter its practice became common only in the 19th century. In the 20th century such sanctions were modified in one way or another in various countries, beginning with the Soviet Union in 1920, with Scandinavian countries in the 1930s, and with Japan and several eastern European countries in the 1950s. In some countries the unavailability of birth control devices was a factor in the acceptance of abortion. In the late 20th century China used abortion on a large scale as part of its population control policy. In the early 21st century some jurisdictions with large Roman Catholic populations, such as Portugal and Mexico City , decriminalized abortion despite strong opposition from the church, while others, such as Nicaragua, increased restrictions on it.

A broad social movement for the relaxation or elimination of restrictions on abortion resulted in the passing of liberalized legislation in several states in the United States during the 1960s. The U.S. Supreme Court ruled in Roe v. Wade (1973) that unduly restrictive state regulation of abortion was unconstitutional, in effect legalizing abortion for any reason for women in the first three months of pregnancy. A countermovement for the restoration of strict control over the circumstances under which abortions might be permitted soon sprang up, and the issue became entangled in social and political conflict. In rulings in 1989 ( Webster v. Reproductive Health Services ) and 1992 ( Planned Parenthood v. Casey ), a more conservative Supreme Court upheld the legality of new state restrictions on abortion, though it proved unwilling to overturn Roe v. Wade itself. In 2007 the Court also upheld a federal ban on a rarely used abortion method known as intact dilation and evacuation. In a later ruling, Dobbs v. Jackson Women’s Health Organization (2022), the Court overturned both Roe and Casey , holding that there is no constitutional right to abortion. Following the Court’s decision in Dobbs , several states adopted new (or reinstated old) abortion restrictions or banned the procedure altogether.

In April 2023 a federal district court judge in Texas issued an order effectively invalidating the federal Food and Drug Administration ’s (FDA) approval of RU-486 in 2000. An approximately simultaneous order by a federal district court judge in Washington state prohibited the FDA from further limiting access to RU-486 in 17 states and the District of Columbia . Shortly after the two rulings, the U.S. Court of Appeals for the Fifth Circuit temporarily blocked the Texas judge’s finding that RU-486 had been improperly approved but declined to reverse his separate stays of measures that the FDA had taken since 2016 to make RU-486 accessible to more patients, including extending the period during which the drug could be used from 7 to 10 weeks of pregnancy and permitting the drug to be mailed to patients rather than administered at an in-person visit with a doctor. The administration of Pres. Joe Biden then submitted an emergency appeal to the Supreme Court, asking that it temporarily uphold the FDA’s approval of RU-486 and its measures since 2016 to make the drug more accessible. One week later the Supreme Court granted the administration’s request. In December 2023, following the Fifth Circuit’s decision in August upholding the district court’s invalidation of the FDA’s accessibility measures since 2016, the Supreme Court agreed to review the case, Food and Drug Administration v. Alliance for Hippocratic Medicine , the first major abortion-related case on its docket since Dobbs v. Jackson Women’s Health Organization . On June 13, 2024, the Court unanimously reversed and remanded the Fifth’s Circuit’s decision, holding that the original plaintiffs in the case—a group of pro-life medical associations and several individual doctors—lacked standing to sue .

The public debate of the abortion issue has demonstrated the enormous difficulties experienced by political institutions in grappling with the complex and ambiguous ethical problems raised by the question of abortion. Opponents of abortion, or of abortion for any reason other than to save the life of the mother, argue that there is no rational basis for distinguishing the fetus from a newborn infant; each is totally dependent and potentially a member of society, and each possesses a degree of humanity. Proponents of liberalized regulation of abortion hold that only a woman herself, rather than the state, has the right to manage her pregnancy and that the alternative to legal, medically supervised abortion is illegal and demonstrably dangerous, if not deadly, abortion.

The Constitutional Right to Reproductive Autonomy: Realizing the Promise of the 14th Amendment

Introduction

For the first time in history, the U.S. Supreme Court has taken away a right that it had recognized as fundamental to personal liberty: the right to abortion. The Supreme Court, in its ruling in Dobbs v. Jackson Women’s Health Organization , overruled Roe v. Wade and nearly 50 years of constitutional precedent and held that there is no constitutional right to abortion.

Contrary to the majority’s opinion — and as the dissent powerfully explains — the right to reproductive autonomy is deeply grounded in the U.S. Constitution and is about much more than Roe and the right to abortion. In recognizing the constitutional importance of decisions about childbearing, the Supreme Court’s holding in Roe was correct — and like watershed decisions before and after it, Roe grounded reproductive rights in federal constitutional rights of privacy and liberty .

The Supreme Court’s decimation of precedent requires a rebuilding of jurisprudence to align with the promise of the 14th Amendment. While the Amendment’s guarantee against state deprivation of liberty — including a right to privacy and to control one’s body — must remain a core pillar of reproductive autonomy, it should not be the only pillar. Multiple legal rights establish that government restrictions on reproductive autonomy constitute sex, race, and economic discrimination, and that such restrictions can deny people their lives, as well as their ability to live their lives with dignity. 

Despite the Supreme Court’s radical and harmful ruling in Dobbs, courts must remain rights-protecting institutions in our democracy—and we must insist that they fulfill their role in ensuring equal justice for all.

A new report from the Center for Reproductive Rights, “The Constitutional Right to Reproductive Autonomy: Realizing the Promise of the 14 th Amendment,” delves into constitutional rights and guarantees in U.S. law that undergird the right to reproductive autonomy—and how those principles, along with related jurisprudence, can strengthen reproductive rights going forward.  

It draws on instructive international and comparative law, scholarship by leading experts in constitutional and human rights law, the transformative work of reproductive justice advocates, and the Center’s expertise as the only global legal organization dedicated to protecting and advancing reproductive rights as human rights.

> Read the full report here.

The report illuminates:

How reproductive oppression is used as a tool to control women, people of color, and people living on low incomes and to perpetuate stereotypes and women’s second-class status.

Why reproductive autonomy matters to health, life, and economic and family wellbeing.

Jurisprudence protecting reproductive autonomy that can inform future rulings.

The ways in which international human rights law protects reproductive autonomy.

Constitutional rights to liberty, equal protection, and life and how these principles can strengthen protections for reproductive autonomy going forward.

Highlights of the report follow. To explore these topics and others in-depth, read the full report:

• “The Constitutional Right to Reproductive Autonomy: Realizing the Promise of the 14 th Amendment”

“No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.” United States Constitution, 14 th Amendment, Section 1

I. Reproductive Autonomy and Why it Matters

Reproductive autonomy—the power to make and act on decisions about reproduction—is central to how people shape their lives. To enable people to fulfill their reproductive autonomy rights, governments must respect and protect those rights. In the U.S., however, the history of reproductive oppression and modern-day realities confirm the devastating and lasting harms when the government fails to protect the right to reproductive autonomy.

The Historical Context of Reproductive Control

For centuries, the nation’s laws enforced the second-class status of women. Laws and policies perpetuated stereotypes about women’s proper role in society and enforced their second-class status in myriad ways, from limiting women’s ability to own property, vote, pursue an education, work, and participate fully in civic life. 

At the same time, laws authorized coercive and brutal means to control the childbearing of women viewed by lawmakers as “unfit”—in particular, Black, Native American, immigrant, and disabled women. Among these policies were the forced childbirth of Black women who were enslaved, forced removal of children from Native American households, racially restrictive immigration policies, forced sterilization, and the denial of public benefits to unmarried women.

Read more about the historical context of reproductive control on page 4 of the report .

Reproductive Autonomy Is Critical to Health, Life, and Economic and Family Wellbeing

Bringing a child into the world, raising and nurturing children, and building families and communities are among the most joyful and meaningful life experiences. At the same time, pregnancy and childbirth carry significant health risks, including death. Thus, pregnancy and childbirth should be safe, healthy, and supported experiences. But today in the U.S., maternal mortality is rising, with disproportionate impacts on Black, Indigenous, and other people of color.

For people who decide to end a pregnancy, abortion is extremely safe, but criminalizing it—as states are doing in the aftermath of Dobbs —will exacerbate this maternal mortality crisis. It will also endanger the economic and social wellbeing of women and their families.

The legalization of abortion after Roe v. Wade had measurable and significant positive impacts on women’s socioeconomic standing and on gender equality overall, enabling generations of women to plan and control if and when to start a family, participate more fully in society, and attain higher levels of education, employment, and economic security. 

Read more about the importance of reproductive autonomy on page 7 of the report.

II. Constitutional and Human Rights Bases of the Right to Reproductive Autonomy

Because of the deep and lasting impacts of pregnancy and childbirth on an individual’s life, the right to reproductive autonomy is grounded in the life, liberty, and equal protection clauses of the 14th Amendment. The right is also grounded in international human rights, which promote and protect the dignity and equality of all people.

Courts must be clear that people do not lose their legal rights when they become pregnant or may become pregnant– but have an equal claim to all recognized rights—and must be able to make decisions related to pregnancy and childbearing without government coercion.

The Right to Liberty: Personal Decision Making and Bodily Autonomy

The Supreme Court was correct decades ago when it concluded that the 14th Amendment’s Liberty Clause protects individual decisions about whether and when to have a child. Indeed, for more than 100 years, the Supreme Court has interpreted the Constitution’s textual protection for liberty to include the right to make personal decisions related to family, marriage, and childrearing, as well as the right to control one’s body. Many state courts, interpreting their similar state constitutions, have done the same. 

International human rights treaty bodies have likewise made clear that governments must protect, respect, and fulfill the right to make personal decisions, including regarding reproductive capacity.

The Supreme Court’s decision in Dobbs to excise the right to abortion as a component of personal liberty was wrong and undermines decades of jurisprudence about the meaning of liberty, including cases recognizing rights to contraception, sexual intimacy between consenting adults, and to marry the person of one’s choice.

Read more about the 14th Amendment’s right to liberty on page 16 of the report .  

The Right to Equal Protection and Freedom from Discrimination

Government control of reproductive capacity has long persisted as a tool to subordinate women, people of color, people living on lower incomes and other disfavored groups. The Supreme Court has acknowledged aspects of this history, and a body of judicial opinions and scholarship confirms that a correct understanding of the right to equal protection prohibits the government from regulating people who are pregnant or who have the capacity to become pregnant in these discriminatory ways. International human rights law reinforces robust protections for the right to equality and non-discrimination.

• Sex Stereotyping and Gender Discrimination— Under current federal constitutional standards, laws that discriminate on the basis of sex are subject to heightened scrutiny. Such laws are unconstitutional if they are based on stereotypes about men, women, and traditional gender roles, or if they otherwise perpetuate the second-class status of women. Because government control of decisions related to reproduction and pregnancy perpetuates the legal, social, and economic inferiority of women, these laws are a form of sex discrimination subject to heightened scrutiny.
• Race Discrimination— The constitutional guarantee of equal protection also requires redressing reproductive oppression targeting Black women and other people of color and the ongoing impact of systemic racism on reproductive health and rights. Building on and moving beyond existing case law under the Equal Protection Clause, courts can and should address both the discriminatory intent and impact of laws and policies denying Black women and other people of color the equal right to reproductive autonomy.
• Economic Inequality— Seminal Supreme Court decisions recognize that courts can hold governments accountable for remedying the laws, systems, and institutions that discriminate against people living on lower incomes or in poverty, especially when liberty and family relationships are at stake. Under equal protection analysis, courts should apply heightened scrutiny to all policies that deprive people struggling to make ends meet of decisional autonomy, dignity, and non-discriminatory health care during pregnancy, childbirth, and postpartum.
• Intersecting Forms of Discrimination and Interdependent Rights— Courts also should apply heightened scrutiny to intersectional claims under the 14th Amendment.  First, courts can apply legal frameworks that recognize and address the  multiple and intersecting forms of discrimination marginalized groups experience. Second, when the state discriminates against traditionally subordinated groups seeking to make deeply personal and intimate decisions, courts can build on Supreme Court precedent recognizing that the protections of the Liberty and Equal Protection Clauses are mutually reinforcing. In these ways, an intersectional analysis drawing on reproductive justice and human rights frameworks can provide a stronger legal framework for securing the equal right to reproductive autonomy for all.

Read more about the 14 th Amendment’s right to equal protection and freedom from discrimination on page 20 of the report.

The Right to Life of the Pregnant Person

International human rights law recognizes that the right to life provides critical protections for reproductive autonomy. While underdeveloped in U.S. jurisprudence, a growing body of scholarship looks at the ways government interference with personal decisions about pregnancy and medical care threatens a person’s constitutional right to life.

Thus, challenges to state policies or official actions that threaten the health, safety, and lives of individuals who are pregnant, giving birth, and postpartum as violations of the right to life are ripe for development. An important guide in doing so is the strong recognition under human rights law of the right to life as a critical protection for reproductive autonomy. 

Read more about the 14 th Amendment’s right to life on page 41 of the Report.

The U.S. Constitution requires the government to respect—and courts to protect—the human right to reproductive autonomy. The 14th Amendment ensures this through its multiple and interdependent guarantees of life, liberty, and equal protection—as does international human rights law. Each of these foundational sources supports a broad right to reproductive autonomy that advocates, scholars, and jurists must not only defend against further retrogression, but also strengthen for future generations.

Read the complete report here:

• “ The Constitutional Right to Reproductive Autonomy: Realizing the Promise of the 14 th Amendment ”

U.S. Supreme Court Takes Away the Constitutional Right to Abortion

On June 24, 2022, U.S. Supreme Court abandoned its duty to protect fundamental rights and overturned  Roe v. Wade , ruling there is no constitutional right to abortion. The decision marks the first time in history that the Supreme Court has taken away a fundamental right.  Read more here.

State Constitutions and Abortion Rights: Building Protections for Reproductive Autonomy

Learn how state supreme court cases have resulted in broader protections for abortion rights and access and influenced outcomes in other cases and courts—and how this jurisprudence can expand and shape further efforts to secure reproductive rights. Read more here.

Legal Analysis: What Dobbs Got Wrong

This briefing paper by the Center for Reproductive Rights analyzes the majority, concurring, and dissenting opinions in Dobbs . Read more here.

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Introduction: The Politics of Abortion 50 Years after Roe

Katrina Kimport is a professor with the Department of Obstetrics, Gynecology, and Reproductive Sciences and a medical sociologist with the ANSIRH program at the University of California, San Francisco. Her research examines the (re)production of inequality in health and reproduction, with a topical focus on abortion, contraception, and pregnancy. She is the author of No Real Choice: How Culture and Politics Matter for Reproductive Autonomy (2022) and Queering Marriage: Challenging Family Formation in the United States (2014) and co-author, with Jennifer Earl, of Digitally Enabled Social Change (2011). She has published more than 75 articles in sociology, health research, and interdisciplinary journals.

[email protected]

Rebecca Kreitzer is an associate professor of public policy at the University of North Carolina at Chapel Hill. Her research focuses on gendered political representation and intersectional policy inequality in the US states. Much of her research focuses on the political dynamics of reproductive health care, especially surrounding contraception and abortion. She has published dozens of articles in political science, public policy, and law journals.

[email protected]

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Katrina Kimport , Rebecca Kreitzer; Introduction: The Politics of Abortion 50 Years after Roe . J Health Polit Policy Law 1 August 2023; 48 (4): 463–484. doi: https://doi.org/10.1215/03616878-10451382

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Abortion is central to the American political landscape and a common pregnancy outcome, yet research on abortion has been siloed and marginalized in the social sciences. In an empirical analysis, the authors found only 22 articles published in this century in the top economics, political science, and sociology journals. This special issue aims to bring abortion research into a more generalist space, challenging what the authors term “the abortion research paradox,” wherein abortion research is largely absent from prominent disciplinary social science journals but flourishes in interdisciplinary and specialized journals. After discussing the misconceptions that likely contribute to abortion research siloization and the implications of this siloization for abortion research as well as social science knowledge more generally, the authors introduce the articles in this special issue. Then, in a call for continued and expanded research on abortion, the introduction to this special issue closes by offering three guiding practices for abortion scholars—both those new to the topic and those deeply familiar with it—in the hopes of building an ever-richer body of literature on abortion politics, policy, and law. The need for such a robust literature is especially acute following the US Supreme Court's June 2022 overturning of the constitutional right to abortion.

Abortion has been both siloed and marginalized in social science research. But because abortion is a perennially politically and socially contested issue as well as vital health care that one in four women in the United States will experience in their lifetime (Jones and Jerman 2022 ), it is imperative that social scientists make a change. This special issue brings together insightful voices from across disciplines to do just that—and does so at a particularly important historical moment. Fifty years after the United States Supreme Court's Roe v. Wade (1973) decision set a national standard amid disparate state policies on abortion, we again find ourselves in a country with a patchwork of laws about abortion. In Dobbs v. Jackson Women's Health Organization (2022), the Supreme Court overturned the constitutional right to abortion it had established in Roe , purportedly returning the question of legalization of abortion to the states. In the immediate aftermath of the Dobbs decision, state policies polarized, and public opinion shifted. This moment demands scholarly evaluation of where we have been, how we arrived at this moment, and what we should be attentive to in coming years. This special issue came about, in part, in response to the on-the-ground conditions of abortion in the United States.

As we argue below, the siloization of abortion research means that the social science literature broadly is not (yet) equipped to make sense of this moment, our history, and what the future holds. First, though, we make a case for the importance of political scientists, economists, and sociologists studying abortion. Then we describe the siloization of abortion research through what we call the “abortion research paradox,” wherein abortion research—despite its social and political import—is curiously absent from top disciplinary journals, even as it thrives in other publication venues that are often interdisciplinary and usually specialized. We theorize some reasons for this siloization and discuss the consequences, both for generalist knowledge and for scientific understanding of abortion. We then introduce the articles in this special issue, noting the breadth of methodological, topical, and theoretical approaches to abortion research they demonstrate. Finally, we offer three suggestions for scholars—both those new to abortion research and those already deeply familiar with it—embarking on abortion research in the hopes of building an ever-richer body of literature on abortion politics, policy, and law.

• Why Abortion?

Abortion has arguably shaped the American political landscape more than any other domestic policy issue in the last 50 years. Since the Supreme Court initially established a nationwide right to abortion in Roe v. Wade (1973), debate over this right has influenced elections at just about every level of office (Abramowitz 1995 ; Cook, Hartwig, and Wilcox 1993 ; Cook, Jelen, and Wilcox 1994 ; Cook, Jelen, and Wilcox 1992 ; Paolino 1995 ; Roh and Haider-Markel 2003 ), inspired political activism (Carmines and Woods 2002 ; Killian and Wilcox 2008 ; Maxwell 2002 ; Verba, Schlozman, and Brady 1995 ) and social movements (Kretschmer 2014 ; Meyer and Staggenborg 1996 , 2008 ; Munson 2010a , Munson 2010b ; Rohlinger 2006 ; Staggenborg 1991 ), and fundamentally structured partisan politics (Adams 1997; Carsey and Layman 2006 ; Killian and Wilcox 2008 ). Position on abortion is frequently used as the litmus test for those seeking political office (Flaten 2010 ; Kreitzer and Osborn 2019 ). Opponents to legal abortion have transformed the federal judiciary (Hollis-Brusky and Parry 2021 ; Hollis-Brusky and Wilson 2020 ). Indeed, abortion is often called the quintessential “morality policy” issue (Kreitzer 2015 ; Kreitzer, Kane, and Mooney 2019 ; Mooney 2001 ; Mucciaroni, Ferraiolo, and Rubado 2019 ) and “ground zero” in the prominent culture wars that have polarized Americans (Adams 1997 ; Lewis 2017 ; Mouw and Sobel 2001 ; Wilson 2013 ). Almost fifty years after Roe v. Wade , in June 2022, the US Supreme Court overturned the constitutional right to abortion in its Dobbs v. Jackson Women's Health Organization decision, ushering in a new chapter of political engagement on abortion.

But abortion is not simply an abstract political issue; it is an extremely common pregnancy outcome. Indeed, as noted above, about one in four US women will get an abortion in her lifetime (Jones and Jerman 2022 ), although the rates of unintended pregnancy and abortion vary substantially across racial and socioeconomic groups (Dehlendorf, Harris, and Weitz 2013 ; Jones and Jerman 2022 ). Despite rampant misinformation claiming otherwise, abortion is a safe procedure (Raymond and Grimes 2012 ; Upadhyay et al. 2015 ), reduces physical health consequences and mortality (Gerdts et al. 2016 ), and does not cause mental health issues (Charles et al. 2008 ; Major et al. 2009 ) or regret (Rocca et al. 2013 , 2015 , 2020 ). Abortion also has a significant impact on people's lives beyond health outcomes. Legal abortion is associated with educational attainment (Everett et al. 2019 ; Ralph et al. 2019 ; Mølland 2016 ) as well as higher female labor force participation, and it affects men's and women's long-term earning potential (Bernstein and Jones 2019 ; Bloom et al. 2009 ; Everett et al. 2019 ; Kalist 2004 ). Access to abortion also shapes relationship satisfaction and stability (Biggs et al. 2014 ; Mauldon, Foster, and Roberts 2015 ). The preponderance of evidence, in other words, demonstrates substantial benefits and no harms to allowing pregnant people to choose abortion.

Yet access to abortion in the United States has been rapidly declining for years. Most abortion care in the United States takes place in stand-alone outpatient facilities that primarily provide reproductive health care (Jones, Witwer, and Jerman 2019 ). As antiabortion legislators in some states have advanced policies that target these facilities, the number of abortion clinics has decreased (Gerdts et al. 2022 ; Venator and Fletcher 2021 ), leaving large geographical areas lacking an abortion facility (Cartwright et al. 2018 ; Cohen and Joffe 2020 ) and thus diminishing pregnant people's ability to obtain abortion care when and where they need it.

The effects of policies regulating abortion, including those that target facilities, have been unevenly experienced, with people of color (Jones and Jerman 2022 ), people in rural areas (Bearak, Burke, and Jones 2017 ), and those who are financially struggling (Cook et al. 1999 ; Roberts et al. 2019 ) disproportionately affected. Even before the Dobbs decision overturned the constitutional right to abortion, the American landscape was characterized by ever-broadening contraception deserts (Axelson, Sealy, and McDonald-Mosley 2022 ; Barber et al. 2019 ; Kreitzer et al. 2021 ; Smith et al. 2022 ), maternity care deserts (Simpson 2020 ; Taporco et al. 2021 ; Wallace et al. 2021 ), and abortion deserts (Cartwright et al. 2018 ; Cohen and Joffe 2020 ; Engle and Freeman 2022 ; McNamara et al. 2022 ; Pleasants, Cartwright, and Upadhyay 2022 ). After Dobbs , access to abortion around the country changed in a matter of weeks. In the 100 days after Roe was overturned, at least 66 clinics closed in 15 states, with 14 of those states no longer having any abortion facilities (Kirstein et al. 2022 ). In this moment of heightened contention about an issue with a long history of social and political contestation, social scientists have a rich opportunity to contribute to scientific knowledge as well as policy and practice that affect millions of lives. This special issue steps into that opportunity.

• The Abortion Research Paradox

This special issue is also motivated by what we call the abortion research paradox. As established above, abortion fundamentally shapes politics in a myriad of ways and is a very common pregnancy outcome, with research consistently demonstrating that access to abortion is consequential and beneficial to people's lives. However, social science research on abortion is rarely published in top disciplinary journals. Abortion is a topic of clear social science interest and is well suited for social science inquiry, but it is relatively underrepresented as a topic in generalist social science journals. To measure this underrepresentation empirically, we searched for original research articles about abortion in the United Sates in the top journals of political science, sociology, and economics. We identified the top three journals for each discipline by considering journal reputation within their respective discipline as well as impact factors and Google Scholar rankings. (There is room for debate about what makes a journal a “top” general interest journal, but that is beyond our scope. Whether these journals are exactly the top three is debatable; nonetheless, these are undoubtedly among the top general-interest or “flagship” disciplinary journals and thus representative of what the respective disciplines value as top scholarship.) Then we searched specified journal databases for the keyword “abortion” for articles published in this century (i.e., 2000–2021), excluding commentaries and book reviews. We found few articles about abortion: just seven in economics journals, eight in political science journals, and seven in sociology journals. We read the articles and classified each into one of three categories: articles primarily about abortion; articles about more than one aspect of reproductive health, inclusive of abortion; or articles about several policy issues, among which abortion is one ( table 1 ).

In the three top economics journals, articles about abortion focused on the relationships between abortion and crime or educational attainment, or on the impact of abortion policies on trends in the timing of first births of women (Bitler and Zavodny 2002 ; Donohue III and Levitt 2001 ; Myers 2017 ). Articles that studied abortion as one among several topics also studied “morally controversial” issues (Elías et al. 2017 ), the electoral implications of abortion (Glaeser, Ponzetto, and Shapiro 2005 ; Washington 2008 ), or contraception (Bailey 2010 ). Articles published in the three top political science journals that focused primarily on abortion evaluated judicial decision-making and legitimacy (Caldarone, Canes-Wrone, and Clark 2009 ; Zink, Spriggs, and Scott 2009 ) or public opinion (Kalla, Levine, and Broockman 2022 ; Rosenfeld, Imai, and Shapiro 2016 ). More commonly, abortion was one of several (or many) different issues analyzed, including government spending and provision of services, government help for African Americans, law enforcement, health care, education, free speech, Hatch Act restrictions, and the Clinton impeachment. The degree to which these articles are “about abortion” varies considerably. In the three top sociology journals, articles represented a slightly broader range of topics, including policy diffusion (Boyle, Kim, and Longhofer 2015 ), public opinion (Mouw and Sobel 2001 ), social movements (Ferree 2003 ), and crisis pregnancy centers (McVeigh, Crubaugh, and Estep 2017 ). Unlike in economics and political science, articles in sociology on abortion mostly focused directly on abortion.

The Journal of Health Politics, Policy and Law ( JHPPL ) would seem well positioned to publish research on abortion. Yet, even in JHPPL , abortion research is not very common. In the same time period (2000–2021), JHPPL published five articles on reproductive health: two articles on abortion (Daniels et al. 2016 ; Kimport, Johns, and Upadhyay 2018 ), one on contraception (Kreitzer et al. 2021 ), one on forced interventions on pregnant people (Paltrow and Flavin 2013 ), and one about how states could respond to the passage of the Affordable Care Act mandate regarding reproductive health (Stulberg 2013 ).

This is not to say that there is no extensive, rigorous published research on abortion in the social science literature. Interdisciplinary journals that are focused on reproductive health, such as Contraception and Perspectives on Sexual and Reproductive Health , as well as health research journals, such as the American Journal of Public Health and Social Science & Medicine , regularly published high-quality social science research on abortion during the focal time period. Research on abortion can also be found in disciplinary subfield journals. In the same time period addressed above, the Journal of Women, Politics, and Public Policy and Politics & Gender— two subfield journals focused on gender and politics—each published around 20 articles that mentioned abortion in the abstract. In practice, while this means excellent research on abortion is published, the net effect is that abortion research is siloed from other research areas in the disciplines of economics, political science, and sociology. This special issue aims to redress some of this siloization and to inspire future scholarship on abortion. Our motivation is not simply premised on quantitative counts, however. As we assert below, abortion research siloization has significant consequences for knowledge—and especially for real people's lives. First, though, we consider some of the possible reasons for this siloization.

• The Origins of Siloization

We do not know why abortion research is not more commonly published in top disciplinary journals, given the topic's clear importance in key areas of focus for these disciplines, including public discourse, politics, law, family life, and health. The siloing and marginalization of abortion is likely related to several misconceptions. For one, because of social contention on the issue, peer reviewers may not have a deep understanding of abortion as a research topic, may express hostility to the topic, or may believe that abortion is exceptional in some way—a niche or ungeneralizable research topic better published in a subfield journal. Scholars themselves may share this mischaracterization of abortion. As Borgman ( 2014 ) argues about the legal arena, and as Roberts, Schroeder, and Joffe ( 2020 ) provide evidence of in medicine, abortion is regularly treated as exceptional, making it both definitional and reasonable that abortion be treated differently in the law and in health care from other medical experiences. Scholars are not immune to social patterns that exceptionalize abortion. In their peer and editor reviews, they may inappropriately—and perhaps inadvertently—draw on their social, rather than academic, knowledge. For scholars of abortion, reviews premised on social knowledge may not be constructive to strengthening the research, and additional labor may be required to educate reviewers and editors on the academic parameters of the topic, including which social assumptions about abortion are scientifically inaccurate. Comments from authors educating editors and peer reviewers on abortion research may then counterintuitively reinforce the (mis)perception that abortion research is niche and not of general interest.

Second, authors' negative experiences while trying to publish about abortion or reproductive health in top disciplinary journals may compound as scholars share information about journals. This is the case for research on gender; evidence from political science suggests that certain journals are perceived as more or less likely to publish research on gender (Brown et al. 2020 ). Such reputations, especially for venues that do not publish abortion research, may not even be rooted in negative experiences. The absence of published articles on abortion may itself dissuade scholars from submitting to a journal based on an educated guess that the journal does not welcome abortion research. Regardless of the veracity of these perceptions, certain journals may get a reputation for publishing on abortion (or not), which then may make future submissions of abortion research to those outlets more (or less) likely. After all, authors seek publication venues where they believe their research will get a robust review and is likely to be published. This pattern may be more common for some author groups than others. Research from political science suggests women are more risk averse than men when it comes to publishing strategies and less likely to submit manuscripts to journals where the perceived likelihood of successful publication is lower (Key and Sumner 2019 ). Special issues like this one are an important way for journals without a substantial track record of publishing abortion research to establish their willingness to do so.

Third, there might be a methodological bias, which unevenly intersects with some author groups. Top disciplinary journals are more likely to publish quantitative approaches rather than qualitative ones, which can result in the exclusion of women and minority scholars who are more likely to utilize mixed or qualitative methods (Teele and Thelen 2017 ). To the extent that investigations of abortion in the social sciences have utilized qualitative rather than quantitative methods, that might contribute to the underrepresentation of abortion-focused scholarship in top disciplinary journals.

Stepping back from the idiosyncrasies of peer review and methodologies, a fourth explanation for why abortion research is not more prominent in generalist social science journals may arise far earlier than the publishing process. PhD-granting departments in the social sciences may have an undersupply of scholars with expertise in reproductive health who can mentor junior scholars interested in studying abortion. (We firmly believe one need not be an expert in reproductive health to mentor junior scholars studying reproductive health, so this explanation only goes so far.) Anecdotally, we have experienced and heard many accounts of scholars who were discouraged from focusing on abortion in dissertation research because of advisors', mentors', and senior scholars' misconceptions about the topic and about the viability of a career in abortion research. In data provided to us by Key and Sumner from their analysis of the “leaky pipeline” in the publication of research on gender at top disciplinary journals in political science (Key and Sumner 2019 ), there were only nine dissertations written between 2000 and 2013 that mention abortion in the abstract, most of which are focused on judicial behavior or political party dynamics rather than focusing on abortion policy itself. If few junior scholars focus on abortion, it makes sense there may be an undersupply of cutting-edge social science research on abortion submitted to top disciplinary journals.

• The Implications of Siloization

The relative lack of scholarly attention to abortion as a social phenomenon in generalist journals has implications for general scholarship. Most concerningly, it limits our ability to understand other social phenomena for which the case of abortion is a useful entry point. For example, the case of abortion as a common, highly safe medical procedure is useful for examining medical innovations and technologies, such as telemedicine. Similarly, given the disparities in who seeks and obtains abortion care in the United States, abortion is an excellent case study for scholars interested in race, class, and gender inequality. It also holds great potential as an opportunity for exploration of public opinion and attitudes, particularly as a case of an issue whose ties to partisan politics have solidified over time and that is often—but not always—“moralized” in policy engagement (Kreitzer, Kane, and Mooney 2019 ). Additionally, there are missed opportunities to generate theory from the specifics of abortion. For example, there is ample evidence of abortion stigma and stigmatization (Hanschmidt et al. 2016 ) and of their effects on people who obtain abortions (Sorhaindo and Lavelanet 2022 ). This research is often unmoored from existing theorization on stigmatization, however, because the bulk of the stigma literature focuses on identities; and having had an abortion is not an identity the same way as, for example, being queer is. (For a notable exception to this trend, see Beynon-Jones 2017 .)

There is, it must be noted, at least one benefit of abortion research being regularly siloed within social science disciplines. The small but growing number of researchers engaged in abortion research has often had to seek mentorship and collaborations outside their disciplines. Indeed, several of the articles included in this special issue come from multidisciplinary author teams, building bridges between disciplinary literatures and pushing knowledge forward. Social scientists studying abortion regularly engage with research by clinicians and clinician-researchers, which is somewhat rare in the academy. The interdisciplinary journals noted above that regularly publish social science abortion research ( Contraception and Perspectives on Sexual and Reproductive Health ) also regularly publish clinical articles and are read by advocates and policy makers. In other words, social scientists studying abortion frequently reach audiences that include clinicians, advocates, and policy makers, marking an opportunity for social science research to influence practice.

The siloization of abortion research in the social sciences affects more than broad social science knowledge; it also dramatically shapes our understanding of abortion. When abortion researchers are largely relegated to their own spaces, they risk missing opportunities to learn from other areas of scholarship that are not related to abortion. Lacking context from other topics, abortion scholars may inaccurately understand an aspect of abortion as exceptional that is not, or they may reinvent the proverbial theoretical wheel to describe an abortion-related phenomenon that is not actually unique to abortion. For example, scholars have studied criminalized behavior for decades, offering theoretical insights and methodological best practices for research on illegal activities. With abortion now illegal in many states, abortion researchers can benefit from drawing on that extant literature to examine the implications of illegality, identifying which aspects of abortion illegality are unique and which are common to other illegal activities. Likewise, methodologically, abortion researchers can learn from other researchers of illegal activities about how to protect participants' confidentiality.

The ontological and epistemological implications for the siloization of abortion research extend beyond reproductive health. When abortion research is not part of the central discussions in economics, political science, and sociology, our understanding of health policy, politics, and law is impoverished. We thus miss opportunities to identify and address chronic health disparities and health inequities, with both conceptual and practical consequences. These oversights matter for people's lives. Following the June 2022 Dobbs decision, millions of people with the capacity of pregnancy are now barred from one key way to control fertility: abortion. The implications of scholars' failure to comprehensively grapple with the place of abortion in health policy, politics, and law are playing out in those people's lives and the lives of their loved ones.

Articles in this Special Issue

In this landscape, we offer this special issue on “The Politics of Abortion 50 Years After Roe .” We seek in this issue to illustrate some of the many ways abortion can and should be studied, with benefits not only for scholarly knowledge about abortion and its role in policy, politics, and law but also for general knowledge about health policy, politics, and law themselves.

The issue's articles represent multiple disciplines, including several articles by multidisciplinary teams. Although public health has long been a welcoming home for abortion research, authors in this special issue point to opportunities in anthropology, sociology, and political science, among other disciplines, for the study of abortion. We do not see the differences and variations among disciplinary approaches as a competition. Rather, we believe that the more diverse the body of researchers grappling with questions about abortion, abortion provision, and abortion patients, the better our collective knowledge about abortion and its role in the social landscape.

The same goes for diversity of methodological approaches. Authors in this issue employ qualitative, quantitative, and mixed methods, showcasing compelling methodological variation. There is no singular or best methodology for answering research questions about abortion. Instead, the impressive variation in methodological approaches in this special issue highlights the vast methodological opportunities for future research. A diversity of methodologies enables a diversity of research questions. Indeed, different methods can identify, generate, and respond to different research questions, enriching the literature on abortion. The methodologies represented in this issue are certainly not exhaustive, but we believe they are suggestive of future opportunities for scholarly exploration and investigation. We hope these articles will provide a road map for rich expansions of the research literature on abortion.

By way of brief introduction, we offer short summaries of the included articles. Baker traces the history of medication abortion in the United States, cataloging the initial approval of the two-part regimen by the Food and Drug Administration (FDA), subsequent policy debates over FDA-imposed restrictions on how medication abortion is dispensed, and the work of abortion access advocates to get medication abortion to people who need it. Weaving together accounts of health care policy, abortion advocacy, and on-the-ground activism, Baker illustrates both the unique contentions specific to abortion policy and how the history of medication abortion can be seen as a case of health care advocacy.

Two of the issue's articles focus on state-level legislative policy on abortion. Roth and Lee generate an original data set cataloging the introduction and implementation of statutes on abortion and other aspects of reproductive health at the state level in the United States monthly, from 1994 to 2022. In their descriptive analysis, the authors highlight trends in abortion legislation and the emergent pattern of state polarization around abortion. Their examination adds rich longitudinal context to contemporary analyses of reproductive health legislation, providing a valuable resource for future scholarship. Carson and Carter similarly attend to state-level legislation, zeroing in on the case of abortion policy in response to the COVID-19 pandemic to show how legislation unrelated to abortion has been opportunistically used to restrict abortion access. The authors also examine how abortion is discursively constructed as a risk to public health. This latter move, they argue, builds on previous constructions of abortion as a risk to individual health and points to a new horizon of antiabortion constructions of the meaning of abortion access.

Kim et al. and Kumar examine the implementation of US abortion policies. Kim et al. use an original data set of 20 years of state supreme court decisions to investigate factors that affect state supreme court decision-making on abortion. Their regression analysis uncovers the complex relationship between state legislatures, state supreme courts, and the voting public for the case of abortion. Kumar charts how 50 years of US abortion policy have affected global access to abortion, offering insights into the underexamined international implications of US abortion policy and into social movement advocacy that has expanded abortion access around the world.

Karlin and Joffe and Heymann et al. draw on data collected when Roe was still the law of the land to investigate phenomena that are likely to become far more common now that Roe has been overturned. Karlin and Joffe utilize interviews with 40 physicians who provide abortions to examine their perspectives on people who terminate their pregnancies outside the formal health care system—an abortion pathway whose popularity increases when abortion access constricts (Aiken et al. 2022 ). By contextualizing their findings on the contradictions physicians voiced—desiring to support reproductive autonomy but invested in physician authority—in a historical overview of how mainstream medicine has marginalized abortion provision since the early days after Roe , the authors add nuance to understandings of the “formal health care system,” its members, and the stakes faced by people bypassing this system to obtain their desired health outcome. Heymann et al. investigate a process also likely to increase in the wake of the Dobbs decision: the implementation of restrictive state-level abortion policy by unelected bureaucrats. Using the case of variances for a written transfer agreement requirement in Ohio—a requirement with no medical merit that is designed to add administrative burden to stand-alone abortion clinics—Heymann et al. demonstrate how bureaucratic discretion by political appointees can increase the administrative burden of restrictive abortion laws and thus further constrain abortion access. Together, these two articles demonstrate how pre- Roe data can point scholars to areas that merit investigation after Roe has been overturned.

Finally, using mixed methods, Buyuker et al. analyze attitudes about abortion acceptability and the Roe v. Wade Supreme Court decision, distinguishing what people think about abortion from what they know about abortion policy. In addition to providing methodological insights about survey items related to abortion attitudes, the authors expose a disconnect between how people think about abortion acceptability and their support for the Roe decision. In other words, as polarized as abortion attitudes are said to be, there is unacknowledged and largely unmeasured complexity in how the general public thinks about abortion.

Future Research on Abortion

We hope that a desire to engage in abortion research prompts scholars to read the excellent articles in this special issue. We also hope that reading these pieces inspires at least some readers to engage in abortion research. Having researched abortion for nearly three decades between us, we are delighted by the emerging interest in studying abortion, whether as a focal topic or alongside a different focus. This research is essential to our collective understanding of abortion politics, policy, and law and the many millions of people whose lives are affected by US abortion politics, policy, and law annually. In light of the limitations of the current field of abortion research, we have several suggestions for scholars of abortion, regardless of their level of familiarity with the topic.

First, know and cite the existing literature on abortion. To address the siloization of abortion research, and particularly the scarcity of abortion research published in generalist journals, scholars must be sure to build on the impressive work that has been published on the topic in specialized spaces. Moreover, becoming familiar with existing research can help scholars avoid several common pitfalls in abortion research. For example, being immersed in existing literature can help scholars avoid outdated, imprecise, or inappropriate language and terminology. Smith et al. ( 2018 ), for instance, illuminate the implications of clinicians deploying seemingly everday language around “elective” abortion. They find that it muddies the distinction between the use of “elective” colloquially and in clinical settings, contributing to the stigmatization of abortion and abortion patients. Examinations like theirs advance understanding of abortion stigmatization while highlighting for scholars the importance of being sensitive to and reflective about language. Familiarity with existing research can help scholars avoid methodological pitfalls as well, such as incomplete understanding of the organization of abortion provision. Although Planned Parenthood has brand recognition for providing abortion care, the majority of abortions in the United States are performed at independent abortion clinics. Misunderstanding the provision landscape can have consequences for some study designs.

Second, we encourage scholars of abortion to think critically about the ideological underpinnings of how their research questions and findings are framed. Academic research of all kinds, including abortion, is better when it is critical of ideologically informed premises. Abortion scholars must be careful to avoid uncritically accepting both antiabortion premises and abortion-supportive premises, especially as those premises unconsciously guide much of the public discourse on abortion. Scholars have the opportunity to use methodological tools not to find an objective truth per se but to challenge the uncontested common sense claims that frequently guide public thinking on abortion. One strategy for avoiding common framing pitfalls is to construct research and analysis to center the people most affected by abortion politics, policy, and law (Kimport and McLemore 2022 ). Another strategy is to critique what Baird and Millar ( 2019 , 2020 ) have termed the performative nature of abortion scholarship. Abortion scholarship, they note, has predominantly focused on negative aspects and effects of abortion care. Research that finds and explores affirmatively positive aspects—for instance, the joy in abortion—can crucially thicken scholarly understanding.

Third, related to our discussion above, scholars of abortion face an interesting challenge regarding how abortion is and is not exceptional. Research on abortion must attend to how abortion has been exceptionalized—and marginalized—in policy and practices. But there are also numerous instances where abortion is only one example of many. In these cases, investigation of abortion under the assumption that it is exceptional is an unnecessary limitation on the work's contribution. Scholars of abortion benefit from mastery of the literature on abortion, yet knowing this literature is not sufficient. There are important bridges from scholarship on abortion to scholarship in other areas, important conversations across and within literatures, that can yield insights both about abortion and about other topical foci.

As guest coeditors of this special issue, we are delighted by the rich and growing body of scholarship on abortion, to which the articles in this special issue represent an important addition. There is still much more work to be done. Going forward, we are eager to see future scholarship on abortion build on this work and tackle new questions.

• Acknowledgments

The authors thank Krystale Littlejohn, Jon Oberlander, Ellen Key, and Jane Sumner for their helpful feedback on earlier drafts of this article. Both authors contributed equally to this article and are listed alphabetically.

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Data & Figures

Number of Articles about Abortion in Top Disciplinary Journals, 2000–2021

Note : AER  =  American Economic Review ; QJE  =  Quarterly Journal of Economics ; JPE  =  Journal of Political Economy ; APSR  =  American Political Science Review ; AJPS  =  American Journal of Political Science ; JOP  =  Journal of Politics ; ASR  =  American Sociological Review ; AJS  =  American Journal of Sociology ; ARS  =  Annual Review of Sociology.

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Amdt14.S1.6.4.1 Abortion, Roe v. Wade, and Pre-Dobbs Doctrine

Fourteenth Amendment, Section 1:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

In 1973, the Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. 1 Footnote 410 U.S. 113 (1973) , overruled by Dobbs v. Jackson Women’s Health Org. , No. 19-1392 (U.S. June 24, 2022) . The Court’s decision dramatically increased judicial oversight of legislation under the privacy line of cases, striking down aspects of abortion-related laws in numerous states, the District of Columbia, and the territories. In reaching its decision, the Court conducted a lengthy historical review of medical and legal views regarding abortion, finding that modern prohibitions on the procedure were of relatively recent vintage and thus lacked the historical foundation that might have preserved them from constitutional review. 2 Footnote Id. at 129–47 .

The Roe Court ruled that states may not categorically proscribe abortions by making their performance a crime. 3 Footnote Id. at 164–65 . The constitutional basis for the decision rested upon the conclusion that the right of privacy embraces a woman’s decision to carry a pregnancy to term. 4 Footnote Id. at 153 . With regard to the scope of that privacy right, the Court stated that it includes only personal rights that can be deemed ‘fundamental’ or ‘implicit in the concept of ordered liberty’ and bears some extension to activities related to marriage, procreation, contraception, family relationships, child rearing, and education. 5 Footnote Id. at 152–53 . Such a right, the Court concluded, is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy. 6 Footnote Id. at 153 .

With respect to protecting the right to an abortion against state interference, the Court held that because the right of privacy is a fundamental right, only a compelling state interest could justify its limitation by a state. 7 Footnote Id. at 155. Thus, while it recognized the legitimacy of a state interest in protecting maternal health and preserving a fetus’s potential life, as well as the existence of a rational connection between these two interests and a state’s abortion restrictions, the Court held these interests insufficient to justify an absolute ban on abortions. 8 Footnote Id. at 164–65 .

Instead, the Court emphasized the durational nature of pregnancy and found the state’s interests in maternal health and fetal life to be sufficiently compelling at only certain stages of pregnancy to permit the regulation or prohibition of the procedure. Finding that an abortion is no more dangerous to maternal health than childbirth in the first trimester of pregnancy, the Court concluded that the compelling point for regulating abortion to further a state’s interest in maternal health was at approximately the end of the first trimester. 9 Footnote Id. at 163 . Until that point, the abortion decision and its effectuation was to be left exclusively to the medical judgment of the pregnant woman’s doctor in consultation with the patient. 10 Footnote Id. After the end of the first trimester, however, the state could promote its interest in maternal health by regulating the abortion procedure in ways reasonably related to maternal health. 11 Footnote Id.

The compelling point with respect to the state’s other interest in potential life was at viability, which the Court described as the point at which the fetus is potentially able to live outside the mother’s womb. 12 Footnote Id. at 160 . See also id. (identifying viability as usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks ). Following viability, the state’s interest permitted it to regulate and even proscribe an abortion except when necessary, in appropriate medical judgment, for the preservation of the life or health of the woman.

In a companion case, Doe v. Bolton , the Court extended Roe by warning that just as states may not restrict abortion by making its performance a crime, they may not make abortions unreasonably difficult to obtain by prescribing elaborate procedural barriers. 13 Footnote 410 U.S. 179, 201 (1973) . In Doe , the Court struck down Georgia’s requirements that abortions be performed in licensed hospitals; that abortions be approved beforehand by a hospital committee; and that two physicians concur in the abortion decision. 14 Footnote Id. at 193–200 .

Following Roe , as states adopted new abortion regulations, the Court settled questions involving a variety of related topics, including informed consent for the woman seeking an abortion, mandatory waiting periods before the procedure could be performed, and spousal consent requirements. 15 Footnote See, e.g. , City of Akron v. Akron Ctr. for Reprod. Health , 462 U.S. 416, 450 (1983) (invalidating Akron ordinance requiring 24-hour waiting period between signing of consent form and performance of abortion because city failed to demonstrate that any legitimate state interest is furthered by an arbitrary and inflexible waiting period ), overruled in part by Planned Parenthood of Se. Penn. v. Casey , 505 U.S. 833 (1992) ; Bellotti v. Baird , 443 U.S. 622 (1979) (invalidating parental consent requirement for minors seeking abortions); Colautti v. Franklin , 439 U.S. 379 (1979) (finding Pennsylvania law imposing standard of care on abortion providers upon viability determination unconstitutionally vague); Planned Parenthood of Cent. Mo. v. Danforth , 428 U.S. 52 (1976) (upholding Missouri informed consent requirement, but invalidating spousal consent requirement); Singleton v. Wulff , 428 U.S. 106 (1976) (finding standing for physicians to bring suit on behalf of patients seeking Medicaid-funded abortions); Connecticut v. Menillo , 423 U.S. 9 (1975) (state law prohibiting attempted abortion by any person was not unconstitutional as applied to nonphysician). In 1983, in City of Akron v. Akron Center for Reproductive Health , the Court expressly reaffirmed Roe before invalidating several provisions of an Akron, Ohio abortion ordinance. 16 Footnote City of Akron , 462 U.S. at 419–20 . Acknowledging the Court’s role in defining the limits of a state’s authority to regulate abortion, the Court in City of Akron maintained that the doctrine of stare decisis while perhaps never entirely persuasive on a constitutional question, is a doctrine that demands respect in a society governed by the rule of law. 17 Footnote Id.

In 1986, the Court again reaffirmed Roe in Thornburgh v. American College of Obstetricians and Gynecologists . 18 Footnote Thornburgh v. Am. Coll. of Obstetricians & Gynecologists , 476 U.S. 747 (1986) , overruled in part by Casey , 505 U.S. 833 . Reviewing several provisions of Pennyslvania’s Abortion Control Act, the Court observed that the constitutional principles that guided its decisions in Roe and Doe v. Bolton still provide the compelling reason for recognizing the constitutional dimensions of a woman’s right to decide whether to end her pregnancy. 19 Footnote Id. at 759 .

In 1989, however, a plurality of the Court questioned the continued use of Roe 's trimester framework to evaluate abortion regulations. In Webster v. Reproductive Health Services , the Court upheld two Missouri abortion regulations: a restriction on the use of public employees and facilities for the performance of abortions; and a requirement that a physician ascertain a fetus’s viability before performing an abortion, if the physician had reason to believe that a woman was twenty or more weeks pregnant. 20 Footnote 492 U.S. 490 (1989) . Although the Court did not overrule Roe in Webster , a plurality of Justices indicated that it was willing to apply a less stringent standard of review to abortion regulations. 21 Footnote Id. at 516–22 . In separate concurring opinions, two Justices also criticized Roe and the trimester framework. 22 Footnote Id. at 522 (O’Connor, J., concurring in part and concurring in the judgment), 532 (Scalia, J., concurring in part and concurring in the judgment).

In 1992, a plurality of the Court rejected Roe 's trimester framework in a case involving Pennsylvania’s Abortion Control Act. 23 Footnote Casey , 505 U.S. 833 , overruled by Dobbs v. Jackson Women’s Health Org. , No. 19-1392 (U.S. June 24, 2022) . In Planned Parenthood of Southeastern Pennsylvania v. Casey , the plurality explained that in its formulation [the framework] misconceives the pregnant woman’s interest . . . and in practice it undervalues the State’s interest in potential life[.] 24 Footnote Id. at 873 . In its place, the plurality adopted a new undue burden standard, maintaining that this standard recognized the need to reconcile the government’s interest in potential life with a woman’s right to decide to terminate her pregnancy. 25 Footnote Id. at 876 . The plurality indicated that an undue burden exists if the purpose or effect of an abortion regulation is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability. 26 Footnote Id. at 878 .

In adopting the new undue burden standard, Casey nonetheless reaffirmed the essential holding of Roe , which the plurality described as having three parts. 27 Footnote Id. at 846 . First, a woman has a right to choose to have an abortion prior to viability without undue interference from the state. 28 Footnote Id. Second, the state has a right to restrict abortions after viability so long as the regulation provides an exception for pregnancies that endanger a woman’s life or health. 29 Footnote Id. Third, the state has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus. 30 Footnote Id.

Following Casey , the Court applied the undue burden standard in two cases involving the so-called partial-birth abortion procedure. 31 Footnote Stenberg v. Carhart , 530 U.S. 914 (2000) ; Gonzales v. Carhart , 550 U.S. 124 (2007) . In Stenberg v. Carhart , the Court concluded that a Nebraska statute that prohibited the performance of partial-birth abortions was unconstitutional because it failed to include an exception to protect the health of the mother and because the language defining the prohibited procedure was too vague. In Gonzales v. Carhart , the Court applied the undue burden standard to the federal Partial-Birth Abortion Ban Act of 2003. 32 Footnote Gonzales , 550 U.S. at 150 . Distinguishing the act from the Nebraska statute at issue in Stenberg , the Court concluded that the federal law did not impose an undue burden on a woman’s ability to obtain an abortion and was not unconstitutionally vague. 33 Footnote Id. at 168 .

In Gonzales , the Court also concluded that the federal law was not unconstitutionally vague because it provides doctors with a reasonable opportunity to know what conduct is prohibited. 34 Footnote Id. at 149 . Unlike the Nebraska statute, which prohibited the delivery of a substantial portion of the fetus, the federal law includes anatomical landmarks that identify when an abortion procedure will be subject to the act’s prohibitions. 35 Footnote See id. at 148; see also Neb. Rev. Stat. Ann. § 28-326(9) (Supp. 1999) ; 18 U.S.C. § 1531 (b)(1)(A) . The Court observed: [I]f an abortion procedure does not involve the delivery of a living fetus to one of these ‘anatomical landmarks'—where, depending on the presentation, either the fetal head or the fetal trunk past the navel is outside the body of the mother—the prohibitions of the Act do not apply. 36 Footnote Gonzales , 550 U.S. at 148 .

In 2016, the Court provided further guidance on applying the undue burden standard in Whole Woman’s Health v. Hellerstedt . 37 Footnote No. 15-274, slip op. at 21 (U.S. June 27, 2016) . In Whole Woman’s Health , the Court invalidated two Texas requirements that applied to abortion providers and physicians who perform the procedure: a requirement that physicians who perform or induce abortions have admitting privileges at a hospital within thirty miles from the location where the abortion was performed or induced; and a requirement that abortion facilities satisfy the same standards as ambulatory surgical centers. 38 Footnote Id. at 1–2 . In applying the undue burden standard, the Court in Whole Woman’s Health emphasized that reviewing courts must consider the burdens a law imposes on abortion access together with the benefits those laws confer. 39 Footnote Id. at 19–20 . The Court also indicated that considerable weight should be given to the evidence and arguments presented in judicial proceedings when evaluating the constitutionality of abortion regulations. 40 Footnote Id. at 20 .

In 2020, the Court invalidated a Louisiana law that required physicians who performed abortions to have admitting privileges at a hospital within thirty miles of the location where the procedure was performed. In June Medical Services v. Russo , a majority of the Court concluded that the law imposed an undue burden on a woman’s ability to obtain an abortion. 41 Footnote No. 18-1323, slip op. at 3 (U.S. June 29, 2020) . Justice Stephen Breyer authored an opinion, joined by Justices Ruth Bader Ginsburg, Sonia Sotomayor, and Elena Kagan, that relied heavily on Whole Woman’s Health . 42 Footnote Id. at 1 . Justice Breyer maintained that the laws being reviewed in June Medical Services and Whole Woman’s Health were nearly identical, and that the Louisiana law must consequently reach a similar conclusion. 43 Footnote Id. at 40 . In a separate opinion, Chief Justice John Roberts concurred in the judgment, emphasizing that the legal doctrine of stare decisis required June Medical Services to be decided like Whole Woman’s Health . 44 Footnote Id. at 2 (Roberts, C.J., concurring in the judgment).

Applying the undue burden standard in June Medical Services , Justice Breyer reiterated that the standard requires balancing an abortion regulation’s benefits against any burdens it imposes. 45 Footnote Id. at 16–17 . The plurality maintained that the district court faithfully engaged in this balancing, concluding that the closure of abortion facilities and a reduction in the number of physicians performing abortions outweighed the fact that the admitting privileges requirement provided no significant health benefit. 46 Footnote Id. at 17–38 .

Concurring in the judgment, Chief Justice Roberts agreed that the Louisiana law and the Texas law at issue in Whole Woman’s Health were nearly identical. 47 Footnote Id. at 2 (Roberts, C.J., concurring in the judgment). Although he dissented in Whole Woman’s Health and indicated in his concurrence that the Texas case was wrongly decided, he nevertheless maintained that stare decisis required the invalidation of the Louisiana law. 48 Footnote Id. at 2–4 . Despite his concurrence in the judgment, however, Chief Justice Roberts questioned how the undue burden standard is now applied as a result of Whole Woman’s Health . 49 Footnote Id. at 6 . Discussing the balancing of an abortion regulation’s benefits and burdens, the Chief Justice contended that nothing in Casey suggested that courts should engage in this kind of weighing of factors. 50 Footnote Id. According to the Chief Justice, Casey focused on the existence of a substantial obstacle as sufficient to invalidate an abortion regulation and did not call for consideration of a regulation’s benefits[.] 51 Footnote Id. at 11 . Reviewing the burdens imposed by the Louisiana law, such as fewer abortion providers and facility closures, the Chief Justice agreed with the plurality that the determination in Whole Woman’s Health that Texas’s law imposed a substantial obstacle requires the same determination about Louisiana’s law. 52 Footnote Id. Nevertheless, the Chief Justice further observed that the discussion of benefits in Whole Woman’s Health was not necessary to its holding. 53 Footnote Id. at 12 n.3 .

•   Jump to essay-1 410 U.S. 113 (1973) , overruled by Dobbs v. Jackson Women’s Health Org. , No. 19-1392 (U.S. June 24, 2022) .
•   Jump to essay-2 Id. at 129–47 .
•   Jump to essay-3 Id. at 164–65 .
•   Jump to essay-4 Id. at 153 .
•   Jump to essay-5 Id. at 152–53 .
•   Jump to essay-6 Id. at 153 .
•   Jump to essay-7 Id. at 155.
•   Jump to essay-8 Id. at 164–65 .
•   Jump to essay-9 Id. at 163 .
•   Jump to essay-10 Id.
•   Jump to essay-11 Id.
•   Jump to essay-12 Id. at 160 . See also id. (identifying viability as usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks ).
•   Jump to essay-13 410 U.S. 179, 201 (1973) .
•   Jump to essay-14 Id. at 193–200 .
•   Jump to essay-15 See, e.g. , City of Akron v. Akron Ctr. for Reprod. Health , 462 U.S. 416, 450 (1983) (invalidating Akron ordinance requiring 24-hour waiting period between signing of consent form and performance of abortion because city failed to demonstrate that any legitimate state interest is furthered by an arbitrary and inflexible waiting period ), overruled in part by Planned Parenthood of Se. Penn. v. Casey , 505 U.S. 833 (1992) ; Bellotti v. Baird , 443 U.S. 622 (1979) (invalidating parental consent requirement for minors seeking abortions); Colautti v. Franklin , 439 U.S. 379 (1979) (finding Pennsylvania law imposing standard of care on abortion providers upon viability determination unconstitutionally vague); Planned Parenthood of Cent. Mo. v. Danforth , 428 U.S. 52 (1976) (upholding Missouri informed consent requirement, but invalidating spousal consent requirement); Singleton v. Wulff , 428 U.S. 106 (1976) (finding standing for physicians to bring suit on behalf of patients seeking Medicaid-funded abortions); Connecticut v. Menillo , 423 U.S. 9 (1975) (state law prohibiting attempted abortion by any person was not unconstitutional as applied to nonphysician).
•   Jump to essay-16 City of Akron , 462 U.S. at 419–20 .
•   Jump to essay-17 Id.
•   Jump to essay-18 Thornburgh v. Am. Coll. of Obstetricians & Gynecologists , 476 U.S. 747 (1986) , overruled in part by Casey , 505 U.S. 833 .
•   Jump to essay-19 Id. at 759 .
•   Jump to essay-20 492 U.S. 490 (1989) .
•   Jump to essay-21 Id. at 516–22 .
•   Jump to essay-22 Id. at 522 (O’Connor, J., concurring in part and concurring in the judgment), 532 (Scalia, J., concurring in part and concurring in the judgment).
•   Jump to essay-23 Casey , 505 U.S. 833 , overruled by Dobbs v. Jackson Women’s Health Org. , No. 19-1392 (U.S. June 24, 2022) .
•   Jump to essay-24 Id. at 873 .
•   Jump to essay-25 Id. at 876 .
•   Jump to essay-26 Id. at 878 .
•   Jump to essay-27 Id. at 846 .
•   Jump to essay-28 Id.
•   Jump to essay-29 Id.
•   Jump to essay-30 Id.
•   Jump to essay-31 Stenberg v. Carhart , 530 U.S. 914 (2000) ; Gonzales v. Carhart , 550 U.S. 124 (2007) .
•   Jump to essay-32 Gonzales , 550 U.S. at 150 .
•   Jump to essay-33 Id. at 168 .
•   Jump to essay-34 Id. at 149 .
•   Jump to essay-35 See id. at 148; see also Neb. Rev. Stat. Ann. § 28-326(9) (Supp. 1999) ; 18 U.S.C. § 1531 (b)(1)(A) .
•   Jump to essay-36 Gonzales , 550 U.S. at 148 .
•   Jump to essay-37 No. 15-274, slip op. at 21 (U.S. June 27, 2016) .
•   Jump to essay-38 Id. at 1–2 .
•   Jump to essay-39 Id. at 19–20 .
•   Jump to essay-40 Id. at 20 .
•   Jump to essay-41 No. 18-1323, slip op. at 3 (U.S. June 29, 2020) .
•   Jump to essay-42 Id. at 1 .
•   Jump to essay-43 Id. at 40 .
•   Jump to essay-44 Id. at 2 (Roberts, C.J., concurring in the judgment).
•   Jump to essay-45 Id. at 16–17 .
•   Jump to essay-46 Id. at 17–38 .
•   Jump to essay-47 Id. at 2 (Roberts, C.J., concurring in the judgment).
•   Jump to essay-48 Id. at 2–4 .
•   Jump to essay-49 Id. at 6 .
•   Jump to essay-50 Id.
•   Jump to essay-51 Id. at 11 .
•   Jump to essay-52 Id.
•   Jump to essay-53 Id. at 12 n.3 .

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In This Article Expand or collapse the "in this article" section Abortion

Introduction, general overviews, definitions, terminology, and reference resources, historical perspectives, laws and public health consequences, demography and epidemiology, safety, techniques, and health-related controversies, postabortion care, related articles expand or collapse the "related articles" section about, about related articles close popup.

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Abortion by Andrzej Kulczycki LAST REVIEWED: 25 February 2022 LAST MODIFIED: 24 May 2017 DOI: 10.1093/obo/9780199756797-0090

An abortion refers to the termination of a pregnancy. It can be induced (see Definitions, Terminology, and Reference Resources ) through a pharmacological or a surgical procedure, or it may be spontaneous (also called miscarriage ). Both in the United States and globally, approximately one-fifth of all known pregnancies end in abortion, which is currently one of the safest procedures in medicine when performed by a trained professional in hygienic conditions using modern methods. In 2016, it was estimated that about 56 million abortions were induced worldwide each year from 2010 to 2014, corresponding to about 35 abortions per 1,000 women of childbearing age. However, it was previously estimated that about 21.6 million abortions performed annually were unsafe, causing some 47,000 maternal deaths or 13 percent of all maternal deaths. Abortion-related mortality may have since fallen, but multiple challenges with measurement and data quality persist. The incidence of abortion may be reduced through good access to a range of effective contraceptive methods, sex education, and appropriate support for women who want to have a child. Historically, women who underwent abortions risked their personal health and social standing. In the 20th century, this situation changed slowly in many countries as abortion procedures became safer and efforts to legalize abortion gained momentum. Nevertheless, abortion is often a controversial matter of health and social policy due to divergent views on such matters as when human life begins, women’s roles and rights, and the role of government in individuals’ private lives. This entry reflects the broad scope of public health issues concerning the demography of abortion, its epidemiology, legality, and abortion-related methods. It also provides a collection of resources on postabortion care. This article first briefly reviews the terminology used for different types of abortion and outlines resources that detail the history of abortion as well as its general public heath contours in the United States and the world. Less attention is paid to the ethical aspects of abortion, arguments for or against the practice, different cultural or religious views on abortion, and public or political aspects of conflict concerning abortion.

Although recent textbooks on the public health aspects of abortion are lacking, Faúndes and Barzelatto 2006 provides an accessible account of many pertinent issues written in plain language for nonspecialists. Singh, et al. 2009 summarizes recent trends in abortion incidence, with a focus on unsafe abortion, as well as changes in legality, safety, and accessibility of abortion services worldwide. Sedgh, et al. 2016 presents the most recent abortion estimates for major world regions. Paul, et al. 2009 offers an informative text written primarily for clinicians on the provision of abortion care. A well-referenced handbook, World Health Organization 2012 (WHO), gives guidance to health professionals inside and outside governments who are working to reduce poor maternal health on the many ways of ensuring access to abortion care as allowed by law. Several reference guides explore the evolution of the US abortion debate from various viewpoints and may assist those working in the medical, social science, historical, legal, and public health fields. McBride 2007 includes a collection of biographical sketches, chronology, and excerpts from key statutes and court cases that have pushed the abortion controversy into the public arena, and Rose 2008 provides a selection of forty-one primary source documents from medical workers, judges, feminists, religious leaders, and politicians from the 19th century through 2007.

Faúndes, Anibal, and José S. Barzelatto. 2006. The human drama of abortion: A global search for consensus . Nashville: Vanderbilt Univ. Press.

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This book includes overviews of why women have abortions, the scale of the practice, consequences of unsafe abortions, effective interventions, values, and conclusions about what can be done to reach a necessary and practical societal consensus.

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McBride, Dorothy E. 2007. Abortion in the United States: A reference handbook . Santa Barbara, CA: ABC-CLIO.

This reference volume covers multiple aspects of how abortion is considered in the United States. The guide also provides commentary on major Supreme Court cases and state laws regulating abortion policy as well as other background information.

Paul, Maureen, E. Steve Lichtenberg, Lynn Borgatta, David A. Grimes, Phillip G. Stubblefield, and Mitchell D. Creinin, eds. 2009. Management of unintended and abnormal pregnancy: Comprehensive abortion care . Oxford: Wiley-Blackwell.

DOI: 10.1002/9781444313031 Save Citation » Export Citation » Share Citation »

This widely used evidence-based reference text in abortion care discusses abortion methods, pre- and postprocedure care, the management of ectopic and other abnormal pregnancies (including the risks of multiple pregnancies resulting from assisted reproductive technologies), and public health aspects of abortion service delivery.

Rose, Melody. 2008. Abortion: A documentary and reference guide . Westport, CT: Greenwood.

This reference work carries primary documents and commentary on the public health situation and sociopolitical controversy concerning abortion in the United States. Excerpts are also included from popular women’s self-help books, memoirs of early abortion providers, important legal papers, and the text of Pope Paul VI’s 1968 encyclical, Humanae Vitae .

Sedgh, Gilda, Jonathan Bearak, Susheela Singh, Akirinola Bankole, Anna Popinchalk, Bela Ganatra, et al. 2016. Abortion incidence between 1990 and 2014: Global, regional, and subregional levels and trends. Lancet 388.10041: 258–267.

DOI: 10.1016/S0140-6736(16)30380-4 Save Citation » Export Citation » Share Citation »

The most recent update on abortion levels and trends worldwide, including for countries and major regions in which abortion is legally permitted and generally available, as well as for those in which it is not. Available online for purchase or by subscription.

Singh, Susheela, Deirdre Wulf, Rubina Hussain, Akinrinola Bankole, and Gilda Sedgh. 2009. Abortion worldwide: A decade of uneven progress . New York: Guttmacher Institute.

This report reviews changes in abortion incidence, legality, and safety, with greater attention paid to unsafe abortion and the situation in low-income countries. The report also examines the relation among unintended pregnancy, contraception, and abortion. Also available in Spanish .

World Health Organization. 2012. Safe abortion: Technical and policy guidance for health systems . 2d ed. Geneva, Switzerland: World Health Organization.

This updated and expanded version of the report gives guidance to health professionals and others on actions to ensure the provision of safe, quality abortion services as allowed by law. It also provides an overview of the public health challenges, including clinical aspects of care, health system issues, and the legal, regulatory, and policy environment for improving the quality and accessibility of care.

Definitions of abortion vary across and within countries as well as among different institutions. Language used to refer to abortion often also reflects societal and political opinions and not only scientific knowledge ( Grimes and Gretchen 2010 ). Popular use of the word abortion implies a deliberate pregnancy termination, whereas a miscarriage is used to refer to spontaneous fetal loss when the fetus is not viable (i.e., not yet unable to survive independently outside the womb). Spontaneous abortions may account for up to one in four pregnancies. Most occur in the first two weeks after conception, typically due to embryonic malformations or chromosomal abnormalities, and before a woman is aware that she is pregnant ( Wilcox 2010 ). Induced abortion is the deliberate termination of pregnancy before viability (which may vary from twenty to twenty-eight weeks’ gestation, but medical advances now imply that viability can be generally assumed at about twenty-four weeks). An abortion can be induced for medical reasons or because of an elective decision to end the pregnancy. In an incomplete abortion, parts of the fetus or placental tissue are retained in the uterus and can result in hemorrhage, intense pain, uterine infection, and death if left untreated. An unsafe abortion may have adverse consequences for women’s health because it is performed by persons lacking the necessary skills in an environment lacking the minimal medical standards, or both. Many electronic resources maintained by various nonprofit organizations provide helpful and free downloadable materials on different aspects of abortion. Health professional organizations with useful websites include the Association of Reproductive Health Professionals , whose members provide reproductive health services and education, conduct reproductive health research, and influence reproductive health policy. Another authoritative source is the American College of Obstetricians and Gynecologists , whose 52,000 members comprise over 90 percent of US board-certified obstetrician-gynecologists. The broad international focus of the WHO’s Sexual and Reproductive Health division means that many of its materials relate to all major parts of the world. Gynuity Health Projects and Ipas conduct research and technical assistance focused on improving and expanding access to methods, including safe and more acceptable abortion services that reduce maternal mortality and morbidity. The Guttmacher Institute conducts research and policy analysis related to abortion in the United States and internationally and makes much of its information available online.

American College of Obstetricians and Gynecologists .

This website includes various publications and resource guides on abortion as well as on many other aspects of women’s health care.

Association of Reproductive Health Professionals .

This website carries links to featured research, clinical publications and resources, and news on abortion as well as vetted links to organizations for patients seeking abortion information.

Grimes, David A., and Stuart B. Gretchen. 2010. Abortion jabberwocky: The need for better terminology. Contraception 81.2: 93–96.

DOI: 10.1016/j.contraception.2009.09.005 Save Citation » Export Citation » Share Citation »

This article is a lively critique of widely used but imprecise, misleading, and ambiguous terminology associated with how abortion is considered in both the lay and the professional literature. The authors discuss a number of such problematic terms in the public health, medical, and social science fields. Available online for purchase or by subscription.

Guttmacher Institute .

The Guttmacher Institute makes available online a range of resources, including fact sheets, media kits, state policy briefs, reports, and policy and research articles related to abortion.

Gynuity Health Projects .

Gynuity Health Projects maintains a website that includes links to various resources and publications that it has developed for health-care providers, policy makers, and advocates.

HRP: Sexual and Reproductive Health .

The WHO’s special program for research on human reproduction, HRP, conducts research to help eliminate unsafe abortion. HRP’s website makes the agency’s publications and research findings available.

Ipas provides a number of resources related to abortion, both for health-care providers and researchers, that are accessible through its website.

Wilcox, Allen J. 2010. Fertility and pregnancy: An epidemiologic perspective . New York: Oxford Univ. Press.

Written by an epidemiologist, this informative textbook on reproduction and pregnancy includes a discussion of early pregnancy loss.

Abortion and infanticide were historically used after conception to control fertility. Riddle 1992 documents how women from ancient Egyptian times to the 15th century relied on an extensive pharmacopoeia of herbal abortifacients and contraceptives as well as manipulation to regulate fertility. Himes 1963 outlines the widespread knowledge of such ancient and premodern practices and of their menstrual-regulating qualities, which herbalists, laywomen, and health healers across the world handed down for generations. However, knowledge of these practices, many risky and ineffective, gradually became viewed with more suspicion by medical and pharmaceutical personnel keen to assert their professional role and interests. Mohr 1978 reviews the history of abortion in the United States since the colonial days, with a focus on the enactment of restrictive 19th-century laws at the state level. The author further examines how the medical establishment was far more instrumental than religious activism in pushing through the late-19th-century wave of antiabortion legislation, even though it became among its foremost advocates a century later. Stringent antiabortion laws were also passed in Europe in the 19th century. Both Gordon 2007 and Joffe 1995 report how safe abortions were performed for some women by highly skilled laypersons and physicians through the 20th century, when attitudes slowly became more liberal. Tribe 1990 provides one of the more widely cited surveys of the historical, legal, and moral issues related to abortion. By the 1970s, abortion had been legalized in Japan and most European countries. In the United States, the 1973 Supreme Court ruling Roe v. Wade permitted abortions during the first three months of pregnancy and with increasing restrictions thereafter. The Court subsequently reaffirmed its landmark decision despite numerous legal challenges, although in 1976 the US Congress passed the Hyde Amendment, which barred the use of Medicaid funds for abortion except for all but the most extreme circumstances (rape, incest, or if the pregnant woman’s life was threatened). Abortion-related mortality fell greatly after nationwide legalization as documented by numerous sources, including Coble, et al. 1992 . However, conflict over abortion continues, with many of its underpinnings described in Luker 1984 . This authoritative study avoids common negative stereotypes and shows that the contrasting worldviews of pro-choice and pro-life activists are rooted in different sets of values and ideas about women’s roles.

Coble, Yank D., E. Harvey Estes, C. Alvin Head, et al. 1992. Induced termination of pregnancy before and after Roe v. Wade : Trends in the mortality and morbidity of women. Journal of the American Medical Association 268.22: 3231–3239.

DOI: 10.1001/jama.1992.03490220075032 Save Citation » Export Citation » Share Citation »

This article compares the mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision with mortality and morbidity after Roe v. Wade . Available online for purchase or by subscription.

Gordon, Linda. 2007. The moral property of women: A history of birth control politics in America . Rev. ed. Urbana: Univ. of Illinois Press.

An updated edition of a widely cited history of the intense struggles over reproductive rights, including abortion, that have taken place over the past 150 years in America as seen from the perspective of women who are seeking sexual and reproductive self-determination.

Himes, Norman E. 1963. Medical history of contraception . New York: Gamut.

Written by an anthropologist, this significant study provides extensive documentation of the use of birth control from preliterate cultures to the 1930s and reports that many earlier societies relied on abortion and infanticide. Originally published in 1936.

Joffe, Carole E. 1995. Doctors of conscience: The struggle to provide abortion before and after Roe v. Wade . Boston: Beacon.

In contrast to other accounts, this study of the experiences of physicians is placed within a discussion of important health policy issues. It also examines how the medical profession has marginalized abortion services before and since their legalization as well as the role it could play in improving abortion services.

Luker, Kristin. 1984. Abortion and the politics of motherhood . Berkeley: Univ. of California Press.

Based on detailed fieldwork, this work is a detailed sociological examination of the different perceptions of abortion and related issues held by different groups of women.

Mohr, James C. 1978. Abortion in America: The origins and evolution of national policy, 1800–1900 . New York: Oxford Univ. Press.

An influential and heavily cited history of abortion in 19th-century America. This study also highlights the role of regularly trained physicians in the movement to criminalize abortion.

Riddle, John M. 1992. Contraception and abortion from the ancient world to the Renaissance . Cambridge, MA: Harvard Univ. Press.

This study collates disparate historical sources of knowledge about fertility control and how this female-centered, oral culture was passed on until it was lost in the Early Modern period due to the organization of medicine. Physicians’ ties with folk traditions were broken as they became increasingly trained in universities, where fertility regulation was not part of the curriculum.

Tribe, Laurence H. 1990. Abortion: The clash of absolutes . New York: Norton.

This work is a review by a well-known constitutional law scholar of the historical, legal, and moral issues related to abortion both in the United States and in different parts of the world.

Laws determine the official availability of abortion services and also their safety. Changes in abortion legislation monitored by the United Nations show modest increases for the period 1996–2013 in the number of countries allowing early abortion for social or economic reasons, or on request, but only about one-third permit it on such grounds ( United Nations Department of Economic and Social Affairs 2014 ). Kulczycki 1999 analyzes the forces shaping the abortion debate and controversy globally and how these have shaped abortion trends and policies beyond Western liberal democracies. Cook, et al. 2014 examines recent transnational legal developments. Although the risk of death and injury to women seeking abortion is always present in countries where abortion is illegal, safe abortion services are readily accessible for those able to pay for them, as in nearly all of Latin America, the region of the world with the most restrictive abortion laws ( Kulczycki 2011 ). Two well-documented case studies demonstrate how legalizing abortion increases the safety of the procedure. When Romania banned abortion and contraceptives in 1966, maternal deaths soared, but after the procedure was legalized again in 1990 and access to modern contraceptives improved, they fell sharply ( David 1999 ; Stephenson, et al. 1992 ). After abortion became available on the request of a pregnant woman in South Africa in 1997 and postabortion care and family planning services improved, abortion-related deaths fell by 91 percent during the period 1994–2001, with steep declines in serious morbidity also observed ( Jewkes, et al. 2005 ). The actual implementation of laws and societal and cultural views on sexuality and reproduction, further condition access to abortion. India has more abortion-related deaths than any other country despite closely following the United Kingdom in allowing abortion on public health grounds. Poor and rural women are most likely to have clandestine procedures, often performed by untrained persons in unhygienic conditions at sites other than registered government institutions. Many women are not aware of the legal status of abortion and services are insufficient to meet the demand. In 1994, India banned prenatal testing when done solely to determine the sex of the fetus, but Jha, et al. 2011 shows that most of India’s population now lives in states where selective abortion of girls is common, especially for pregnancies after a first-born girl. The diffusion of safer, less costly abortion methods and ultrasound examination technology and the persistence of son preference in various South and East Asian societies have contributed to the rise of sex-selective abortion. However, normative changes have driven a reversal of this trend in South Korea.

Cook, Rebecca J., Joanna N. Erdman, and Bernard M. Dickens, eds. 2014. Abortion law in transnational perspective: Cases and controversies . Philadelphia: Univ. of Philadelphia Press.

This edited volume examines recent transnational legal developments, including judicial decisions, constitutional texts, and regulatory reforms of abortion law in a number of countries and regions.

David, Henry, ed. 1999. From abortion to contraception: A resource to public policies and reproductive behavior in central and eastern Europe from 1917 to the present . Westport, CT: Greenwood.

This edited work chronicles the interaction of public policies and private reproductive behavior in the twenty-eight formerly socialist countries of central and eastern Europe and the USSR successor states from 1917 to the present.

Jewkes, Rachel, Helen Rees, Kim Dickson, Heather Brown, and Jonathan Levin. 2005. The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change . British Journal of Obstetrics and Gynaecology 112.3: 355–359.

DOI: 10.1111/j.1471-0528.2004.00422.x Save Citation » Export Citation » Share Citation »

A descriptive study using hospital data to show that legalization of abortion in South Africa reduced abortion mortality and morbidity, especially in younger women. Comparisons are drawn to an earlier study undertaken in 1994 before legislative change.

Jha, Prabhat, Maya A. Kesler, Rajesh Kumar, et al. 2011. Trends in selective abortions of girls in India: Analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011. Lancet 377.9781: 1921–1928.

DOI: 10.1016/S0140-6736(11)60649-1 Save Citation » Export Citation » Share Citation »

This study assesses sex ratios by birth order from 1990 to 2005 using nationally representative surveys and quantifies the totals of selective abortions of girls with census cohort data. Declines in the conditional sex ratio of second-order births after a firstborn girl are much greater in more educated mothers and in wealthier households. This is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. Available online for purchase or by subscription.

Kulczycki, Andrzej. 1999. The abortion debate in the world arena . New York: Routledge.

DOI: 10.1057/9780230379183 Save Citation » Export Citation » Share Citation »

This book examines abortion trends and debate, reproductive behavior, and related public health considerations in three countries in particular (Kenya, Mexico, and Poland), seen as regional bellwethers of how abortion is treated, including within the policy-making process.

Kulczycki, Andrzej. 2011. Abortion in Latin America: Changes in practice, growing conflict, and recent policy developments. Studies in Family Planning 42.3: 199–220.

DOI: 10.1111/j.1728-4465.2011.00282.x Save Citation » Export Citation » Share Citation »

This article is a regional analysis of the rapidly changing practice and context of abortion in Latin America, including legal and policy developments, and contrasting country situations. Available online for purchase or by subscription.

Stephenson, Patricia, Marsden Wagner, Mihaela Badea, and Florina Serbanescu. 1992. Commentary: The public health consequences of restricted induced abortion; Lessons from Romania . American Journal of Public Health 82.10: 1328–1331.

DOI: 10.2105/AJPH.82.10.1328 Save Citation » Export Citation » Share Citation »

This article reviews the public health consequences of restricted abortion in Romania, where the pronatalist policies of the Ceaucescu regime resulted in the highest maternal mortality rate in Europe and in thousands of unwanted children in institutions.

United Nations Department of Economic and Social Affairs. 2014. Abortion policies and reproductive health around the world . New York: United Nations.

The United Nations tracks changes in the legal status of induced abortion worldwide. Its most recent overview includes a tabulated summary of key reproductive health indicators and governments’ officially stated levels of concern and support for various reproductive health policies.

An estimated one in five pregnancies worldwide are aborted, but the incidence of abortion is known in detail only for those countries where abortion is legally permitted with few restrictions and official statistics are reasonably complete. Sedgh, et al. 2016 (cited under General Overviews ) provides a recent summary of these trends. Rossier 2003 and Singh, et al. 2010 review the range of estimation methodologies developed for use in contexts where abortion is legally restricted and where it remains a very sensitive issue. In the United States, the Centers for Disease Control and Prevention compiles annual numbers and basic characteristics of women obtaining abortions, such as its report for 2013 ( Jatlaoui, et al. 2016 ). However, these data are unavailable for some states and are of varying reliability for others in which reporting is not mandatory or is poorly enforced. A more complete count of the total number of abortions is available from the Guttmacher Institute based on its periodic census of abortion providers, with certain characteristics also available through its surveys of women having abortions. The US abortion rate fell to an estimated 15 abortions per 1,000 women aged 15–44 in 2014, primarily due to improved contraceptive use ( Jones and Jerman 2017 ). Both unintended pregnancy and abortion rates are higher among certain groups of women, typically including those under age thirty, in poverty, and from more disadvantaged racial and ethnic minority groups. The World Health Organization presents national, regional, and global estimates of unsafe abortion and associated mortality ( Åhman and Shah 2011 ). It also estimated that abortion-related deaths still account for about 8 percent of maternal mortality worldwide, although these deaths are often underreported ( Say, et al. 2014 ). Evidence from a diverse set of countries shows that, over time, abortion rates fall as levels of contraceptive use rise ( Marston and Cleland 2003 ). The highest abortion rates in the world are found in many former Soviet bloc republics, and Westoff 2005 reports how levels of abortion fell to a varying degree as the availability, accessibility, and quality of available contraceptive options improved. However, even widespread modern contraceptive use will not entirely eliminate abortions because no contraceptive works perfectly every time. Women have abortions for many reasons, most often because they feel unable in their current circumstances to fulfill their parental responsibilities as they would like or to provide the kind of family support they believe their children deserve ( Biggs, et al. 2013 ).

Åhman, Elisabeth, and Iqbal Shah. 2011. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 . 6th ed. Geneva, Switzerland: World Health Organization.

The sixth update in a series of reports on the topic, with this round pertaining to 2008.

Biggs, M. Antonia, Heather Gould, and Diana G. Foster. 2013. Understanding why women seek abortions in the US . BMC Women’s Health 13:29.

DOI: 10.1186/1472-6874-13-29 Save Citation » Export Citation » Share Citation »

This study of 954 women recruited at thirty different abortion facilities across the United States identified eleven predominant themes, although most women reported multiple reasons for seeking an abortion, in common with previous studies.

Jatlaoui, Tara C., Alexander Ewing, Michele G. Mandel, et al. 2016. Abortion Surveillance—United States, 2013. Morbidity and Mortality Weekly Report Surveillance Summaries 65.12: 1–44.

CDC’s surveillance system compiles information on legal induced abortions. More information is available online . This source provides the latest available annual assessment, which is also available online .

Jones, Rachel K., and Jenna Jerman. 2017. Abortion incidence and service availability in the United States, 2014. Perspectives on Sexual and Reproductive Health 49.1: 3–14.

DOI: 10.1363/psrh.12015 Save Citation » Export Citation » Share Citation »

This report shows the long-term decline in US abortion incidence, which in 2014 fell below one million for the first time since abortion was legalized nationally in 1973. Available online for purchase or by subscription.

Marston, Cicely, and John Cleland. 2003. Relationships between contraception and abortion: A review of the evidence. International Family Planning Perspectives 29.1: 6–13.

DOI: 10.2307/3180995 Save Citation » Export Citation » Share Citation »

This article reviews data from countries with reliable information on both contraception and abortion. It also explores how the relationship between them may be mediated by the stability of levels of fertility.

Rossier, Clémentine. 2003. Estimating induced abortion rates: A review. Studies in Family Planning 34.2: 87–102.

DOI: 10.1111/j.1728-4465.2003.00087.x Save Citation » Export Citation » Share Citation »

The author describes the methodological requirements, advantages and disadvantages, and empirical records of eight methods used to estimate the frequency of abortion. Available online for purchase or by subscription.

Say, Lale, Doris Chou, Alison Gemmill, et al. 2014. Global causes of maternal death: A WHO systematic analysis. Lancet Global Health 2.6: e323–e333.

DOI: 10.1016/S2214-109X(14)70227-X Save Citation » Export Citation » Share Citation »

This article develops and analyses global, regional, and subregional estimates of major causes of maternal death, including abortion, during 2003–09.

Singh, Susheela, Remez Lisa, and Alyssa Tartaglione, eds. 2010. Methodologies for estimating abortion incidence and abortion-related morbidity: A review . New York: Guttmacher Institute.

Based on a seminar convened on the topic by the International Union for the Scientific Study of Population, each of the fourteen chapters in this volume is available separately, along with the full report, online .

Westoff, Charles F. 2005. Recent trends in abortion and contraception in 12 countries . Calverton, MD: ORC Macro.

This report analyzes recent trends in abortion and contraception in twelve central Asian and eastern European countries where abortion had long been an important birth control method. All have experienced sharp declines in the number of children desired and in fertility rates, and most, but not all, have seen falling abortion and rising contraceptive prevalence rates.

Abortion is one of the safest procedures in medicine when conducted early in a pregnancy by a trained provider under hygienic conditions. Estimates show that for the United States the risk of death associated with childbirth is about fourteen times higher than that associated with all abortions ( Raymond and Grimes 2012 ) and would be even lower with improved prevention of unintended pregnancy and increased access to early abortion services ( Zane, et al. 2015 ). Paul, et al. 2009 (cited under General Overviews ) describes both surgical and medical methods of abortion. Vacuum aspiration is the preferred surgical method prior to twelve weeks’ gestation and the suction mechanism may be electric or manual (MVA). Dilatation and curettage (D&C or sharp curettage) carries higher risks and is now recommended by the WHO only when MVA is unavailable, although it remains performed for a variety of other gynecological reasons. A medical (or medication abortion) ends an early-term pregnancy (typically before nine weeks’ gestation) by pharmacological drugs. It involves a combination of mifepristone (an antiprogestogen, also known by its brand name, Mifeprex and previously as RU-486) followed by a prostaglandin, usually misoprostol, that causes uterine contractions. It is safe, effective, and acceptable to most women. Early abortion before nine weeks gestation with mifepristone/misoprostol combinations has replaced many surgical procedures. Although less effective, the use of misoprostol alone for abortion has increased throughout Latin America, reducing complications related to self-induced procedures and other unsafe abortions, thereby also decreasing the number of women admitted to hospitals ( Ipas 2010 ). In the United States, about one in nine abortions are performed in the second trimester, for which a very rare procedure, intact dilatation and extraction, was federally banned in 2003. Opponents labeled it “partial-birth abortion,” a term that remains in use in the vernacular but is not recognized medically ( Johnson, et al. 2005 ). Several hypothesized potential side-effects of abortion have been the subject of much controversy. Breast cancer and adverse mental health effects are two such disputed side effects. Abortion has been postulated to increase the risk of developing breast cancer, but the scientific consensus is that no such association exists (e.g., National Cancer Institute 2003– , Collaborative Group on Hormonal Factors in Breast Cancer 2004 ). Claims have also been made about the emotional effects of abortion, but these are largely benign, at least in countries where abortion is legal and safely performed ( Charles, et al. 2008 ). Also, postabortion syndrome is not a valid psychiatric or medical diagnosis ( Major, et al. 2008 ). Being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes than having an abortion, but outcomes for both groups eventually converge ( Biggs, et al. 2017 ).

Biggs, M. Antonia, Ushma D. Upadhyay, Charles E. McCulloch, et al. 2017. Women’s mental health and well-being 5 years after receiving or being denied an abortion: A prospective, longitudinal cohort study. JAMA Psychiatry 74.2: 169–178.

DOI: 10.1001/jamapsychiatry.2016.3478 Save Citation » Export Citation » Share Citation »

Findings from a five-year longitudinal (“Turnaway”) study that examined mental health and other effects of receiving or being denied an abortion. Psychological well-being improved over time so that both groups of women eventually converged.

Charles, Vignetta E., Chelsea B. Polis, Srinivas K. Sridhara, and Robert W. Blum. 2008. Abortion and long term mental health outcomes: A systematic review of the evidence. Contraception 78.6: 436–450.

DOI: 10.1016/j.contraception.2008.07.005 Save Citation » Export Citation » Share Citation »

Articles focused on the potential association between abortion and long-term mental health outcomes are rated for their methodological quality and appropriateness to explore the research question. Better quality studies suggest few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae. Available online for purchase or by subscription.

Collaborative Group on Hormonal Factors in Breast Cancer. 2004. Breast cancer and abortion: Collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. Lancet 363.9414: 1007–1016.

DOI: 10.1016/S0140-6736(04)15835-2 Save Citation » Export Citation » Share Citation »

A meta-analysis of available epidemiological evidence worldwide, this study shows no relation between induced abortion (or previous miscarriage) and the risk of subsequent breast cancer. Available online for purchase or by subscription.

Ipas. 2010. Misoprostol and medical abortion in Latin America and the Caribbean . Chapel Hill, NC: Ipas.

This report discusses how misoprostol, a proven medication for a variety of obstetric and gynecologic uses, is being increasingly used in Latin America, thereby reducing incomplete abortions and related mortality and morbidity.

Johnson, Timothy R. B., Lisa H. Harris, Vanessa K. Dalton, and Joel D. Howell. 2005. Language matters: Legislation, medical practice, and the classification of abortion procedures. Obstetrics & Gynecology 105.1: 201–204.

DOI: 10.1097/01.AOG.0000149803.31623.b0 Save Citation » Export Citation » Share Citation »

This article discusses changing medical practice concerning abortion, efforts to clarify and obfuscate medical language, and legislative attempts to keep up with such changes. Available online for purchase or by subscription.

Major, Brenda, Mark Appelbaum, Linda Beckman, Mary Ann Dutton, Nancy Felipe Russo, and Carolyn West. 2008. Report of the APA task force on mental health and abortion . Washington, DC: American Psychological Association.

This report concludes that a first abortion does not lead to any increased risk of mental health problems. Evidence for multiple terminations is more equivocal in part due to methodological difficulties and also because the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health problems.

National Cancer Institute. 2003–. Summary report: Early reproductive events and breast cancer workshop . Atlanta: National Institutes of Health.

This report emerged from an extensive workshop on early reproductive events and cancer and was updated with more recent evidence in 2010. The review of the available evidence does not support any hypothesis that early termination of pregnancy causes breast cancer.

Raymond, Elizabeth G., and David A. Grimes. 2012. The comparative safety of legal induced abortion and childbirth in the United States. Obstetrics & Gynecology 119.2, Part 1: 215–219.

DOI: 10.1097/AOG.0b013e31823fe923 Save Citation » Export Citation » Share Citation »

Using national surveillance, survey, and birth certificate data for 1998–2005, the authors find that the risk of death associated with childbirth (8.8 deaths per 100,000 live births) is approximately fourteen times higher than that with abortion (0.6 deaths per 100,000). Similarly, the overall morbidity associated with childbirth exceeds that with abortion. Available online for purchase or by subscription.

Zane, Suzanne, Andreea A. Creanga, Cynthia J. Berg, et al. 2015. Abortion-related mortality in the United States, 1998–2010. Obstetrics & Gynecology 126.2: 258–265.

DOI: 10.1097/AOG.0000000000000945 Save Citation » Export Citation » Share Citation »

This article examines characteristics and causes of legal induced abortion-related deaths. Abortion mortality rates are computed by maternal age, gestational age, and race and the distribution of causes of death by gestational age and procedure.

Postabortion care (PAC) is needed to provide both emergency treatment for complications caused by incomplete or spontaneous abortion and family planning counseling and services to prevent future unplanned pregnancies that may result in repeat abortions. The Postabortion Care Consortium was formed in 1993 by family planning and reproductive health agencies, nongovernmental organizations, and donor agencies. Its expanded and updated Essential Elements of PAC model includes emergency treatment of postabortion complications, strengthening contraceptive provision and family planning services, providing referrals to other accessible facilities for other reproductive health services, building partnerships with communities and service providers, and counseling for women’s emotional and physical health needs and other concerns. Billings and Benson 2005 and Senlet, et al. 2001 describe the experience of several Latin American countries and Turkey, respectively, in institutionalizing the provision of the main elements of PAC. The revised PAC model was extended in practice by the CATALYST Consortium of reproductive health and family planning agencies initiated by the US Agency for International Development (USAID; CATALYST Consortium 2005 ). Curtis 2007 describes more recent strategies by USAID in tandem with multiple organizations to provide this critical health-care service, and multiple downloadable resources are available from USAID’s Information and Knowledge for Optimal Health (INFO) Project and the Postabortion Care Consortium . Huber, et al. 2016 reviews findings from PAC studies published in the peer-reviewed and gray literature and proceeds to highlight programmatic implications. Overall, PAC services have expanded in a number of countries and their quality has generally improved, but a recent assessment— RamaRao, et al. 2011 —points out that in many countries where abortion is legally restricted or otherwise sensitive, PAC services are often deficient, and postabortion contraceptive counseling is still poorly integrated with family planning and other reproductive health care.

Billings, Deborah L., and Janie Benson. 2005. Postabortion care in Latin America: Policy and service recommendations from a decade of operations research . Health Policy and Planning 20.3: 158–166.

DOI: 10.1093/heapol/czi020 Save Citation » Export Citation » Share Citation »

This article reviews results from ten major PAC operations research projects conducted in public sector hospitals in seven Latin American countries. These operations achieved positive outcomes and indicated that more comprehensive PAC can and should be made available.

CATALYST Consortium. 2005. PAC compilation document . Washington, DC: US Agency for International Development.

This report documents PAC programs implemented in Bolivia, Egypt, and Peru as well as lessons learned.

Curtis, Carolyn. 2007. Meeting health care needs of women experiencing complications of miscarriage and unsafe abortion: USAID’s postabortion care program. Journal of Midwifery & Women’s Health 52.4: 368–375.

DOI: 10.1016/j.jmwh.2007.03.005 Save Citation » Export Citation » Share Citation »

This article describes the five-year strategy initiated in 2003 by USAID to provide financial and technical assistance for PAC services in seven countries. Available online for purchase or by subscription.

Huber, Douglas, Carolyn Curtis, Laili Irani, Sara Pappa, and Lauren Arrington. 2016. Postabortion care: 20 years of strong evidence on emergency treatment, family planning, and other programming components. Global Health: Science and Practice 4.3: 481–494.

A review of findings from studies published between 1994 and 2013 that offer strong evidence on postabortion care (PAC) and its components, particularly in low- and middle-income countries. In addition, the article considers some of the important programmatic implications.

Postabortion Care Consortium .

This website describes the essential elements of a widely adopted model of PAC care. It also makes available information and resources about PAC care, with examples from different parts of the world.

RamaRao, Saumya, John W. Townsend, Nafissatou Diop, and Sarah Raifman. 2011. Postabortion care: Going to scale . International Perspectives on Sexual and Reproductive Health 37.1: 40–44.

DOI: 10.1363/3704011 Save Citation » Export Citation » Share Citation »

This article reviews what is required to scale up PAC programs in many countries and obstacles that must be overcome to make such services more accessible.

Senlet, Pinar, Levent Cagatay, Julide Ergin, and Jill Mathis. 2001. Bridging the gap: Integrating family planning with abortion services in Turkey . International Family Planning Perspectives 27.2: 90–95.

DOI: 10.2307/2673821 Save Citation » Export Citation » Share Citation »

This article reviews Turkey’s experience of implementing and scaling up postabortion family planning services, which were delivered through three related phases. This process reduced abortion through increasing contraceptive use, tilting the method mix toward more effective methods, and securing the commitment of decision makers.

US Agency for International Development. Information and Knowledge for Optimal Health (INFO) Project .

The INFO project website provides multiple resources that can be freely downloaded on PAC. These include a guide to research evidence on PAC, recommended policies, service delivery guidelines, assessment tools, and other documents and tools.

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• Fact sheets /
• Six out of 10 unintended pregnancies end in induced abortion.
• Abortion is a common health intervention. It is very safe when carried out using a method recommended by WHO, appropriate to the pregnancy duration and by someone with the necessary skills.
• However, around 45% of abortions are unsafe.
• Unsafe abortion is an important preventable cause of maternal deaths and morbidities. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems.
• Lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue.

Around 73 million induced abortions take place worldwide each year. Six out of 10 (61%) of all unintended pregnancies, and 3 out of 10 (29%) of all pregnancies, end in induced abortion (1) .

Comprehensive abortion care is included in the list of essential health care services published by WHO in 2020. Abortion is a simple health care intervention that can be safely and effectively managed by a wide range of health workers using medication or a surgical procedure. In the first 12 weeks of pregnancy, a medical abortion can also be safely self-managed by the pregnant person outside of a health care facility (e.g. at home), in whole or in part. This requires that the woman has access to accurate information, quality medicines and support from a trained health worker (if she needs or wants it during the process).

Comprehensive abortion care includes the provision of information, abortion management and post-abortion care. It encompasses care related to miscarriage (spontaneous abortion and missed abortion), induced abortion (the deliberate interruption of an ongoing pregnancy by medical or surgical means), incomplete abortion as well as intrauterine fetal demise.

The information in this fact sheet focuses on care related to induced abortion.

Scope of the problem

When carried out using a method recommended by WHO appropriate to the pregnancy duration, and by someone with the necessary skills, abortion is a safe health care intervention (5).

However, when people with unintended pregnancies face barriers to attaining safe, timely, affordable, geographically reachable, respectful and non-discriminatory abortion care, they often resort to unsafe abortion. 1

Global estimates from 2010–2014 demonstrate that 45% of all induced abortions are unsafe. Of all unsafe abortions, one third were performed under the least safe conditions, i.e. by untrained persons using dangerous and invasive methods.  More than half of all these unsafe abortions occurred in Asia, most of them in south and central Asia. In Latin American and Africa, the majority (approximately 3 out of 4) of all abortions were unsafe. In Africa, nearly half of all abortions occurred under the least safe circumstances (3) .

Consequences of inaccessible quality abortion care

Lack of access to safe, affordable, timely and respectful abortion care, and the stigma associated with abortion, pose risks to women’s physical and mental well-being throughout the life-course.

Inaccessibility of quality abortion care risks violating a range of human rights of women and girls, including the right to life; the right to the highest attainable standard of physical and mental health; the right to benefit from scientific progress and its realization; the right to decide freely and responsibly on the number, spacing and timing of children; and the right to be free from torture, cruel, inhuman and degrading treatment and punishment.

One review from 2003–12, found that 4.7-13% of maternal deaths were linked to abortive pregnancy outcomes (4) but noted that maternal deaths due to abortion, and more specifically unsafe abortion, are often misclassified and underreported given the stigma. 

Deaths from safe abortion are negligible, <1/100 000 (5). On the other hand, in regions where unsafe abortions are common, the death rates are high, at > 200/100 000 abortions. Estimates from 2012 indicate that in developing countries alone, 7 million women per year were treated in hospital facilities for complications of unsafe abortion (6) .

Physical health risks associated with unsafe abortion include:

• incomplete abortion (failure to remove or expel all pregnancy tissue from the uterus);
• haemorrhage (heavy bleeding);
• uterine perforation (caused when the uterus is pierced by a sharp object); and
• damage to the genital tract and internal organs as a consequence of inserting dangerous objects into the vagina or anus.

Restrictive abortion regulation can cause distress and stigma, and risk constituting a violation of human rights of women and girls, including the right to privacy and the right to non-discrimination and equality, while also imposing financial burdens on women and girls. Regulations that force women to travel to attain legal care, or require mandatory counselling or waiting periods, lead to loss of income and other financial costs, and can make abortion inaccessible to women with low resources (6,8) .

Estimates from 2006 show that complications of unsafe abortions cost health systems in developing countries US$ 553 million per year for post-abortion treatments. In addition, households experienced US$ 922 million in loss of income due to long-term disability related to unsafe abortion (10) . Countries and health systems could make substantial monetary savings by providing greater access to modern contraception and quality induced abortion (8,9) .

Expanding quality abortion care

Evidence shows that restricting access to abortions does not reduce the number of abortions (1) ; however, it does affect whether the abortions that women and girls attain are safe and dignified. The proportion of unsafe abortions are significantly higher in countries with highly restrictive abortion laws than in countries with less restrictive laws (2) .

Barriers to accessing safe and respectful abortion include high costs, stigma for those seeking abortions and health care workers, and the refusal of health workers to provide an abortion based on personal conscience or religious belief. Access is further impeded by restrictive laws and requirements that are not medically justified, including criminalization of abortion, mandatory waiting periods, provision of biased information or counselling, third-party authorization and restrictions regarding the type of health care providers or facilities that can provide abortion services.

Multiple actions are needed at the legal, health system and community levels so that everyone who needs abortion care has access to it. The three cornerstones of an enabling environment for quality comprehensive abortion care are:

• respect for human rights, including a supportive framework of law and policy;
• the availability and accessibility of information; and
• a supportive, universally accessible, affordable and well functioning health system.

A well-functioning health system implies many factors, including:

• evidence-based policies;
• universal health coverage;
• the reliable supply of quality, affordable medical products and equipment;
• that an adequate number of health workers, of different types, provide abortion care at a reachable distance to patients; 
• the delivery of abortion care through a variety of approaches, e.g. care in health facilities, digital interventions and self-care approaches, allowing for choices depending on the values and preferences of the pregnant person, available resources, and the national and local context;
• that health workers are trained to provide safe and respectful abortion care, to support informed decision-making and to interpret laws and policies regulating abortion;
• that health workers are supported and protected from stigma; and
• provision of contraception to prevent unintended pregnancies.

Availability and accessibility of information implies:

• provision of evidence-based comprehensive sexuality education; and
• accurate, non-biased and evidence-based information on abortion and contraceptive methods.

WHO response

WHO provides global technical and policy guidance on the use of contraception to prevent unintended pregnancy, provision of information on abortion care, abortion management (including miscarriage, induced abortion, incomplete abortion and fetal death) and post-abortion care. In 2022, WHO published an updated, consolidated guideline on abortion care, including all WHO recommendations and best practice statements across three domains essential to the provision of abortion care: law and policy, clinical services and service delivery. 

WHO also maintains the Global Abortion Policies Database . This interactive online database contains comprehensive information on the abortion laws, policies, health standards and guidelines for all countries. 

Upon request, WHO provides technical support to countries to adapt sexual and reproductive health guidelines to specific contexts and strengthen national policies and programmes related to contraception and safe abortion care. A quality abortion care monitoring and evaluation framework is also in development.

WHO is a cosponsor of the HRP (UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) , which carries out research on clinical care, abortion regulation, abortion stigma, as well as implementation research on community and health systems approaches to quality abortion care. It also monitors the global burden of unsafe abortion and its consequences.

1 An “unsafe abortion” is defined as a procedure for terminating a pregnancy performed by persons lacking the necessary information or skills or in an environment not in conformity with minimal medical standards, or both. The persons, skills and medical standards considered safe in the provision of abortion are different for medical and surgical abortion and by pregnancy duration. In using this definition, what is considered ‘safe’ or unsafe needs to be interpreted in line with the most current WHO technical and policy guidance (2).

(1) Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6. 

(2) Ganatra B, Tunçalp Ö, Johnston H, Johnson BR, Gülmezoglu A, Temmerman M. From concept to measurement: Operationalizing WHO's definition of unsafe abortion. Bull World Health Organ 2014;92:155; 10.2471/BLT.14.136333.

(3) Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017 Sep.

(4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.

(5) Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012 Feb;119(2 Pt 1):215-9. doi: 10.1097/AOG.0b013e31823fe923. PMID: 22270271.

(6) Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG 2015; published online Aug 19. DOI:10.1111/1471-0528.13552.

(7) Coast E, Lattof SR, Meulen Rodgers YV, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PLoS One. 2021 Jun 9;16(6):e0252005. doi: 10.1371/journal.pone.0252005. PMID: 34106927; PMCID: PMC8189560.

(8) Lattof SR, Coast E, Rodgers YVM, Moore B, Poss C. The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems. PLoS One. 2020 Nov 4;15(11):e0237227. doi: 10.1371/journal.pone.0237227. PMID: 33147223; PMCID: PMC7641432.

(9) Rodgers YVM, Coast E, Lattof SR, Poss C, Moore B. The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes. PLoS One. 2021 May 6;16(5):e0250692. doi: 10.1371/journal.pone.0250692. PMID: 33956826; PMCID: PMC8101771.

(10). Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports 59).

• Abortion care guideline
• Classification of abortions by safety: article in The Lancet
• Quality of care
• Maintaining essential health services during the COVID-19 outbreak
• Sexual and reproductive health and research including the Special Programme HRP

Global Abortion Policies Database

Related health topic

A Tragic Conflict of Competing Goods

Searching for nuance at a pivotal moment in the abortion debate

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Conversations of Note

Abortion has been discussed intensely this past week due to oral arguments in a Supreme Court case that could significantly alter the constitutional right to the procedure in the United States. At issue is a Mississippi law that bans abortions after 15 weeks of pregnancy, contra current precedent. If upheld, the law will likely inspire new abortion restrictions in many red states.

The Legal Fight

We begin with the law’s sponsor, Becky Currie , a Mississippi state legislator and registered nurse. “I pray my bill will save millions of babies,” she wrote in Newsweek , where she explained that she’s helped to deliver many, including a 14-week-old born too early to survive. “I stayed with the mother and baby, watching his heart continue to beat in his tiny chest for about 20 minutes,” she recounted. “Preborn babies can feel pain by 15 weeks,” she argued, noting that many countries protect them at 12 weeks. She wants SCOTUS to take what she characterizes as “a monumental step to limit abortions and protect preborn life by restoring the constitutional protections that long existed in our nation until the disastrous decision in Roe v. Wade .”

The Harvard Law professor Jeannie Suk Gersen framed the law differently. In her telling, it is not an attempt to restore a right to life; it is an attempt to abrogate a constitutional right to privacy and bodily autonomy. “The conservative Justices seemed eager to ‘return’ the question of abortion to the people,” she wrote after listening to oral arguments in the case. “But the point of a fundamental constitutional right is that it shouldn’t be at the people’s mercy, particularly when the composition of the Court itself has been shifted through political means for this purpose.”

What’s more, she argued that the Supreme Court would undermine its own authority by overturning a long-standing precedent in response to a state law that ran afoul of it. As she put the argument: “The spectacle of states brazenly flying in the face of the Court’s constitutional precedents, shortly followed by the Court’s discarding those precedents to make illegal actions legal after all, would effectively communicate that the Supreme Court is not, in fact, supreme.”

The journalist Cynthia Gorney’s reported essay “ Gambling With Abortion ,” originally published in Harper’s , evenhandedly captures an earlier era of debate about so-called partial-birth abortion.

[Caitlin Flanagan: The dishonesty of the abortion debate ]

The Moral Debate

Ross Douthat recently made the straightforward case against abortion . Bill Scher attempted to rebut it , focusing on what he sees as the necessity of abortion rights if women and men are to be equal.

In a winding, sometimes graphic, carefully considered Boston Review essay, “ Why I Provide Abortions ,” Christine Henneberg wrote that she tries to preserve “the woman’s contextualized autonomy.”

I trust that my patients can take the facts I offer and make their own well-informed decisions, even if it is difficult. And it is often very, very difficult. When a woman asks to see a copy of her ultrasound image, I show it to her. When she asks to see the fetus after I’ve removed it (some women do), I will bring it into the room afterward in a small dish. One twenty-five-year-old mother of five asked if she was allowed to take the fetal tissue home to perform a funeral for it. In our clinic, this isn’t permitted; the consent she’d signed specified that all fetal tissue would be disposed of with biomedical waste. So instead she bowed her head toward the dish in my hand, closed her eyes, and whispered, “I love you. And I’m sorry.” The real secret is that abortion is difficult. It is difficult because in a pregnant woman, there are no clear physiologic boundaries, no clean line showing what belongs to whom. Also—and this might sound shocking, coming from someone on this “side” of the debate—it is difficult because mothers love their children, and they often don’t know exactly how to think about, or whether they are allowed to love, an unborn child. Every woman has her reasons for seeking abortion. She may not view her reasons as tragic—probably very few women do. But I am always aware of the tragedy in the shadows, the silent gray area: all the things she will never say outside of that room, the messy truths no one else wants to hear; all the ways we, as women, are squeezed into impossible choices by a society that decontextualizes our autonomy, devalues our work, and disregards our equality.

New York once published vignettes by 26 women describing their abortions. One example:

When I got pregnant with my son, my very controlling boyfriend had convinced me that birth control poisoned my body. We usually slept in the car. I took a pregnancy test peeing over the kind of bucket you mix concrete in outside a dilapidated, vacant house. I decided I couldn’t abort a baby based on a stupid decision I made. They tell you that you love the baby automatically, but it’s not true. Then, in 2008, I was pregnant by my boyfriend Steve. We worked together at Target. He wanted to get married and have the baby. I was barely supporting the son I had, still living with my parents. I didn’t want to be tied to Steve forever. My mom and I went to Planned Parenthood. It was pouring rain. The picketers met us at the car with disgusting pictures. I was quite emotional, but I was so scared that if I showed any emotions, they wouldn’t let me do it. I told them I already had a baby. The doctor acted like it was assembly-line work. I told Steve I miscarried. We dated another year. The secret was devastating. People might be more understanding if I’d had an abortion when I was living in a car in an abusive relationship. This time, I was on birth control, with a full-time job, a boyfriend. People might think I should’ve kept it, but I couldn’t.

Caitlin Flanagan argued in 2019 that the abortion debate is often dishonest because neither side wants to grapple with the most powerful arguments for the position that they hope to defeat.

The argument for abortion, if made honestly, requires many words: It must evoke the recent past, the dire consequences to women of making a very simple medical procedure illegal. The argument against it doesn’t take even a single word. The argument against it is a picture. This is not an argument anyone is going to win. The loudest advocates on both sides are terrible representatives for their cause. When women are urged to “shout your abortion,” and when abortion becomes the subject of stand-up comedy routines, the attitude toward abortion seems ghoulish. Who could possibly be proud that they see no humanity at all in the images that science has made so painfully clear? When anti-abortion advocates speak in the most graphic terms about women “sucking babies out of the womb,” they show themselves without mercy. They are not considering the extremely human, complex, and often heartbreaking reasons behind women’s private decisions. The truth is that the best argument on each side is a damn good one, and until you acknowledge that fact, you aren’t speaking or even thinking honestly about the issue. You certainly aren’t going to convince anybody. Only the truth has the power to move.

Similar conflictedness once led George McKenna to posit that “we can find in Lincoln’s anti-slavery rhetoric a coherent position that could serve as a model for pro-life politicians today.”

Here’s what he advised such a politician to say, in part:

If elected, I will not try to abolish an institution that the Supreme Court has ruled to be constitutionally protected, but I will do everything in my power to arrest its further spread and place it where the public can rest in the belief that it is becoming increasingly rare. I take very seriously the imperative, often expressed by abortion supporters, that abortion should be rare. Therefore, if I am elected, I will seek to end all public subsidies for abortion, for abortion advocacy, and for experiments on aborted children. I will support all reasonable abortion restrictions that pass muster with the Supreme Court, and I will encourage those who provide alternatives to abortion. Above all, I mean to treat it as a wrong. I will use the forum provided by my office to speak out against abortion and related practices, such as euthanasia, that violate or undermine the most fundamental of the rights enshrined in this nation’s founding charter.

As he saw it, the “permit, restrict, discourage” position “is unequivocally pro-life even as it is effectively pro-choice,” because “it does not say ‘I am personally opposed to abortion’; it says abortion is evil. Yet in its own way it is pro-choice … it does not demand an immediate end to abortion … it concludes that all those who oppose abortion can do right now is to contain the cancer … It thus acknowledges the present legal status of ‘choice’ even as it urges Americans to choose life.”

Question of the Week

“A striking thing about the American abortion debate,” Douthat wrote in his column , “is how little abortion itself is actually debated. The sensitivity and intimacy of the issue, the mixed feelings of so many Americans, mean that most politicians and even many pundits really don’t like to talk about it. The mental habits of polarization, the assumption that the other side is always acting with hidden motives or in bad faith, mean that accusations of hypocrisy or simple evil are more commonplace than direct engagement with the pro-choice or pro-life argument.”

The late Christopher Hitchens once wrote, “The only moral losers in this argument are those who say that there is no conflict, and nothing to argue about. The irresoluble conflict of right with right was Hegel’s definition of tragedy, and tragedy is inseparable from human life, and no advance in science or medicine is ever going to enable us to evade that.”

I’m eager to read anything you have to say about abortion that honors the spirit of either of those quotations, whether you’re hopelessly conflicted or a strong proponent of any position.

Email [email protected] .

Provocation of the Week

Barton Gellman, who anticipated Donald Trump’s refusal to accept defeat in the 2020 election in the November 2020 articles “ The Election That Could Break America ” and “ How Trump Could Attempt a Coup ,” has a new article up, “ Trump’s Next Coup Has Already Begun .” It argues, in part:

For more than a year now, with tacit and explicit support from their party’s national leaders, state Republican operatives have been building an apparatus of election theft. Elected officials in Arizona, Texas, Georgia, Pennsylvania, Wisconsin, Michigan, and other states have studied Donald Trump’s crusade to overturn the 2020 election. They have noted the points of failure and have taken concrete steps to avoid failure next time. Some of them have rewritten statutes to seize partisan control of decisions about which ballots to count and which to discard, which results to certify and which to reject. They are driving out or stripping power from election officials who refused to go along with the plot last November, aiming to replace them with exponents of the Big Lie. They are fine-tuning a legal argument that purports to allow state legislators to override the choice of the voters. By way of foundation for all the rest, Trump and his party have convinced a dauntingly large number of Americans that the essential workings of democracy are corrupt, that made-up claims of fraud are true, that only cheating can thwart their victory at the polls, that tyranny has usurped their government, and that violence is a legitimate response.

That’s concerning.

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Abortion access and policy after Roe

July 19, 2022 – Patients traveling further and waiting longer for abortion care. Doctors hesitating to provide pregnant individuals with life-saving treatment. Pharmacists refusing to fill prescriptions for abortion medication.

In the wake of the U.S. Supreme Court’s June 24 decision to overturn Roe v. Wade, the impacts of losing the constitutional right to abortion have been immediate and widespread. Twenty-six states have or are expected to ban or severely restrict abortion, with effects disproportionately falling on people of color and poor people. As a result, the policy response to this public health crisis should be well-coordinated and extend beyond the realm of reproductive health , according to a panel of experts who spoke at a July 14 event at Harvard T.H. Chan School of Public Health.

“I know that for many of us who care, it will feel easy to be hopeless—but we cannot give in to despair,” said Dean Michelle Williams in her opening remarks. “Here is my message to you all: clarity is power. The American people need a clear understanding of the science and of the evidence on the consequences of depriving girls and women of this essential component to health care.”

One consequence is that patients traveling to other states to receive care are already experiencing longer wait times. “That happens very quickly, over a matter of days, weeks, and months. That in turn means that some folks are going to be too far along to get an abortion by the time they get there, so we’re going to see more denials of care,” said Elizabeth Janiak , assistant professor in Harvard Chan School’s Department of Social and Behavioral Sciences ; assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School; and director of social science research at Planned Parenthood League of Massachusetts.

For instance, even before Roe was overturned, in September 2021, Texas implemented a ban on abortions after six weeks of pregnancy. At clinics in the neighboring state of Oklahoma, the wait time for an abortion increased from five to 21 days.

Meanwhile, in situations without travel, doctors are changing how they treat people who are experiencing pregnancy complications. In Texas and some other states, to avoid legal repercussions, providers are waiting for patients to lose their pregnancies spontaneously or become sick enough to justify intervening. “Sometimes they get it wrong, and people do pass away,” Janiak said.

Such changes to reproductive health care will worsen existing health disparities for people of color, according to the panelists. States with the strongest abortion restrictions also have the highest rates of maternal mortality for Black people and other people of color, the worst health outcomes for children , and the lowest rates of health care access for those groups.

Additionally, the panelists noted, laws against abortion will overwhelmingly affect poor people, since half of the individuals who seek care are below the poverty line and a quarter of them are just above the poverty line. In 60 percent of cases, these individuals already have children.

“These women care about their children,” said Jane Mansbridge, Adams Professor of Political Leadership and Democratic Values, Emerita at Harvard Kennedy School. “They realize—and they’re in a far better position than anyone else to realize—that they cannot, at that point in their lives, handle another child. … If they add another to a family that’s already stretched to the max, their existing children will suffer.”

In response to the Supreme Court’s decision and its wide-reaching public health effects, the Biden administration has begun taking steps to support abortion care through preexisting federal laws. The U.S. Department of Health and Human Services issued a memo emphasizing that under the Emergency Medical Treatment and Labor Act, hospitals are obligated to provide necessary care to patients with emergency conditions—including abortion, since federal law overrides state laws. The department also released guidance stating that pharmacists who do not fill prescriptions for abortion medications could be discriminating based on pregnancy and thus violating civil rights laws.

While states without abortion restrictions can also help—for example, by protecting their providers who prescribe medication to patients in abortion-restricted states—the most effective action happens at the federal level, said Evelynn Hammonds , Barbara Gutmann Rosenkrantz Professor of the History of Science and of African and African American Studies in the Harvard Faculty of Arts and Sciences and professor in the Harvard Chan Department of Social and Behavioral Sciences.

“There is a very serious program being put forward by those people who supported the overturning of Roe to go for a federal ban on abortion,” Hammonds said. “The federal government response cannot be piecemeal. It can’t be, let’s look at the particulars of each state’s response—but rather, look at what is the overarching role of the federal government in supporting equal protection under the law and bodily autonomy.”

Government response should also take into account the broader implications of the Supreme Court’s decision, according to Mary Ziegler, Daniel P.S. Paul Visiting Professor of Constitutional Law at Harvard Law School and professor of law at University of California, Davis. “Our democratic institutions have changed in fundamental ways to make this moment possible,” she said. Among other trends, changes to campaign finance laws have enabled greater spending by anti-abortion groups, and the Supreme Court has become more willing to rule against the country’s popular opinion of supporting abortion rights.

“When we say this is a women’s issue or this is an issue for pregnant people, that’s implying that other people shouldn’t care,” Ziegler said. “If we understand the history that brought us to Roe, we would understand this has absolutely changed things that will affect everybody.”

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What Does ‘Abortion’ Mean? Even the Word Itself Is Up for Debate.

In medical terms, the definition is clear. But when disputes arise, opponents argue that not every termination is an abortion.

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By Kate Zernike

Even after five decades of argument about abortion in the United States, the most contentious question newly at the forefront is a very basic one: What is abortion?

Major medical societies, and medical billing codes , define abortion as any procedure that terminates a pregnancy — whether that pregnancy is wanted or unwanted, whether a woman is seeking the procedure to clean out her uterus after a miscarriage, or because of a dire fetal diagnosis, or to terminate a pregnancy that she had not expected.

“An abortion is an abortion is an abortion,” said Dr. Louise King, an obstetrician-gynecologist and bioethicist at Harvard Medical School.

Anti-abortion lawmakers and groups disagree, arguing that it’s an abortion only if the woman or her medical provider elects to end the pregnancy. This generally means that terminating a pregnancy in a dire medical situation is acceptable, while terminating an unwanted pregnancy is not.

During the five decades that Roe v. Wade established a constitutional right to abortion, this was mostly a semantic dispute. But in the aftermath of the Supreme Court’s decision to overturn Roe, simply defining the word abortion has taken on new political, legal and medical consequences.

States are struggling to define what they will and will not allow. Doctors, too, are grappling : those in states that now ban abortion say they have stopped providing the procedures because violations of the law can result in lengthy prison terms, large fines and the loss of a medical license.

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• Continuing Education Activity

Abortion is one of the common procedures performed among women. In the U.S., in 2014, one in 5 pregnancies ended in abortion, and one in 4 women is estimated to have an abortion in their lifetime. Globally, one in 4 pregnancies ends in abortion. It is important that all providers understand the prevalence of abortion, the options available, the safety, the restrictions, and the access issues associated with abortion to be able to provide safe and optimal quality of care to the patients. This activity reviews the options available to the woman when she has a positive pregnancy test, describes the various methods of safe abortion care, outlines the indications and contraindications of the various methods of abortion, explains the techniques of performing an abortion, outlines the complications and the steps that help manage these complications.

• Describe options available to a woman with a positive pregnancy test.
• Explain the methods of abortion available and describe the pros and cons of each method.
• Outline the steps of medical abortion, identify complications and explain how these can be managed.
• Review steps of aspiration or surgical abortion, identify complications, and explain how these can be managed.
• Introduction

Abortion is one of the common procedures performed among women. In the US, in 2014, one in 5 pregnancies ended in abortion, and one in 4 women is estimated to have an abortion in their lifetime [1] . Globally, one in 4 pregnancies ends in abortion. It is important that all providers understand the prevalence of abortion, the options available, the safety, the restrictions, and the access issues associated with abortion to be able to provide safe and optimal quality of care to the patients.

A committee of the National Academies of Sciences, Engineering, and Medicine reviewed the data available and confirmed in their report in 2018 that all forms of abortion, including medication and aspiration abortion, are safe and effective and that the only factors decreasing safety are those decreasing access [2] [3] .  First trimester abortions pose no long-term risk of infertility, ectopic pregnancy, spontaneous abortion, or breast cancer.  Abortion does not pose a hazard to a patient’s mental health [4] . 

Abortion can be completed with medication or by a procedure which is often called surgical abortion or aspiration abortion. The reasons for terminating a pregnancy may be maternal factors or fetal indications. Preabortion workup often includes obtaining a complete blood count, coagulation profile, type and crossmatch, sexually transmitted infection screen, human chorionic gonadotropin levels, and a pelvic ultrasound to confirm that the pregnancy is intrauterine. Medication abortion can be completed at home. The aspiration abortion is usually performed in a clinic or hospital under local anesthesia, with or without conscious sedation. [5] [6] [7]

• Anatomy and Physiology

External and internal genitalia typically comprise the female genital tract. The external genitalia includes:

• Mons pubis:  A rounded mass of fatty tissue lying over the joint of pubic bones.
• Labia majora:  Two cutaneous folds extend from the mons pubis down to the perineum.
• Labia minora:  The region of the female genital tract buried inside the labia majora.
• Bartholin gland:  These are like bulbourethral glands in men and pour lubrication right at the entry of the vagina.
• Clitoris: T he vagina's pea-sized, most heavily innervated organ that detects sensation and stimulation.
• Vulva:  The collective term for women's external genitalia.

The female reproductive system's internal genitalia includes:

• Ovaries:  Female reproductive organs which produce all the ova (eggs) during a normal menstrual cycle.
• Fallopian tubes:  Also known as uterine tubes, these are responsible for the transportation of ova from the ovaries to the uterus. They are clinically important in abortion because they are the most common site of ectopic pregnancy (pregnancy outside the uterus).
• Uterus: The womb is a hormone-sensitive reproductive organ where a fertilized ovum implants. It is responsible for nurturing the fertilized ovum and stages of development inside the mother's body that take place in the uterus.
• Cervix:  The lower part of the uterus, or the connection between the uterus and vagina.
• Vagina:  The lowest part of the female genital tract, starting from an external orifice to the cervix.

Understanding the normal anatomy of the female genital tract helps manage complications of medication abortion and performing the aspiration or surgical abortion.

• Indications

According to the National Abortion Federation 2020 clinical policy guidelines for abortion care, any patient choosing to have an abortion must be counseled in a nonjudgmental manner about their options. The patient’s desires must be explored, and options including continuing the pregnancy, parenting, adoption, and termination of pregnancy should be discussed during this time. If the patient desires to end the pregnancy, then the benefits, risks, and details of the process need to be discussed. 

Early medication abortion is non-invasive, avoids the risk of a surgical procedure, and the risk of anesthesia can be done up to 11 weeks. It allows for more privacy and control for the patient. It usually involves the use of medications such as mifepristone and misoprostol and rarely methotrexate [8] [9] [10] . Medication abortion after the first trimester can also be performed safely and effectively by trained clinicians in settings that are equipped to support the patient. Induced fetal demise may be necessary for later gestational ages.

Aspiration or surgical abortion involves a procedure and the use of instruments in the vagina, cervix, and uterus to remove the pregnancy. The procedure is usually short. Aspiration abortion might be needed if medication abortion fails or the woman bleeds heavily during the medication abortion. According to the 2020 National Abortion Federation Clinical Policy Guidelines for Abortion Care, the incidence of aspiration after medication abortion is 2-9% for >63 days LMP and even less to less than 1 to 3% when the second dose of misoprostol is used. The other indication for aspiration or surgical abortion is suspected molar pregnancy [11]  

• Contraindications

Contraindications to medication abortion include

• IUD in place - may be removed before the medication abortion
• Allergy to medication used 
• Chronic adrenal failure, especially in patients who are on long-term systemic corticosteroid therapy
• Suspected ectopic pregnancy
• Hemorrhagic disorders
• Anticoagulant therapy, excluding aspirin
• Hemodynamic instability 
• Inherited porphyria

Anemia, seizures, asthma on steroid inhalers, obesity, breastfeeding, HIV or AIDs, and sexually transmitted infection are not considered contraindications. 

Exercise care in case of any coagulopathy or any other bleeding disorder, but these are not contraindications for surgical or aspiration abortion. In case the products of conception are not confirmed on the aspirate after a surgical abortion, trend the HCG levels to ensure ectopic pregnancy or pregnancy of unknown location is ruled out and treated if this is the case. 

Equipment used for aspiration abortion includes:

• Vacuum single valve aspirator/Manual vacuum aspirator plus
• Locking 60 cc syringe
• Specimen cup
• Standard Graves speculum
• Single tooth tenaculum
• Ring forceps with cotton
• Small polyp forceps
• Pratt cervical dilators
• Preparation

Medical Abortion

Once the pregnancy test is positive and the patient has opted for abortion, take the following steps to ensure the patient is eligible for medication abortion.

Confirm the last menstrual period(LMP) and estimate the gestational age(GA). The first day of LMP alone is an accurate means of estimating the gestational age through the mid-first trimester. If the LMP is not known or unreliable, obtain an ultrasound to date the pregnancy. There is no need for an ultrasound prior to medication abortion in all cases [12]

Take a detailed medical history from the patient, including allergies, review of medical conditions, medications, and substance use. Complete a physical exam if indicated by the patient’s history and symptoms. Patients choosing medication abortion with a definite LMP do not need a pelvic exam. The pelvic and bimanual exams may be performed prior to the procedure. Patients with no medical conditions do not need routine pre-abortion lab testing. Labs that are recommended include glucose for patients with Insulin Dependent Diabetes Mellitus, INR for those on anticoagulants (warfarin) beyond 12 weeks of GA, rhesus D testing for consenting patients beyond 56 days from LMP and unknown Rh status, hemoglobin and hematocrit only for those with history or symptoms of anemia, gonorrhea and chlamydia testing for those at increased risk or less than 25 years of age. When clinical dating is uncertain, an ultrasound scan is performed to confirm the location and viability of the pregnancy. Combined mifepristone/misoprostol regimens are more effective than misoprostol alone or methotrexate/misoprostol [13] .

According to the National Abortion Federation (NAF) 2020 guidelines, after counseling the patient about the methods and the pros and cons of the procedure, determine pregnancy dating and eligibility for medication abortion by one of the following.  

• LMP< or = 77 days from the anticipated date of mifepristone use and
• First positive pregnancy test was less than 6 weeks ago
• No ectopic risk factors, including previous ectopic pregnancy, history of Pelvic Inflammatory Disease, Intra Uterine Device in place at the time of conception, bleeding since LMP, unilateral pelvic pain
• Regular menses with no hormonal contraception use 2 months prior to LMP
• LMP and physical examination, including a bimanual examination if needed
• Pelvic ultrasound to date the pregnancy

Ensure the patient has no contraindications for medication abortion. Obtain signed informed consent, including the manufacturer’s patient agreement and medication guide from the patient, after discussing the risks involved in medication abortion and the side effects of the medication.

Side effects of mifepristone include mainly vaginal bleeding. Side effects of misoprostol include nausea, vomiting, diarrhea, low-grade fever, and muscle aches that resolve within 6 hours of use. If the mifepristone or misoprostol are vomited less than 15 to 30 minutes of use, repeating the dosing can be considered. Antiemetic medications can help manage nausea and vomiting. Vaginal bleeding usually starts 4 to 6 hours after misoprostol use and can be heavy with clots. Patients bleeding heavier than 2 pads per hour or for over 2 hours need to be evaluated by the clinician. Bleeding lasts from 1 to 45 days. Patients need to be informed of the risks, including heavy bleeding that may need additional doses of misoprostol, NSAIDs, the need for aspiration in some cases, the small risk for endometritis, failure of medication abortion needing additional doses of misoprostol or aspiration, teratogenicity of misoprostol. The patient’s phone number or email is confirmed. Lastly, transportation for follow-up is ensured.

Surgical Abortion

After taking a detailed medical history, pregnancy must be confirmed, and gestational age must be assessed. Ultrasound is often used to confirm the location of the pregnancy. Baseline vitals, including pulse, and blood pressure, must be performed for all, and a physical exam for those indicated by patient symptoms and history. Confirm and arrange all the instruments required for the procedure ahead of time. 

• Technique or Treatment

Mifepristone/Misoprostol protocol

Mifepristone - one 200mg tablet is swallowed on day 1 in the clinic or at home. Misoprostol can be administered in the following routes

• Buccally: Four 200mcg tablets are placed between gum and cheek for 30 minutes and swallowed thereafter, 24 to 48 hours after mifepristone administration. 
• Vaginal: Four 200mcg tablets of misoprostol can also be placed in the vagina 6 to 48 hours after the mifepristone
• Sublingual: Two to four 200mcg tablets of misoprostol under the tongue for 30 minutes

According to the NAF 2020 guidelines, if a patient is > 63 days from LMP, a second dose of 800mcg misoprostol can be administered 4 hours after the first dose. If the patient more than 70 days from LMP, a second dose of 800mcg misoprostol is recommended 4 hours after mifepristone.

NSAIDs help pain management for the patient while at home [14] , and the routine prescription of opiates is not necessary. A short prescription for opiates may be prescribed in case NSAIDs are not tolerated or cannot be used due to an allergy. Prophylactic antibiotics are not routinely recommended for medical abortion. Contraception can be discussed if the patient is willing to engage at this time.

The patient is instructed to contact the provider if 

• Bleeding heavily, soaking 2 or more pads in 2 or more consecutive hours
• Severe pain that is not responding to the medication prescribed
• Fever of more than 100.4 degrees Fahrenheit (38 C) for more than 24 hours after misoprostol
• No bleeding within 24 hours of misoprostol
• Nausea, vomiting, diarrhea, abdominal pain more than 24 hours after misoprostol

According to the NAF 2020 guidelines, an ultrasound is not needed to confirm the completion of a successful abortion if using clinical history and home pregnancy tests [15] . It can be performed by checking baseline serum HCG on the day of mifepristone and one after misoprostol. A decrease of hCG of 50% from baseline by 72 hours, 60% by 4-5 days [16] , and 80% by 7 days from initiating treatment [17]  are confirmative of a successful MAB. It can also be confirmed by ultrasound examination before and after medication administration. An absence of the gestational sac or embryo confirms the success of the abortion. 

According to the NAF 2020 guidelines, when methotrexate and misoprostol are used, an evidence-based regimen of oral or intramuscular methotrexate followed in three to five days with vaginal misoprostol is recommended for gestations up to 63 days

Surgical/Aspiration Abortion 

Aspiration abortion is performed up to 16 weeks.

Technique: Don gloves, perform a bimanual examination, and confirm the uterine position and size. Confirm you have all the equipment you need. Adjust table and light, insert the speculum, and evaluate and collect samples for infection screening and testing. Apply the antiseptic solution to the cervix. Administer a paracervical block if the patient is awake. Place the tenaculum on the cervix. Dilate the cervix to the size of the cannula you will be using ( gestational age in weeks + or - 1 to 2 mm). The cervix is dilated using tapered dilators like Pratt or Denniston dilators [18] . Misoprostol can also be used for cervical preparation prior to the procedure [19] [20] [21] . Osmotic dilators are used when cervical dilation is expected to be difficult. Insert cannula through the cervix with gentle but firm traction on the cervix using the tenaculum. Connect the aspirator to the cannula. The procedure is completed by aspiration of the uterus using a manual or electric vacuum and not by sharp curettage. The procedure is considered complete when the uterus is empty. Ultrasound can be used to confirm the completion of the procedure. Remove the tenaculum and the speculum. Check for the adequacy of the products of conception. If molar pregnancy is suspected, send the tissue to the pathologist for examination. Inform the patient of the complete procedure and the recovery process. The procedure usually takes 5 to 10 minutes, and antibiotics are given at the end of the procedure to avoid infection.

Dilatation and evacuation are performed beyond 16 weeks by experienced clinicians in appropriate clinical settings. Intravenous access should be established prior to the procedure. If induced fetal demise is used, appropriate evidence-based protocols must be followed. Osmotic dilators including Dilapan and laminaria, misoprostol, mifepristone, and or other cervical agents are used to achieve adequate dilation. Osmotic dilators may be placed in the cervix prior to the procedure. All instruments entering the uterine cavity must be sterile. Ultrasound should be used during the procedure to locate fetal parts, visualize instruments, and verify the completion of the procedure, thus reducing the risk of uterine perforation and shortening the procedure [22] [23] . Uterotonics must be used to help control uterine bleeding during and after the procedure.

• Complications

 Complications of  Medication abortion [10] [24]  and the management options when these arise include the following:

• Heavy bleeding and or severe cramping. 
• Repeat misoprostol/NSAIDs
• Uterine aspiration 
• Blood transfusion [25]
• Failure of medication abortion
• Uterine aspiration
• Repeat misoprostol [26]
• Infection - endometritis (fever>24 hours after misoprostol, abdominal and pelvic pain, vaginal discharge, uterine/adnexal tenderness)
• Uterine aspiration if retained pregnancy tissue in the uterus and antibiotics per CDC guidelines 
• Immediate admission to the hospital will be required if hemodynamically unstable and aggressive treatment with antibiotics. 
• Ectopic pregnancy
• Treat or refer for the next steps 

Aspiration Abortion [27]

• Vasovagal episode 
• Cool compresses
• Elevate legs above the chest
• Isometric extremity contractions
• Atropine IM 0.4mg or 0.2mg IV, max dose 2mg
• Heavy bleeding - remember 6 Ts [28]
• Tone - Uterine massage and consider uterotonics like methergine, misoprostol
• Tissue - Ensure there is no retained tissue in the uterus 
• Trauma - Identify the source of bleeding and address it, especially cervical and vaginal tears
• Thrombin - review the history of bleeding and consider additional tests like CBC, coagulation tests, clotting test
• Treatment - Consider IV fluid bolus and uterine tamponade with a foley’s catheter bulb
• Transfer - to the hospital if need be, monitor vitals closely
• Perforation
• Stop the suction, examine the contents of the aspirate for omentum, bowel, products of conception
• If stable, continue and complete the procedure under ultrasound guidance. Consider uterotonics and antibiotics. Observe for 1.5 to 2 hours post-procedure. 
• If the patient is unstable, transfer 
• Incomplete abortion
• Offer misoprostol or 
• Reaspiration if bleeding, in pain or have signs of infection
• Accumulation of blood in the uterus post-procedure - patient usually complains of pain and rectal pressure, and this is usually accompanied by hypotension and or vasovagal  syncope
• Uterine aspiration or uterotonics
• Endometritis (fever, pain, vaginal discharge, leukocytosis)
• Antibiotics per the CDC PID regimen
• Ultrasound +/- aspiration procedure
• Test for gonorrhea and chlamydia
• Ectopic Pregnancy  - suspect if POC inadequate at the time
• Transfer to hospital for treatment with methotrexate vs. surgical management
• Clinical Significance

Any woman with a positive pregnancy test should be counseled about her options at the time of the consultation in a nonjudgemental manner. Abortion is an overall safe and effective procedure. Providers should be aware of the prevalence of abortion, the restrictions, and the access issues associated with abortion and strive to provide safe care to patients seeking an abortion.

• Enhancing Healthcare Team Outcomes

Abortion is safer when the laws regarding abortion are less restrictive and in countries where the gross national income is higher. The stigma associated with abortion is another recognized barrier to accessing safe abortion and can contribute to the maternal mortality rate worldwide. Overall, ensuring women have better access to reproductive health care, including modern methods of contraception, can ensure the care provided is safe and help reduce maternal and infant mortality rates.

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Disclosure: Maleeha Ajmal declares no relevant financial relationships with ineligible companies.

Disclosure: Meera Sunder declares no relevant financial relationships with ineligible companies.

Disclosure: Rotimi Akinbinu declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Ajmal M, Sunder M, Akinbinu R. Abortion. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Prenatal screening for fetal aneuploidy in singleton pregnancies. [J Obstet Gynaecol Can. 2011] Prenatal screening for fetal aneuploidy in singleton pregnancies. Chitayat D, Langlois S, Douglas Wilson R, SOGC GENETICS COMMITTEE, CCMG PRENATAL DIAGNOSIS COMMITTEE. J Obstet Gynaecol Can. 2011 Jul; 33(7):736-750.
• Review Fertility after contraception or abortion. [Fertil Steril. 1990] Review Fertility after contraception or abortion. Huggins GR, Cullins VE. Fertil Steril. 1990 Oct; 54(4):559-73.
• Outcomes and Safety of History-Based Screening for Medication Abortion: A Retrospective Multicenter Cohort Study. [JAMA Intern Med. 2022] Outcomes and Safety of History-Based Screening for Medication Abortion: A Retrospective Multicenter Cohort Study. Upadhyay UD, Raymond EG, Koenig LR, Coplon L, Gold M, Kaneshiro B, Boraas CM, Winikoff B. JAMA Intern Med. 2022 May 1; 182(5):482-491.
• Review The effect of pregnancy termination on future reproduction. [Baillieres Clin Obstet Gynaeco...] Review The effect of pregnancy termination on future reproduction. Atrash HK, Hogue CJ. Baillieres Clin Obstet Gynaecol. 1990 Jun; 4(2):391-405.
• Factors hindering access to abortion services. [Fam Plann Perspect. 1995] Factors hindering access to abortion services. Henshaw SK. Fam Plann Perspect. 1995 Mar-Apr; 27(2):54-9, 87.

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Definition of abortion

• abandonment
• calling off
• cancellation
• cancelation

Examples of abortion in a Sentence

Word history.

borrowed from Latin abortiōn-, abortiō , from aborīrī "to miscarry, abort entry 1 " + -tiōn-, tiō , suffix of action nouns

circa 1537, in the meaning defined at sense 1

Phrases Containing abortion

• abortion pill
• contagious abortion
• partial - birth abortion

Articles Related to abortion

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Dictionary Entries Near abortion

abortionist

Cite this Entry

“Abortion.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/abortion. Accessed 4 Aug. 2024.

Kids Definition

Kids definition of abortion, medical definition, medical definition of abortion, legal definition, legal definition of abortion, more from merriam-webster on abortion.

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Britannica.com: Encyclopedia article about abortion

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