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Why Abortion Should Be Legalized

Categories: Abortion Pro Choice (Abortion) Women's Health

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Words: 1331 |

Published: Jan 28, 2021

Words: 1331 | Pages: 3 | 7 min read

Introduction, why abortion should be legal.

Gipson, J. D., Hirz, A. E., & Avila, J. L. (2011). Perceptions and practices of illegal abortion among urban young adults in the Philippines: a qualitative study. Studies in family planning, 42(4), 261-272. (https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1728-4465.2011.00289.x)
Finer, L. B., & Hussain, R. (2013). Unintended pregnancy and unsafe abortion in the Philippines: context and consequences. (https://www.guttmacher.org/report/unintended-pregnancy-and-unsafe-abortion-philippines-context-and-consequences?ref=vidupdatez.com/image)
Flavier, J. M., & Chen, C. H. (1980). Induced abortion in rural villages of Cavite, the Philippines: Knowledge, attitudes, and practice. Studies in family planning, 65-71. (https://www.jstor.org/stable/1965798)
Gallen, M. (1979). Abortion choices in the Philippines. https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/abortion-choices-in-the-philippines/853B8B71F95FEBDD0D88AB65E8364509 Journal of Biosocial Science, 11(3), 281-288.
Holgersson, K. (2012). Is There Anybody Out There?: Illegal Abortion, Social Work, Advocacy and Interventions in the Philippines. (https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A574793&dswid=4931)

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How the Right to Legal Abortion Changed the Arc of All Women’s Lives

By Katha Pollitt

Prochoice demonstrators during the March for Women's Lives rally organized by NOW Washington DC April 5 1992.

I’ve never had an abortion. In this, I am like most American women. A frequently quoted statistic from a recent study by the Guttmacher Institute, which reports that one in four women will have an abortion before the age of forty-five, may strike you as high, but it means that a large majority of women never need to end a pregnancy. (Indeed, the abortion rate has been declining for decades, although it’s disputed how much of that decrease is due to better birth control, and wider use of it, and how much to restrictions that have made abortions much harder to get.) Now that the Supreme Court seems likely to overturn Roe v. Wade sometime in the next few years—Alabama has passed a near-total ban on abortion, and Ohio, Georgia, Kentucky, Mississippi, and Missouri have passed “heartbeat” bills that, in effect, ban abortion later than six weeks of pregnancy, and any of these laws, or similar ones, could prove the catalyst—I wonder if women who have never needed to undergo the procedure, and perhaps believe that they never will, realize the many ways that the legal right to abortion has undergirded their lives.

Legal abortion means that the law recognizes a woman as a person. It says that she belongs to herself. Most obviously, it means that a woman has a safe recourse if she becomes pregnant as a result of being raped. (Believe it or not, in some states, the law allows a rapist to sue for custody or visitation rights.) It means that doctors no longer need to deny treatment to pregnant women with certain serious conditions—cancer, heart disease, kidney disease—until after they’ve given birth, by which time their health may have deteriorated irretrievably. And it means that non-Catholic hospitals can treat a woman promptly if she is having a miscarriage. (If she goes to a Catholic hospital, she may have to wait until the embryo or fetus dies. In one hospital, in Ireland, such a delay led to the death of a woman named Savita Halappanavar, who contracted septicemia. Her case spurred a movement to repeal that country’s constitutional amendment banning abortion.)

The legalization of abortion, though, has had broader and more subtle effects than limiting damage in these grave but relatively uncommon scenarios. The revolutionary advances made in the social status of American women during the nineteen-seventies are generally attributed to the availability of oral contraception, which came on the market in 1960. But, according to a 2017 study by the economist Caitlin Knowles Myers, “The Power of Abortion Policy: Re-Examining the Effects of Young Women’s Access to Reproductive Control,” published in the Journal of Political Economy , the effects of the Pill were offset by the fact that more teens and women were having sex, and so birth-control failure affected more people. Complicating the conventional wisdom that oral contraception made sex risk-free for all, the Pill was also not easy for many women to get. Restrictive laws in some states barred it for unmarried women and for women under the age of twenty-one. The Roe decision, in 1973, afforded thousands upon thousands of teen-agers a chance to avoid early marriage and motherhood. Myers writes, “Policies governing access to the pill had little if any effect on the average probabilities of marrying and giving birth at a young age. In contrast, policy environments in which abortion was legal and readily accessible by young women are estimated to have caused a 34 percent reduction in first births, a 19 percent reduction in first marriages, and a 63 percent reduction in ‘shotgun marriages’ prior to age 19.”

Access to legal abortion, whether as a backup to birth control or not, meant that women, like men, could have a sexual life without risking their future. A woman could plan her life without having to consider that it could be derailed by a single sperm. She could dream bigger dreams. Under the old rules, inculcated from girlhood, if a woman got pregnant at a young age, she married her boyfriend; and, expecting early marriage and kids, she wouldn’t have invested too heavily in her education in any case, and she would have chosen work that she could drop in and out of as family demands required.

In 1970, the average age of first-time American mothers was younger than twenty-two. Today, more women postpone marriage until they are ready for it. (Early marriages are notoriously unstable, so, if you’re glad that the divorce rate is down, you can, in part, thank Roe.) Women can also postpone childbearing until they are prepared for it, which takes some serious doing in a country that lacks paid parental leave and affordable childcare, and where discrimination against pregnant women and mothers is still widespread. For all the hand-wringing about lower birth rates, most women— eighty-six per cent of them —still become mothers. They just do it later, and have fewer children.

Most women don’t enter fields that require years of graduate-school education, but all women have benefitted from having larger numbers of women in those fields. It was female lawyers, for example, who brought cases that opened up good blue-collar jobs to women. Without more women obtaining law degrees, would men still be shaping all our legislation? Without the large numbers of women who have entered the medical professions, would psychiatrists still be telling women that they suffered from penis envy and were masochistic by nature? Would women still routinely undergo unnecessary hysterectomies? Without increased numbers of women in academia, and without the new field of women’s studies, would children still be taught, as I was, that, a hundred years ago this month, Woodrow Wilson “gave” women the vote? There has been a revolution in every field, and the women in those fields have led it.

It is frequently pointed out that the states passing abortion restrictions and bans are states where women’s status remains particularly low. Take Alabama. According to one study , by almost every index—pay, workforce participation, percentage of single mothers living in poverty, mortality due to conditions such as heart disease and stroke—the state scores among the worst for women. Children don’t fare much better: according to U.S. News rankings , Alabama is the worst state for education. It also has one of the nation’s highest rates of infant mortality (only half the counties have even one ob-gyn), and it has refused to expand Medicaid, either through the Affordable Care Act or on its own. Only four women sit in Alabama’s thirty-five-member State Senate, and none of them voted for the ban. Maybe that’s why an amendment to the bill proposed by State Senator Linda Coleman-Madison was voted down. It would have provided prenatal care and medical care for a woman and child in cases where the new law prevents the woman from obtaining an abortion. Interestingly, the law allows in-vitro fertilization, a procedure that often results in the discarding of fertilized eggs. As Clyde Chambliss, the bill’s chief sponsor in the state senate, put it, “The egg in the lab doesn’t apply. It’s not in a woman. She’s not pregnant.” In other words, life only begins at conception if there’s a woman’s body to control.

Indifference to women and children isn’t an oversight. This is why calls for better sex education and wider access to birth control are non-starters, even though they have helped lower the rate of unwanted pregnancies, which is the cause of abortion. The point isn’t to prevent unwanted pregnancy. (States with strong anti-abortion laws have some of the highest rates of teen pregnancy in the country; Alabama is among them.) The point is to roll back modernity for women.

So, if women who have never had an abortion, and don’t expect to, think that the new restrictions and bans won’t affect them, they are wrong. The new laws will fall most heavily on poor women, disproportionately on women of color, who have the highest abortion rates and will be hard-pressed to travel to distant clinics.

But without legal, accessible abortion, the assumptions that have shaped all women’s lives in the past few decades—including that they, not a torn condom or a missed pill or a rapist, will decide what happens to their bodies and their futures—will change. Women and their daughters will have a harder time, and there will be plenty of people who will say that they were foolish to think that it could be otherwise.

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The Messiness of Reproduction and the Dishonesty of Anti-Abortion Propaganda

By Jia Tolentino

A Supreme Court Reporter Defines the Threat to Abortion Rights

By Isaac Chotiner

By Margaret Talbot

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Pro and Con: Abortion

Washington DC.,USA, April 26, 1989. Supporters for and against legal abortion face off during a protest outside the United States Supreme Court Building during Webster V Health Services

To access extended pro and con arguments, sources, and discussion questions about whether abortion should be legal, go to ProCon.org .

The debate over whether abortion should be a legal option has long divided people around the world. Split into two groups, pro-choice and pro-life, the two sides frequently clash in protests.

A June 2, 2022 Gallup poll , 55% of Americans identified as “pro-choice,” the highest percentage since 1995. 39% identified as “pro-life,” and 5% were neither or unsure. For the first time in the history of the poll question (since 2001), 52% of Americans believe abortion is morally acceptable. 38% believed the procedure to be morally wrong, and 10% answered that it depended on the situation or they were unsure.

Surgical abortion (aka suction curettage or vacuum curettage) is the most common type of abortion procedure. It involves using a suction device to remove the contents of a pregnant woman’s uterus. Surgical abortion performed later in pregnancy (after 12-16 weeks) is called D&E (dilation and evacuation). The second most common abortion procedure, a medical abortion (aka an “abortion pill”), involves taking medications, usually mifepristone and misoprostol (aka RU-486), within the first seven to nine weeks of pregnancy to induce an abortion. The Centers for Disease Control and Prevention (CDC) found that 67% of abortions performed in 2014 were performed at or less than eight weeks’ gestation, and 91.5% were performed at or less than 13 weeks’ gestation. 77.3% were performed by surgical procedure, while 22.6% were medical abortions. An abortion can cost from $500 to over $1,000 depending on where it is performed and how long into the pregnancy it is.

Abortion is a safe medical procedure that protects lives.
Abortion bans endangers healthcare for those not seeking abortions.
Abortion bans deny bodily autonomy, creating wide-ranging repercussions.
Life begins at conception, making abortion murder.
Legal abortion promotes a culture in which life is disposable.
Increased access to birth control, health insurance, and sexual education would make abortion unnecessary.

This article was published on June 24, 2022, at Britannica’s ProCon.org , a nonpartisan issue-information source.

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Key facts about the abortion debate in America

A woman receives medication to terminate her pregnancy at a reproductive health clinic in Albuquerque, New Mexico, on June 23, 2022, the day before the Supreme Court overturned Roe v. Wade, which had guaranteed a constitutional right to an abortion for nearly 50 years.

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

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

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

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

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

A bar chart showing that the Supreme Court’s decision to overturn Roe v. Wade draws more strong disapproval among Democrats than strong approval among Republicans

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

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

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

A line graph showing public views of abortion from 1995-2022

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

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

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

A line graph showing that the partisan gap in views of whether abortion should be legal remains wide

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

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

A bar chart showing that there are deep religious divisions in views of abortion

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

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

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

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

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

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

A table showing that there are wide religious and partisan differences in views of the morality of abortion

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

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

Religion & Abortion

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

Cultural Issues and the 2024 Election

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

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ABOUT PEW RESEARCH CENTER Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

The Most Important Study in the Abortion Debate

Researchers rigorously tested the persistent notion that abortion wounds the women who seek it.

The demographer Diana Greene Foster was in Orlando last month, preparing for the end of Roe v. Wade , when Politico published a leaked draft of a majority Supreme Court opinion striking down the landmark ruling. The opinion, written by Justice Samuel Alito, would revoke the constitutional right to abortion and thus give states the ability to ban the medical procedure.

Foster, the director of the Bixby Population Sciences Research Unit at UC San Francisco, was at a meeting of abortion providers, seeking their help recruiting people for a new study . And she was racing against time. She wanted to look, she told me, “at the last person served in, say, Nebraska, compared to the first person turned away in Nebraska.” Nearly two dozen red and purple states are expected to enact stringent limits or even bans on abortion as soon as the Supreme Court strikes down Roe v. Wade , as it is poised to do. Foster intends to study women with unwanted pregnancies just before and just after the right to an abortion vanishes.

Read: When a right becomes a privilege

When Alito’s draft surfaced, Foster told me, “I was struck by how little it considered the people who would be affected. The experience of someone who’s pregnant when they do not want to be and what happens to their life is absolutely not considered in that document.” Foster’s earlier work provides detailed insight into what does happen. The landmark Turnaway Study , which she led, is a crystal ball into our post- Roe future and, I would argue, the single most important piece of academic research in American life at this moment.

The legal and political debate about abortion in recent decades has tended to focus more on the rights and experience of embryos and fetuses than the people who gestate them. And some commentators—including ones seated on the Supreme Court—have speculated that termination is not just a cruel convenience, but one that harms women too . Foster and her colleagues rigorously tested that notion. Their research demonstrates that, in general, abortion does not wound women physically, psychologically, or financially. Carrying an unwanted pregnancy to term does.

In a 2007 decision , Gonzales v. Carhart , the Supreme Court upheld a ban on one specific, uncommon abortion procedure. In his majority opinion , Justice Anthony Kennedy ventured a guess about abortion’s effect on women’s lives: “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained,” he wrote. “Severe depression and loss of esteem can follow.”

Was that really true? Activists insisted so, but social scientists were not sure . Indeed, they were not sure about a lot of things when it came to the effect of the termination of a pregnancy on a person’s life. Many papers compared individuals who had an abortion with people who carried a pregnancy to term. The problem is that those are two different groups of people; to state the obvious, most people seeking an abortion are experiencing an unplanned pregnancy, while a majority of people carrying to term intended to get pregnant.

Foster and her co-authors figured out a way to isolate the impact of abortion itself. Nearly all states bar the procedure after a certain gestational age or after the point that a fetus is considered viable outside the womb . The researchers could compare people who were “turned away” by a provider because they were too far along with people who had an abortion at the same clinics. (They did not include people who ended a pregnancy for medical reasons.) The women who got an abortion would be similar, in terms of demographics and socioeconomics, to those who were turned away; what would separate the two groups was only that some women got to the clinic on time, and some didn’t.

In time, 30 abortion providers—ones that had the latest gestational limit of any clinic within 150 miles, meaning that a person could not easily access an abortion if they were turned away—agreed to work with the researchers. They recruited nearly 1,000 women to be interviewed every six months for five years. The findings were voluminous, resulting in 50 publications and counting. They were also clear. Kennedy’s speculation was wrong: Women, as a general point, do not regret having an abortion at all.

Researchers found, among other things, that women who were denied abortions were more likely to end up living in poverty. They had worse credit scores and, even years later, were more likely to not have enough money for the basics, such as food and gas. They were more likely to be unemployed. They were more likely to go through bankruptcy or eviction. “The two groups were economically the same when they sought an abortion,” Foster told me. “One became poorer.”

Read: The calamity of unwanted motherhood

In addition, those denied a termination were more likely to be with a partner who abused them. They were more likely to end up as a single parent. They had more trouble bonding with their infants, were less likely to agree with the statement “I feel happy when my child laughs or smiles,” and were more likely to say they “feel trapped as a mother.” They experienced more anxiety and had lower self-esteem, though those effects faded in time. They were half as likely to be in a “very good” romantic relationship at two years. They were less likely to have “aspirational” life plans.

Their bodies were different too. The ones denied an abortion were in worse health, experiencing more hypertension and chronic pain. None of the women who had an abortion died from it. This is unsurprising; other research shows that the procedure has extremely low complication rates , as well as no known negative health or fertility effects . Yet in the Turnaway sample, pregnancy ended up killing two of the women who wanted a termination and did not get one.

The Turnaway Study also showed that abortion is a choice that women often make in order to take care of their family. Most of the women seeking an abortion were already mothers. In the years after they terminated a pregnancy, their kids were better off; they were more likely to hit their developmental milestones and less likely to live in poverty. Moreover, many women who had an abortion went on to have more children. Those pregnancies were much more likely to be planned, and those kids had better outcomes too.

The interviews made clear that women, far from taking a casual view of abortion, took the decision seriously. Most reported using contraception when they got pregnant, and most of the people who sought an abortion after their state’s limit simply did not realize they were pregnant until it was too late. (Many women have irregular periods, do not experience morning sickness, and do not feel fetal movement until late in the second trimester.) The women gave nuanced, compelling reasons for wanting to end their pregnancies.

Afterward, nearly all said that termination had been the right decision. At five years, only 14 percent felt any sadness about having an abortion; two in three ended up having no or very few emotions about it at all. “Relief” was the most common feeling, and an abiding one.

From the May 2022 issue: The future of abortion in a post- Roe America

The policy impact of the Turnaway research has been significant, even though it was published during a period when states have been restricting abortion access. In 2018, the Iowa Supreme Court struck down a law requiring a 72-hour waiting period between when a person seeks and has an abortion, noting that “the vast majority of abortion patients do not regret the procedure, even years later, and instead feel relief and acceptance”—a Turnaway finding. That same finding was cited by members of Chile’s constitutional court as they allowed for the decriminalization of abortion in certain circumstances.

Yet the research has not swayed many people who advocate for abortion bans, believing that life begins at conception and that the law must prioritize the needs of the fetus. Other activists have argued that Turnaway is methodologically flawed; some women approached in the clinic waiting room declined to participate, and not all participating women completed all interviews . “The women who anticipate and experience the most negative reactions to abortion are the least likely to want to participate in interviews,” the activist David Reardon argued in a 2018 article in a Catholic Medical Association journal.

Still, four dozen papers analyzing the Turnaway Study’s findings have been published in peer-reviewed journals; the research is “the gold standard,” Emily M. Johnston, an Urban Institute health-policy expert who wasn’t involved with the project, told me. In the trajectories of women who received an abortion and those who were denied one, “we can understand the impact of abortion on women’s lives,” Foster told me. “They don’t have to represent all women seeking abortion for the findings to be valid.” And her work has been buttressed by other surveys, showing that women fear the repercussions of unplanned pregnancies for good reason and do not tend to regret having a termination. “Among the women we spoke with, they did not regret either choice,” whether that was having an abortion or carrying to term, Johnston told me. “These women were thinking about their desires for themselves, but also were thinking very thoughtfully about what kind of life they could provide for a child.”

The Turnaway study , for Foster, underscored that nobody needs the government to decide whether they need an abortion. If and when America’s highest court overturns Roe , though, an estimated 34 million women of reproductive age will lose some or all access to the procedure in the state where they live. Some people will travel to an out-of-state clinic to terminate a pregnancy; some will get pills by mail to manage their abortions at home; some will “try and do things that are less safe,” as Foster put it. Many will carry to term: The Guttmacher Institute has estimated that there will be roughly 100,000 fewer legal abortions per year post- Roe . “The question now is who is able to circumvent the law, what that costs, and who suffers from these bans,” Foster told me. “The burden of this will be disproportionately put on people who are least able to support a pregnancy and to support a child.”

Ellen Gruber Garvey: I helped women get abortions in pre- Roe America

Foster said that there is a lot we still do not know about how the end of Roe might alter the course of people’s lives—the topic of her new research. “In the Turnaway Study, people were too late to get an abortion, but they didn’t have to feel like the police were going to knock on their door,” she told me. “Now, if you’re able to find an abortion somewhere and you have a complication, do you get health care? Do you seek health care out if you’re having a miscarriage, or are you too scared? If you’re going to travel across state lines, can you tell your mother or your boss what you’re doing?”

In addition, she said that she was uncertain about the role that abortion funds —local, on-the-ground organizations that help people find, travel to, and pay for terminations—might play. “We really don’t know who is calling these hotlines,” she said. “When people call, what support do they need? What is enough, and who falls through the cracks?” She added that many people are unaware that such services exist, and might have trouble accessing them.

People are resourceful when seeking a termination and resilient when denied an abortion, Foster told me. But looking into the post- Roe future, she predicted, “There’s going to be some widespread and scary consequences just from the fact that we’ve made this common health-care practice against the law.” Foster, to her dismay, is about to have a lot more research to do.

What can economic research tell us about the effect of abortion access on women’s lives?

Subscribe to the center for economic security and opportunity newsletter, caitlin knowles myers and caitlin knowles myers john g. mccullough professor of economics; co-director, middlebury initiative for data and digital methods - middlebury college @caitlin_k_myers morgan welch morgan welch senior research assistant & project coordinator - center on children and families, economic studies, brookings institution.

November 30, 2021

21 min read

On September 20, 2021, a group of 154 distinguished economists and researchers filed an amicus brief to the Supreme Court of the United States in advance of the Mississippi case, Dobbs v. Jackson Women’s Health Organization . For a full review of the evidence that shows how causal inference tools have been used to measure the effects of abortion access in the U.S., read the brief here .

Introduction

Dobbs v. Jackson Women’s Health Organization considers the constitutionality of a 2018 Mississippi law that prohibits women from accessing abortions after 15 weeks of pregnancy. This case is widely expected to determine the fate of Roe v. Wade as Mississippi is directly challenging the precedent set by the Supreme Court’s decisions in Roe , which protects abortion access before fetal viability (typically between 24 and 28 weeks of pregnancy). On December 1, 2021, the Supreme Court will hear oral arguments in Dobbs v. Jackson . In asking the Court to overturn Roe , the state of Mississippi offers reassurances that “there is simply no causal link between the availability of abortion and the capacity of women to act in society” 1 and hence no reason to believe that abortion access has shaped “the ability of women to participate equally in the economic and social life of the Nation” 2 as the Court had previously held.

While the debate over abortion often centers on largely intractable subjective questions of ethics and morality, in this instance the Court is being asked to consider an objective question about the causal effects of abortion access on the lives of women and their families. The field of economics affords insights into these objective questions through the application of sophisticated methodological approaches that can be used to isolate and measure the causal effects of abortion access on reproductive, social, and economic outcomes for women and their families.

Separating Correlation from Causation: The “Credibility Revolution” in Economics

To measure the causal effect of abortion on women’s lives, one must differentiate its effects from those of other forces, such as economic opportunity, social mores, the availability of contraception. Powerful statistical methodologies in the causal inference toolbox have made it possible for economists to do just that, moving beyond the maxim “correlation isn’t necessarily causation” and applying the scientific method to figure out when it is.

This year’s decision by the Economic Sciences Prize Committee recognized the contributions 3 of economists David Card, Joshua Angrist, and Guido Imbens, awarding them the Nobel Prize for their pathbreaking work developing and applying the tools of causal inference in a movement dubbed “the credibility revolution” (Angrist and Pischke, 2010). The gold standard for establishing such credibility is a well-executed randomized controlled trial – an experiment conducted in the lab or field in which treatment is randomly assigned. When economists can feasibly and ethically implement such experiments, they do. However, in the social world, this opportunity is often not available. For instance, one cannot feasibly or ethically randomly assign abortion access to some individuals but not others. Faced with this obstacle, economists turn to “natural” or “quasi” experimental methods, ones in which they are able to credibly argue that treatment is as good as randomly assigned.

The Effects of Abortion Access on Women’s Reproductive, Economic, and Social Lives

Evidence of the effects of abortion legalization.

The history of abortion legalization in the United States affords both a canonical and salient example of a natural experiment. While Roe v. Wade legalized abortion in most of the country in 1973, five states—Alaska, California, Hawaii, New York, and Washington—and the District of Columbia repealed their abortion bans several years in advance of Roe . Using a methodology known as “difference-in-difference estimation,” researchers compared changes in outcomes in these “repeal states” when they lifted abortion bans to changes in outcomes in the rest of the country. They also compared changes in outcomes in the rest of the country in 1973 when Roe legalized abortion to changes in outcomes in the repeal states where abortion already was legal. This difference-in-differences methodology allows the states where abortion access is not changing to serve as a counterfactual or “control” group that accounts for other forces that were impacting fertility and women’s lives in the Roe era.

Among the first to employ this approach was a team of economists (Levine, Staiger, Kane, and Zimmerman, 1999) who estimated that the legalization of abortion in repeal states led to a 4% to 11% decline in births in those states relative to the rest of the country. Levine and his co-authors found that these fertility effects were particularly large for teens and women of color, who experienced birth rate reductions that were nearly three times greater than the overall population as a result of abortion legalization. Multiple research teams have replicated the essential finding that abortion legalization substantially impacted American fertility while extending the analysis to consider other outcomes. 4 For example, Myers (2017) found that abortion legalization reduced the number of women who became teen mothers by 34% and the number who became teen brides by 20%, and again observed effects that were even larger for Black teens. Farin, Hoehn-Velasco, and Pesko (2021) found that abortion legalization reduced maternal mortality among Black women by 30-40%, with little impact on white women, offering the explanation that where abortion was illegal, Black women were less likely to be able to access safe abortions by traveling to other states or countries or by obtaining a clandestine abortion from a trusted health care provider.

The ripple effects of abortion access on the lives of women and their families

This research, which clearly demonstrates the causal relationship between abortion access and first-order demographic and health outcomes, laid the foundation for researchers to measure further ripple effects through the lives of women and their families. Multiple teams of authors have extended the difference-in-differences research designs to study educational and labor market outcomes, finding that abortion legalization increased women’s education, labor force participation, occupational prestige, and earnings and that all these effects were particularly large for Black women (Angrist and Evans, 1996; Kalist, 2004; Lindo, Pineda-Torres, Pritchard, and Tajali, 2020; Jones, 2021).

Additionally, research shows that abortion access has not only had profound effects on women’s economic and social lives but has also impacted the circumstances into which children are born. Researchers using difference-in-differences research designs have found that abortion legalization reduced the number of children who were unwanted (Bitler and Zavodny, 2002a, reduced cases of child neglect and abuse (Bitler and Zavodny, 2002b; 2004), reduced the number of children who lived in poverty (Gruber, Levine, and Staiger, 1999), and improved long-run outcomes of an entire generation of children by increasing the likelihood of attending college and reducing the likelihood of living in poverty and receiving public assistance (Ananat, Gruber, Levine, and Staiger, 2009).

Access to abortion continues to be important to women’s lives

The research cited above relies on variation in abortion access from the 1970s, and much has changed in terms of both reproductive technologies and women’s lives. Recent research shows, however, that even with the social, economic, and legal shifts that have occurred over the last few decades and even with expanded access to contraception, abortion access remains relevant to women’s reproductive lives. Today, nearly half of pregnancies are unintended (Finer and Zolna, 2016). About 6% of young women (ages 15-34) experience an unintended pregnancy each year (Finer, Lindberg, and Desai, 2018), and about 1.4% of women of childbearing age obtain an abortion each year (Jones, Witwer, and Jerman, 2019). At these rates, approximately one in four women will receive an abortion in their reproductive lifetimes. The fact is clear: women continue to rely on abortion access to determine their reproductive lives.

But what about their economic and social lives? While women have made great progress in terms of their educational attainment, career trajectories, and role in society, mothers face a variety of challenges and penalties that are not adequately addressed by public policy. Following the birth of a child, it’s well documented that working mothers face a “motherhood wage penalty,” which entails lower wages than women who did not have a child (Waldfogel, 1998; Anderson, Binder, and Krause, 2002; Kelven et al., 2019). Maternity leave may combat this penalty as it allows women to return to their jobs following the birth of a child – encouraging them to remain attached to the labor force (Rossin-Slater, 2017). However, as of this writing, the U.S. only offers up to 12 weeks of unpaid leave through the FMLA, which extends coverage to less than 60% of all workers. 5 And even if a mother is able to return to work, childcare in the U.S. is costly and often inaccessible for many. Families with infants can be expected to pay around $11,000 a year for childcare and subsidies are only available for 1 in 6 children that are eligible under the federal program. 6 Without a federal paid leave policy and access to affordable childcare, the U.S. lacks the infrastructure to adequately support mothers, and especially working mothers – making the prospect of motherhood financially unworkable for some.

This is relevant when considering that the women who seek abortions tend to be low-income mothers experiencing disruptive life events. In the most recent survey of abortion patients conducted by the Guttmacher Institute, 97% are adults, 49% are living below the poverty line, 59% already have children, and 55% are experiencing a disruptive life event such as losing a job, breaking up with a partner, or falling behind on rent (Jones and Jerman, 2017a and 2017b). It is not a stretch to imagine that access to abortion could be pivotal to these women’s financial lives, and recent evidence from “The Turnaway Study” 7 provides empirical support for this supposition. In this study, an interdisciplinary team of researchers follows two groups of women who were typically seeking abortions in the second trimester: one group that arrived at abortion clinics and learned they were just over the gestational age threshold for abortions and were “turned away” and a second that was just under the threshold and were provided an abortion. Miller, Wherry, and Foster (2020) match individuals in both groups to their Experian credit reports and observe that in the months leading up to the moment they sought an abortion, financial outcomes for both groups were trending similarly. At the moment one group is turned away from a wanted abortion, however, they began to experience substantial financial distress, exhibiting a 78% increase in past-due debt and an 81% increase in public records related to bankruptcies, evictions, and court judgments.

If Roe were overturned, the number of women experiencing substantial obstacles to obtaining an abortion would dramatically increase.

If Roe were overturned, the number of women experiencing substantial obstacles to obtaining an abortion would dramatically increase. Twelve states have enacted “trigger bans” designed to outlaw abortion in the immediate aftermath of a Roe reversal, while an additional 10 are considered highly likely to quickly enact new bans. 8 These bans would shutter abortion facilities across a wide swath of the American south and midwest, dramatically increasing travel distances and the logistical costs of obtaining an abortion. Economics research predicts what is likely to happen next. Multiple teams of economists have exploited natural experiments arising from mandatory waiting periods (Joyce and Kaestner, 2001; Lindo and Pineda-Torres, 2021; Myers, 2021) and provider closures (Quast, Gonzalez, and Ziemba, 2017; Fischer, Royer, and White, 2018; Lindo, Myers, Schlosser, and Cunningham, 2020; Venator and Fletcher, 2021; Myers, 2021). All have found that increases in travel distances prevent large numbers of women seeking abortions from reaching a provider and that most of these women give birth as a result. For instance, Lindo and co-authors (2020) exploit a natural experiment arising from the sudden closure of half of Texas’s abortion clinics in 2013 and find that an increase in travel distance from 0 to 100 miles results in a 25.8% decrease in abortions. Myers, Jones, and Upadhyay (2019) use these results to envision a post- Roe United States, forecasting that if Roe is overturned and the expected states begin to ban abortions, approximately 1/3 of women living in affected regions would be unable to reach an abortion provider, amounting to roughly 100,000 women in the first year alone.

Restricting, or outright eliminating, abortion access by overturning Roe v. Wade would diminish women’s personal and economic lives, as well as the lives of their families.

Whether one’s stance on abortion access is driven by deeply held views on women’s bodily autonomy or when life begins, the decades of research using rigorous methods is clear: there is a causal link between access to abortion and whether, when, and under what circumstances women become mothers, with ripple effects throughout their lives. Access affects their education, earnings, careers, and the subsequent life outcomes for their children. In the state’s argument, Mississippi rejects the causal link between access to abortion and societal outcomes established by economists and states that the availability of abortion isn’t relevant to women’s full participation in society. Economists provide clear evidence that overturning Roe would prevent large numbers of women experiencing unintended pregnancies—many of whom are low-income and financially vulnerable mothers—from obtaining desired abortions. Restricting, or outright eliminating, that access by overturning Roe v. Wade would diminish women’s personal and economic lives, as well as the lives of their families.

Caitlin Knowles Myers did not receive financial support from any firm or person for this article. She has received financial compensation from Planned Parenthood Federation of America and the Center for Reproductive Rights for serving as an expert witness in litigation involving abortion regulations. She has not and will not receive financial compensation for her role in the amicus brief described here. Other than the aforementioned, she has not received financial support from any firm or person with a financial or political interest in this article. Caitlin Knowles Myers is not currently an officer, director, or board member of any organization with a financial or political interest in this article.

Abboud, Ali, 2019. “The Impact of Early Fertility Shocks on Women’s Fertility and Labor Market Outcomes.” Available from SSRN: https://ssrn.com/abstract=3512913

Anderson, Deborah J., Binder, Melissa, and Kate Krause, 2002. “The motherhood wage penalty: Which mothers pay it and why?” The American Economic Review 92(2). Retrieved from https://www.aeaweb.org/articles?id=10.1257/000282802320191606

Ananat, Elizabeth Oltmans, Gruber, Jonathan, Levine, Phillip and Douglas Staiger, 2009. “Abortion and Selection.” The Review of Economic Statistics 91(1). Retrieved from https://direct.mit.edu/rest/article-abstract/91/1/124/57736/Abortion-and-Selection?redirectedFrom=fulltext .

Angrist, Joshua D., and Alan B. Krueger, 1999. “Does Compulsory School Attendance Affect Schooling and Earnings?” The Quarterly Journal of Economics 106(4). Retrieved from https://doi.org/10.2307/2937954 .

Angrist, Joshua D., and William N. Evans, 1996. “Schooling and Labor Market Consequences of the 1970 State Abortion Reforms.” National Bureau of Economic Research Working Paper 5406. Retrieved from https://www.nber.org/papers/w5406 .

Angrist, Joshua D., and Jörn-Steffen Pischke, 2010. “The Credibility Revolution in Empirical Economics: How Better Research Design Is Taking the Con out of Econometrics.” Journal of Economic Perspectives 24(2). Retrieved from https://www.aeaweb.org/articles?id=10.1257/jep.24.2.3

Bailey, Martha J., Hoynes, Hilary W., Rossin-Slater, Maya and Reed Walker, 2020. “Is the Social Safety Net a Long-Term Investment? Large-Scale Evidence from the Food Stamps Program” National Bureau of Economic Research Working Paper 26942 , Retrieved from https://www.nber.org/papers/w26942

Bitler, Marianne, and Madeline Zavodny, 2002a. “Did Abortion Legalization Reduce the Number of Unwanted Children? Evidence from Adoptions.” Perspectives on Sexual and Reproductive Health, 34 (1): 25-33. Retrieved from https://www.jstor.org/stable/3030229?origin=JSTOR-pdf

Bitler, Marianne, and Madeline Zavodny, 2002b. “Child Abuse and Abortion Availability.” American Economic Review , 92 (2): 363-367. Retrieved from https://www.aeaweb.org/articles?id=10.1257/000282802320191624

Bitler, Marianne, and Madeline Zavodny, 2004. “Child Maltreatment, Abortion Availability, and Economic Conditions.” Review of Economics of the Household 2: 119-141. Retrieved from https://doi.org/10.1023/B:REHO.0000031610.36468.0e

Farin, Sherajum Monira, Hoehn-Velasco, Lauren, and Michael Pesko, 2021. “The Impact of Legal Abortion on Maternal Health: Looking to the Past to Inform the Present.” Retrieved from SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3913899

Finer, Lawrence B., and Mia R. Zolna, 2016. “Declines in Unintended Pregnancy in the United States, 2008–2011” New England Journal of Medicine 374. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26962904/

Finer, Lawrence B., Lindberg, Laura, D., and Sheila Desai. “A prospective measure of unintended pregnancy in the United States.” Contraception 98(6). Retrieved from https://pubmed.ncbi.nlm.nih.gov/29879398/

Fischer, Stefanie, Royer, Heather, and Corey White, 2017. “The Impacts of Reduced Access to Abortion and Family Planning Services on Abortion, Births, and Contraceptive Purchases.” National Bureau of Economic Research Working Paper 23634 . Retrieved from https://www.nber.org/papers/w23634

Gruber, Jonathan, Levine, Phillip, and Douglas Staiger, 1999. “Abortion Legalization and Child Living Circumstances: Who Is the ‘Marginal Child’?” Quarterly Journal of Economics 114. Retrieved from https://doi.org/10.1162/003355399556007

Guldi, Melanie, 2008. “Fertility effects of abortion and birth control pill access for minors.” Demography 45 . Retrieved from https://doi.org/10.1353/dem.0.0026

Hoynes, Hilary, Schanzenbach, Diane Whitmore, and Douglas Almond, 2016. “Long-Run Impacts of Childhood Access to the Safety Net.” American Economic Review 106(4). Retrieved from https://www.aeaweb.org/articles?id=10.1257/aer.20130375

Jones, Kelly, 2021. “At a Crossroads: The Impact of Abortion Access on Future Economic Outcomes.” American University Working Paper . Retrieved from https://doi.org/10.17606/0Q51-0R11 .

Jones, Rachel K., Witwer, Elizabeth, Jerman, Jenna, September 18, 2018. “Abortion Incidence and Service Availability in the United States, 2017.” Guttmacher Institute. Retrieved from https://www.guttmacher.org/sites/ default/files/report_pdf/abortion-inciden ce-service-availability-us-2017.

Jones Rachel K., and Janna Jerman, 2017a. ”Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014.” American Journal of Public Health 107 (12). Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304042

Jones, Rachel K. and Jenna Jerman, 2017b. “Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions.” PLoS One . Retrieved from https://pubmed.ncbi.nlm.nih.gov/28121999/

Joyce, Ted, and Robert Kaestner, 2001. “The Impact of Mandatory Waiting Periods and Parental Consent Laws on the Timing of Abortion and State of Occurrence among Adolescents in Mississippi and South Carolina.” Journal of Policy Analysis and Management 20(2) . Retrieved from https://www.jstor.org/stable/3325799 .

Kalist, David E., 2004. “Abortion and Female Labor Force Participation: Evidence Prior to Roe v. Wade.” Journal of Labor Research 25 (3) .

Keiser, David, and Joseph Shapiro, 2019. “Consequences of the Clean Water Act and the Demand for Water Quality.” The Quarterly Journal of Economics 134 (1).

Kleven, Henrik, Landais, Camille, Posch, Johanna, Steinhauer, Andreas, and Josef Zweimuleler, 2019. “Child Penalties Across Countries: Evidence and Explanations.” AEA Papers and Proceedings 109. Retrieved from https://www.aeaweb.org/articles?id=10.1257/pandp.20191078/

Levine, Phillip, Staiger, Douglas, Kane, Thomas, and David Zimmerman, 1999. “Roe v. Wade and American Fertility.” American Journal Of Public Health 89(2) . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508542/

Lindo, Jason M., Myers, Caitlin Knowles, Schlosser, Andrea, and Scott Cunningham, 2020. “How Far Is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions” Journal of Human Resources 55. Retrieved from http://jhr.uwpress.org/content/55/4/1137.refs

Lindo, Jason M., Pineda-Torres, Mayra, Pritchard, David, and Hedieh Tajali, 2020. “Legal Access to Reproductive Control Technology, Women’s Education, and Earnings Approaching Retirement.” AEA Papers and Proceedings 110. Retrieved from https://www.aeaweb.org/articles?id=10.1257/pandp.20201108

Lindo, Jason M., and Mayra Pineda-Torres, 2021. “New Evidence on the Effects of Mandatory Waiting Periods for Abortion.” J ournal of Health Econ omics. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34607119/

Miguel, Edward, Satyanath, Shanker, and Ernest Sergenti, 2004. “Economic Shocks and Civil Conflict: An Instrumental Variables Approach.” Journal of Political Economy 112(4). Retrieved from https://www.jstor.org/stable/10.1086/421174

Miller, Sarah, Wherry, Laura R., and Diana Greene Foster, 2020. “The Economic Consequences of Being Denied an Abortion.” National Bureau of Economic Research, Working Paper 26662 . Retrieved from https://www.nber.org/papers/w26662 .

Myers, Caitlin Knowles, 2017. “The Power of Abortion Policy: Reexamining the Effects of Young Women’s Access to Reproductive Control” Journal of Political Economy 125(6) . Retrieved from https://doi.org/10.1086/694293 .

Myers, Caitlin Knowles, Jones, Rachel, and Ushma Upadhyay, 2019. “Predicted changes in abortion access and incidence in a post-Roe world.” Contraception 100(5). Retrieved from https://pubmed.ncbi.nlm.nih.gov/31376381/

Myers, Caitlin Knowles, 2021. “Cooling off or Burdened? The Effects of Mandatory Waiting Periods on Abortions and Births.” IZA Institute of Labor Economics No. 14434. Retrieved from https://www.iza.org/publications/dp/14434/cooling-off-or-burdened-the-effects-of-mandatory-waiting-periods-on-abortions-and-births

Quast, Troy, Gonzalez, Fidel, and Robert Ziemba, 2017. “Abortion Facility Closings and Abortion Rates in Texas.” Inquiry: A Journal of Medical Care Organization, Provision and Financing 54 . Retrieved from https://journals.sagepub.com/doi/full/10.1177/0046958017700944

Rossin-Slater, Maya, 2017. “Maternity and Family Leave Policy.” National Bureau of Economic Research Working Paper 23069. Retrieved from https://www.nber.org/papers/w23069

Venator, Joanna, and Jason Fletcher, 2020. “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin.” Journal of Policy Analysis and Management 40(3). Retrieved from https://doi.org/10.1002/pam.22263

Waldfogel, Jane, 1998. “The family gap for young women in the United States and Britain: Can maternity leave make a difference?” Journal of Labor Economics 16(3).

Thomas E. Dobbs v. Jackson Women’s Health Organization. On Writ of Certiorari to the United States Court of Appeals for the Fifth Circuit, Brief in Support of Petitioners, No. 19-1392.
Thomas E. Dobbs v. Jackson Women’s Health Organization. On Writ of Certiorari to the United States Court of Appeals for the Fifth Circuit, Brief for Petitioners, No. 19-139, Retrieved from https://www.supremecourt.gov/DocketPDF/19/19-1392/184703/20210722161332385_19-1392BriefForPetitioners.pdf
The Nobel Prize. 2021. “Press release: The Prize in Economic Sciences 202.” Retrieved from https://www.nobelprize.org/prizes/economic-sciences/2021/press-release/
See Angrist and Evans (1996), Gruber et al. (1999), Ananat et al. (2009), Guldi (2008), Myers (2017), Abboud (2019), Jones (2021).
Brown, Scott, Herr, Jane, Roy, Radha , and Jacob Alex Klerman, July 2020. “Employee and Worksite Perspectives of the FMLA Who Is Eligible?” U.S. Department of Labor. Retrieved from https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA2018PB1WhoIsEligible_StudyBrief_Aug2020.pdf
Whitehurst, Grover J., April 19, 2018. “What is the market price of daycare and preschool?” Brookings Institution. Retrieved from https://www.brookings.edu/research/what-is-the-market-price-of-daycare-and-preschool/; Chien, Nina, 2021. “Factsheet: Estimates of Child Care Eligibility & Receipt for Fiscal Year 2018.” U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/sites/default/files/20 21-08/cy-2018-child-care-subsidy-eligibility.pdf
Advancing New Standards in Reproductive Health (NSIRH). “The Turnaway Study.” Retrieved from https://www.ansirh.org/research/ongoing/turnaway-study.
Center for Reproductive Rights, 2021. “What If Roe Fell?” Retrieved from https://maps.reproductiverights.org/what-if-roe-fell

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Abortion Law: Global Comparisons

Members of a pro-choice group protest in Belfast, Northern Ireland, in October 2019.

The U.S. Supreme Court overturned Roe v. Wade, which guaranteed the constitutional right to abortion for almost fifty years. How does regulation of abortion in the United States compare to that in the rest of the world?

Article by Women and Foreign Policy Program Staff

Last updated March 7, 2024 2:30 pm (EST)

The past fifty years have been characterized by an unmistakable trend toward the liberalization of abortion laws, particularly in the industrialized world. Each year, around seventy-three million abortions take place worldwide, according to the World Health Organization (WHO). This translates to about thirty-nine abortions per one thousand women globally, a rate that has stayed roughly the same since 1990. Notably, rates have diverged between countries with fewer restrictions and those with more: Between 1990–94 and 2015–19, the average abortion rate in countries with generally legal abortion (excluding China and India) declined by 43 percent. By contrast, in countries with severe restrictions on abortion, the average abortion rate increased by around 12 percent.

As nations around the globe have expanded the grounds on which people can access reproductive health services, the quality and safety of abortion care has improved, as has maternal survival. However, the safety of abortion procedures diverges widely between countries where abortion is generally legal and countries with high restrictions on abortion. Almost 90 percent of abortions in countries with liberal abortion laws are considered safe, compared with just 25 percent of abortions [PDF] in countries where abortion is banned. According to the WHO, approximately 5–13 percent of maternal deaths worldwide are due to complications from unsafe abortions, the vast majority of which occur in developing countries.

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Maternal and Child Health

However, there remains strong opposition to abortion among some constituencies. And in recent years, a number of countries, particularly autocracies, have pushed back against the expansion of women’s and reproductive rights. Abortion opponents in the United States won a major victory in June 2022 with Dobbs v. Jackson Women’s Health Organization , a Supreme Court ruling that struck down the 1973 decision Roe v. Wade , which guaranteed the constitutional right to abortion. Since Dobbs , twenty-one states have moved to ban or restrict abortion access.

What does abortion law look like around the world?

Although the legal status of abortion varies considerably by region, a large majority of countries permit abortion under at least some circumstances; globally, twenty-two countries ban abortion entirely. Most industrialized countries allow the procedure without restriction. Around one hundred countries have some restrictions, typically permitting abortion only in limited situations, including for socioeconomic reasons, risks to a woman’s physical or mental health, or the presence of fetal anomalies. However, legal language concerning exemptions for fetal impairment is often vague, resulting in uncertainty for medical professionals about whether performing certain abortions is legal.

Access to safe abortion has been established as a human right by numerous international frameworks , the UN Human Rights Committee, and regional human rights courts, including the European Court of Human Rights, the Inter-American Court of Human Rights, and the African Commission on Human and Peoples’ Rights. At the 1994 International Conference on Population and Development in Cairo, 179 governments signed a program of action [PDF] that included a commitment to prevent unsafe abortion. And in 2015, the United Nations’ 2030 Agenda for Sustainable Development expanded to call for universal access to services for reproductive-health care. The WHO first recognized unsafe abortion as a public health problem in 1967, and in 2003 it developed technical and policy guidelines that include a recommendation that states pass abortion laws to protect women’s health. According to the UN Population Fund, addressing the unmet need for family planning would both considerably reduce maternal mortality and reduce abortion by up to 70 percent in the developing world.

How does the United States compare?

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The Supreme Court’s decision on June 24, 2022, to strike down Roe v. Wade , overturns almost fifty years of precedent that conferred a constitutional right to receive an abortion. In the 1973 Roe decision, the Court held that the Constitution guarantees the right to choose to have an abortion, though it permitted regulations after the first trimester of pregnancy. With Roe , the United States became one of the first countries to liberalize its abortion laws, along with several Western European nations. In 1992, Planned Parenthood v. Casey reaffirmed the right to an abortion but permitted additional restrictions, such as waiting periods and parental consent requirements.

For decades, states have introduced and implemented various laws regulating abortions. Some passed laws to protect abortion access, while others imposed more onerous regulations on abortion providers and sought to prohibit abortion at earlier points in pregnancy. Many states have passed increasingly strict abortion laws in recent years, sometimes banning the procedure after as few as six weeks of pregnancy. Some states with stringent abortion restrictions, such as Idaho, Oklahoma, and Texas, have implemented so-called vigilante laws allowing members of the public to sue abortion providers and anyone they suspect of providing or facilitating abortions. In the last year, more than sixty Planned Parenthood facilities and doctors’ offices have been forced to close or focus on services other than abortion. Some providers have moved to less-restrictive states, leaving many states with only a single abortion provider .

Roe’s reversal allows the thirteen states that have so-called trigger laws to either ban abortion automatically or by quick state action. While all of these state laws exempt abortions in cases of life-threatening pregnancies, many do not exempt pregnancies caused by rape or incest. Republican lawmakers and anti-abortion advocates have praised the Supreme Court’s decision, while Democratic lawmakers and abortion advocates have condemned it.

What have been recent trends?

The global trend in abortion law has been toward liberalization. In the last thirty years, more than sixty countries have changed their abortion laws, and all but four—the United States, El Salvador, Nicaragua, and Poland— expanded the legal grounds on which women can access abortion services. Since 2020, Argentina and Thailand legalized abortions, with certain gestational limits; South Korea decriminalized abortion; and New Zealand eased its abortion restrictions. Most recently, amid a growing “ green wave ” in Latin America, Colombia made abortion legal on demand up to twenty-four weeks of pregnancy, and Mexico decriminalized the procedure, removing its ban from the federal penal code. Although most countries have taken steps to expand grounds for abortion, some—including Honduras and the United States—are enacting policies to tighten restrictions.

Here’s a look at how abortion laws have changed in a handful of countries around the globe:

China . China liberalized its abortion law in the 1950s and promoted the practice under its one-child policy, which was enacted in 1979 in an effort to curb population growth by restricting families to one child. The policy, under which abortion services were made widely available, came with severe coercive measures —including fines, compulsory sterilization, and abortion—to deter unauthorized births. China raised this long-standing limit to a two-child policy in 2016, along with other incentives to encourage population growth amid a rapidly aging population. In 2021, it increased the limit to three children, and China’s State Council issued guidelines on women’s development that called to reduce “non–medically necessary abortions.”

Kenya . Postcolonial Kenya’s abortion law was rooted in the British penal code, which criminalized abortion. When Kenya adopted a new constitution in 2010, it expanded the grounds [PDF] on which women could obtain an abortion to include emergency cases, or those in which the health of the mother is at stake. In June 2019, a court extended the exceptions to include cases of rape . As other former European colonies reevaluate their abortion statutes, many are expanding the grounds for abortion. For instance, Burkina Faso, Chad, Guinea, Mali, and Niger—nations whose restrictive abortion laws were holdovers from the 1810 Napoleonic Code imposed by France—have made abortion legal in cases of rape, incest, or fetal impairment.

Ireland . In 2018, the Irish parliament legalized the termination of pregnancy before twelve weeks, as well as in cases in which the health of the mother is at stake. Previously, Ireland had one of the most restrictive abortion laws in Europe, codified in a 1983 constitutional amendment that effectively banned the practice. The 2012 death of Savita Halappanavar after she was denied an emergency abortion reignited public debate and protest and prompted a countrywide referendum to overturn the amendment; the referendum passed with 66 percent of the vote. In 2019, abortion was legalized in Northern Ireland, which is part of the United Kingdom (UK). The UK’s 1967 Abortion Act, which grants doctors in England, Scotland, and Wales the authority to perform abortions, was extended to Northern Ireland following a vote by the UK Parliament.

Zambia . Zambia is one of the few countries in Africa where abortion is permitted for economic and social reasons, but, despite having a liberal law, structural and cultural barriers make it difficult for Zambian women to obtain abortions. As of 2018, Zambia had one practicing medical doctor per twelve thousand inhabitants; and for the 55 percent of Zambians living in rural areas, health professionals are few and far between. The law stipulates that only a registered medical practitioner [PDF], and not a nurse or midwife, can perform an abortion, rendering safe access out of reach for most. Zambia is plagued by a high rate of abortion-related maternal mortality , with about 30 percent of maternal deaths caused by abortion complications.

Honduras. The Central American country has among the world’s strictest laws on abortion, which has been banned since 1985. In 2021, lawmakers enshrined the ban in the country’s constitution; now, any change to abortion law requires at least a three-quarters majority in the National Congress. UN experts estimate that between around fifty thousand and eighty thousand unsafe abortions take place in Honduras each year. Honduras’s neighbors El Salvador and Nicaragua also have prohibitions on abortion, and they are the only two countries to have imposed new restrictions on abortion since the 1994 Cairo Declaration, which recognized reproductive health as critical to development.

Poland . In 2020, Poland’s Constitutional Tribunal ruled that abortions in cases of fetal impairment are unconstitutional, making the country’s abortion law one of the strictest in Europe. Because the vast majority of abortions performed in Poland prior to the ruling were due to fetal abnormalities, the decision initiated a near-total ban. In response, hundreds of thousands of people took to the streets to protest the decision, though it remains in effect. Polish law still allows abortions in cases of rape, incest, and life-threatening pregnancies, though doctors have reportedly been reluctant to perform legal abortions since the ruling. Doctors face up to three years in prison if the government finds they performed an abortion hastily or without sufficient justification.

France . In 2024, France became the first country to enshrine abortion rights in its constitution. Abortion rights had been decriminalized in 1975 in a controversial act that legalized the procedure up to the tenth week of pregnancy. The gestational limit was extended to twelve weeks in 2001 and fourteen weeks in 2022. That same year, following the overturn of Roe v. Wade, the country sought to formally safeguard the law with a constitutional amendment. Having passed through the National Assembly and Senate, the amended Article 34 now guarantees a woman’s freedom to have an abortion. Polls show that more than 80 percent of respondents endorsed this amendment.

Editor’s note: This article is based on original reporting by Rachel B. Vogelstein and Rebecca Turkington that was previously published on CFR.org in 2019.

Noël James, Haydn Welch, and Antonio Barreras Lozano contributed to this article. Will Merrow created the graphics.

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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

A research on abortion: ethics, legislation and socio-medical outcomes. Case study: Romania

Andreea mihaela niţă.

1 Faculty of Social Sciences, University of Craiova, Romania

Cristina Ilie Goga

This article presents a research study on abortion from a theoretical and empirical point of view. The theoretical part is based on the method of social documents analysis, and presents a complex perspective on abortion, highlighting items of medical, ethical, moral, religious, social, economic and legal elements. The empirical part presents the results of a sociological survey, based on the opinion survey method through the application of the enquiry technique, conducted in Romania, on a sample of 1260 women. The purpose of the survey is to identify Romanians perception on the decision to voluntary interrupt pregnancy, and to determine the core reasons in carrying out an abortion.

The analysis of abortion by means of medical and social documents

Abortion means a pregnancy interruption “before the fetus is viable” [ 1 ] or “before the fetus is able to live independently in the extrauterine environment, usually before the 20 th week of pregnancy” [ 2 ]. “Clinical miscarriage is both a common and distressing complication of early pregnancy with many etiological factors like genetic factors, immune factors, infection factors but also psychological factors” [ 3 ]. Induced abortion is a practice found in all countries, but the decision to interrupt the pregnancy involves a multitude of aspects of medical, ethical, moral, religious, social, economic, and legal order.

In a more simplistic manner, Winston Nagan has classified opinions which have as central element “abortion”, in two major categories: the opinion that the priority element is represented by fetus and his entitlement to life and the second opinion, which focuses around women’s rights [ 4 ].

From the medical point of view, since ancient times there have been four moments, generally accepted, which determine the embryo’s life: ( i ) conception; ( ii ) period of formation; ( iii ) detection moment of fetal movement; ( iv ) time of birth [ 5 ]. Contemporary medicine found the following moments in the evolution of intrauterine fetal: “ 1 . At 18 days of pregnancy, the fetal heartbeat can be perceived and it starts running the circulatory system; 2 . At 5 weeks, they become more clear: the nose, cheeks and fingers of the fetus; 3 . At 6 weeks, they start to function: the nervous system, stomach, kidneys and liver of the fetus, and its skeleton is clearly distinguished; 4 . At 7 weeks (50 days), brain waves are felt. The fetus has all the internal and external organs definitively outlined. 5 . At 10 weeks (70 days), the unborn child has all the features clearly defined as a child after birth (9 months); 6 . At 12 weeks (92 days, 3 months), the fetus has all organs definitely shaped, managing to move, lacking only the breath” [ 6 ]. Even if most of the laws that allow abortion consider the period up to 12 weeks acceptable for such an intervention, according to the above-mentioned steps, there can be defined different moments, which can represent the beginning of life. Nowadays, “abortion is one of the most common gynecological experiences and perhaps the majority of women will undergo an abortion in their lifetimes” [ 7 ]. “Safe abortions carry few health risks, but « every year, close to 20 million women risk their lives and health by undergoing unsafe abortions » and 25% will face a complication with permanent consequences” [ 8 , 9 ].

From the ethical point of view, most of the times, the interruption of pregnancy is on the border between woman’s right over her own body and the child’s (fetus) entitlement to life. Judith Jarvis Thomson supported the supremacy of woman’s right over her own body as a premise of freedom, arguing that we cannot force a person to bear in her womb and give birth to an unwanted child, if for different circumstances, she does not want to do this [ 10 ]. To support his position, the author uses an imaginary experiment, that of a violinist to which we are connected for nine months, in order to save his life. However, Thomson debates the problem of the differentiation between the fetus and the human being, by carrying out a debate on the timing which makes this difference (period of conception, 10 weeks of pregnancy, etc.) and highlighting that for people who support abortion, the fetus is not an alive human being [ 10 ].

Carol Gilligan noted that women undergo a true “moral dilemma”, a “moral conflict” with regards to voluntary interruption of pregnancy, such a decision often takes into account the human relationships, the possibility of not hurting the others, the responsibility towards others [ 11 ]. Gilligan applied qualitative interviews to a number of 29 women from different social classes, which were put in a position to decide whether or not to commit abortion. The interview focused on the woman’s choice, on alternative options, on individuals and existing conflicts. The conclusion was that the central moral issue was the conflict between the self (the pregnant woman) and others who may be hurt as a result of the potential pregnancy [ 12 ].

From the religious point of view, abortion is unacceptable for all religions and a small number of abortions can be seen in deeply religious societies and families. Christianity considers the beginning of human life from conception, and abortion is considered to be a form of homicide [ 13 ]. For Christians, “at the same time, abortion is giving up their faith”, riot and murder, which means that by an abortion we attack Jesus Christ himself and God [ 14 ]. Islam does not approve abortion, relying on the sacral life belief as specified in Chapter 6, Verse 151 of the Koran: “Do not kill a soul which Allah has made sacred (inviolable)” [ 15 ]. Buddhism considers abortion as a negative act, but nevertheless supports for medical reasons [ 16 ]. Judaism disapproves abortion, Tanah considering it to be a mortal sin. Hinduism considers abortion as a crime and also the greatest sin [ 17 ].

From the socio-economic point of view, the decision to carry out an abortion is many times determined by the relations within the social, family or financial frame. Moreover, studies have been conducted, which have linked the legalization of abortions and the decrease of the crime rate: “legalized abortion may lead to reduced crime either through reductions in cohort sizes or through lower per capita offending rates for affected cohorts” [ 18 ].

Legal regulation on abortion establishes conditions of the abortion in every state. In Europe and America, only in the XVIIth century abortion was incriminated and was considered an insignificant misdemeanor or a felony, depending on when was happening. Due to the large number of illegal abortions and deaths, two centuries later, many states have changed legislation within the meaning of legalizing voluntary interruption of pregnancy [ 6 ]. In contemporary society, international organizations like the United Nations or the European Union consider sexual and reproductive rights as fundamental rights [ 19 , 20 ], and promotes the acceptance of abortion as part of those rights. However, not all states have developed permissive legislation in the field of voluntary interruption of pregnancy.

Currently, at national level were established four categories of legislation on pregnancy interruption area:

( i ) Prohibitive legislations , ones that do not allow abortion, most often outlining exceptions in abortion in cases where the pregnant woman’s life is endangered. In some countries, there is a prohibition of abortion in all circumstances, however, resorting to an abortion in the case of an imminent threat to the mother’s life. Same regulation is also found in some countries where abortion is allowed in cases like rape, incest, fetal problems, etc. In this category are 66 states, with 25.5% of world population [ 21 ].

( ii ) Restrictive legislation that allow abortion in cases of health preservation . Loosely, the term “health” should be interpreted according to the World Health Organization (WHO) definition as: “health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [ 22 ]. This type of legislation is adopted in 59 states populated by 13.8% of the world population [ 21 ].

( iii ) Legislation allowing abortion on a socio-economic motivation . This category includes items such as the woman’s age or ability to care for a child, fetal problems, cases of rape or incest, etc. In this category are 13 countries, where we have 21.3% of the world population [ 21 ].

( iv ) Legislation which do not impose restrictions on abortion . In the case of this legislation, abortion is permitted for any reason up to 12 weeks of pregnancy, with some exceptions (Romania – 14 weeks, Slovenia – 10 weeks, Sweden – 18 weeks), the interruption of pregnancy after this period has some restrictions. This type of legislation is adopted in 61 countries with 39.5% of the world population [21].

The Centre for Reproductive Rights has carried out from 1998 a map of the world’s states, based on the legislation typology of each country (Figure (Figure1 1 ).

An external file that holds a picture, illustration, etc.
Object name is RJME-61-1-283-fig1.jpg

The analysis of states according to the legislation regarding abortion. Source: Centre for Reproductive Rights. The World’s Abortion Laws, 2018 [ 23 ]

An unplanned pregnancy, socio-economic context or various medical problems [ 24 ], lead many times to the decision of interrupting pregnancy, regardless the legislative restrictions. In the study “Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008” issued in 2011 by the WHO , it was determined that within the states with restrictive legislation on abortion, we may also encounter a large number of illegal abortions. The illegal abortions may also be resulting in an increased risk of woman’s health and life considering that most of the times inappropriate techniques are being used, the hygienic conditions are precarious and the medical treatments are incorrectly administered [ 25 ]. Although abortions done according to medical guidelines carry very low risk of complications, 1–3 unsafe abortions contribute substantially to maternal morbidity and death worldwide [ 26 ].

WHO has estimated for the year 2008, the fact that worldwide women between the ages of 15 and 44 years carried out 21.6 million “unsafe” abortions, which involved a high degree of risk and were distributed as follows: 0.4 million in the developed regions and a number of 21.2 million in the states in course of development [ 25 ].

Case study: Romania

Legal perspective on abortion

In Romania, abortion was brought under regulation by the first Criminal Code of the United Principalities, from 1864.

The Criminal Code from 1864, provided the abortion infringement in Article 246, on which was regulated as follows: “Any person, who, using means such as food, drinks, pills or any other means, which will consciously help a pregnant woman to commit abortion, will be punished to a minimum reclusion (three years).

The woman who by herself shall use the means of abortion, or would accept to use means of abortion which were shown or given to her for this purpose, will be punished with imprisonment from six months to two years, if the result would be an abortion. In a situation where abortion was carried out on an illegitimate baby by his mother, the punishment will be imprisonment from six months to one year.

Doctors, surgeons, health officers, pharmacists (apothecary) and midwives who will indicate, will give or will facilitate these means, shall be punished with reclusion of at least four years, if the abortion took place. If abortion will cause the death of the mother, the punishment will be much austere of four years” (Art. 246) [ 27 ].

The Criminal Code from 1864, reissued in 1912, amended in part the Article 246 for the purposes of eliminating the abortion of an illegitimate baby case. Furthermore, it was no longer specified the minimum of four years of reclusion, in case of abortion carried out with the help of the medical staff, leaving the punishment to the discretion of the Court (Art. 246) [ 28 ].

The Criminal Code from 1936 regulated abortion in the Articles 482–485. Abortion was defined as an interruption of the normal course of pregnancy, being punished as follows:

“ 1 . When the crime is committed without the consent of the pregnant woman, the punishment was reformatory imprisonment from 2 to 5 years. If it caused the pregnant woman any health injury or a serious infirmity, the punishment was reformatory imprisonment from 3 to 6 years, and if it has caused her death, reformatory imprisonment from 7 to 10 years;

2 . When the crime was committed by the unmarried pregnant woman by herself, or when she agreed that someone else should provoke the abortion, the punishment is reformatory imprisonment from 3 to 6 months, and if the woman is married, the punishment is reformatory imprisonment from 6 months to one year. Same penalty applies also to the person who commits the crime with the woman’s consent. If abortion was committed for the purpose of obtaining a benefit, the punishment increases with another 2 years of reformatory imprisonment.

If it caused the pregnant woman any health injuries or a severe disablement, the punishment will be reformatory imprisonment from one to 3 years, and if it has caused her death, the punishment is reformatory imprisonment from 3 to 5 years” (Art. 482) [ 29 ].

The criminal legislation from 1936 specifies that it is not considered as an abortion the interruption from the normal course of pregnancy, if it was carried out by a doctor “when woman’s life was in imminent danger or when the pregnancy aggravates a woman’s disease, putting her life in danger, which could not be removed by other means and it is obvious that the intervention wasn’t performed with another purpose than that of saving the woman’s life” and “when one of the parents has reached a permanent alienation and it is certain that the child will bear serious mental flaws” (Art. 484, Par. 1 and Par. 2) [ 29 ].

In the event of an imminent danger, the doctor was obliged to notify prosecutor’s office in writing, within 48 hours after the intervention, on the performance of the abortion. “In the other cases, the doctor was able to intervene only with the authorization of the prosecutor’s office, given on the basis of a medical certificate from hospital or a notice given as a result of a consultation between the doctor who will intervene and at least a professor doctor in the disease which caused the intervention. General’s Office Prosecutor, in all cases provided by this Article, shall be obliged to maintain the confidentiality of all communications or authorizations, up to the intercession of any possible complaints” (Art. 484) [ 29 ].

The legislation of 1936 provided a reformatory injunction from one to three years for the abortions committed by doctors, sanitary agents, pharmacists, apothecary or midwives (Art. 485) [ 29 ].

Abortion on demand has been legalized for the first time in Romania in the year 1957 by the Decree No. 463, under the condition that it had to be carried out in a hospital and to be carried out in the first quarter of the pregnancy [ 30 ]. In the year 1966, demographic policy of Romania has dramatically changed by introducing the Decree No. 770 from September 29 th , which prohibited abortion. Thus, the voluntary interruption of pregnancy became a crime, with certain exceptions, namely: endangering the mother’s life, physical or mental serious disability; serious or heritable illness, mother’s age over 45 years, if the pregnancy was a result of rape or incest or if the woman gave birth to at least four children who were still in her care (Art. 2) [ 31 ].

In the Criminal Code from 1968, the abortion crime was governed by Articles 185–188.

The Article 185, “the illegal induced abortion”, stipulated that “the interruption of pregnancy by any means, outside the conditions permitted by law, with the consent of the pregnant woman will be punished with imprisonment from one to 3 years”. The act referred to above, without the prior consent from the pregnant woman, was punished with prison from two to five years. If the abortion carried out with the consent of the pregnant woman caused any serious body injury, the punishment was imprisonment from two to five years, and when it caused the death of the woman, the prison sentence was from five to 10 years. When abortion was carried out without the prior consent of the woman, if it caused her a serious physical injury, the punishment was imprisonment from three to six years, and if it caused the woman’s death, the punishment was imprisonment from seven to 12 years (Art. 185) [ 32 ].

“When abortion was carried out in order to obtain a material benefit, the maximum punishment was increased by two years, and if the abortion was made by a doctor, in addition to the prison punishment could also be applied the prohibition to no longer practice the profession of doctor”.

Article 186, “abortion caused by the woman”, stipulated that “the interruption of the pregnancy course, committed by the pregnant woman, was punished with imprisonment from 6 months to 2 years”, quoting the fact that by the same punishment was also sanctioned “the pregnant woman’s act to consent in interrupting the pregnancy course made out by another person” (Art. 186) [ 26 ].

The Regulations of the Criminal Code in 1968, also provided the crime of “ownership of tools or materials that can cause abortion”, the conditions of this holding being met when these types of instruments were held outside the hospital’s specialized institutions, the infringement shall be punished with imprisonment from three months to one year (Art. 187) [ 32 ].

Furthermore, the doctors who performed an abortion in the event of extreme urgency, without prior legal authorization and if they did not announce the competent authority within the legal deadline, they were punished by imprisonment from one month to three months (Art. 188) [ 32 ].

In the year 1985, it has been issued the Decree No. 411 of December 26 th , by which the conditions imposed by the Decree No. 770 of 1966 have been hardened, meaning that it has increased the number of children, that a woman could have in order to request an abortion, from four to five children [ 33 ].

The Articles 185–188 of the Criminal Code and the Decree No. 770/1966 on the interruption of the pregnancy course have been abrogated by Decree-Law No. 1 from December 26 th , 1989, which was published in the Official Gazette No. 4 of December 27 th , 1989 (Par. 8 and Par. 12) [ 34 ].

The Criminal Code from 1968, reissued in 1997, maintained Article 185 about “the illegal induced abortion”, but drastically modified. Thus, in this case of the Criminal Code, we identify abortion as “the interruption of pregnancy course, by any means, committed in any of the following circumstances: ( a ) outside medical institutions or authorized medical practices for this purpose; ( b ) by a person who does not have the capacity of specialized doctor; ( c ) if age pregnancy has exceeded 14 weeks”, the punishment laid down was the imprisonment from 6 months to 3 years” (Art. 185, Par. 1) [ 35 ]. For the abortion committed without the prior consent of the pregnant woman, the punishment consisted in strict prison conditions from two to seven years and with the prohibition of certain rights (Art. 185, Par. 2) [ 35 ].

For the situation of causing serious physical injury to the pregnant woman, the punishment was strict prison from three to 10 years and the removal of certain rights, and if it had as a result the death of the pregnant woman, the punishment was strict prison from five to 15 years and the prohibition of certain rights (Art. 185, Par. 3) [ 35 ].

The attempt was punished for the crimes specified in the various cases of abortion.

Consideration should also be given in the Criminal Code reissued in 1997 for not punishing the interruption of the pregnancy course carried out by the doctor, if this interruption “was necessary to save the life, health or the physical integrity of the pregnant woman from a grave and imminent danger and that it could not be removed otherwise; in the case of a over fourteen weeks pregnancy, when the interruption of the pregnancy course should take place from therapeutic reasons” and even in a situation of a woman’s lack of consent, when it has not been given the opportunity to express her will, and abortion “was imposed by therapeutic reasons” (Art. 185, Par. 4) [ 35 ].

Criminal Code from 2004 covers abortion in Article 190, defined in the same way as in the prior Criminal Code, with the difference that it affects the limits of the punishment. So, in the event of pregnancy interruption, in accordance with the conditions specified in Paragraph 1, “the penalty provided was prison time from 6 months to one year or days-fine” (Art. 190, Par. 1) [ 36 ].

Nowadays, in Romania, abortion is governed by the criminal law of 2009, which entered into force in 2014, by the section called “aggression against an unborn child”. It should be specified that current criminal law does not punish the woman responsible for carrying out abortion, but only the person who is involved in carrying out the abortion. There is no punishment for the pregnant woman who injures her fetus during pregnancy.

In Article 201, we can find the details on the pregnancy interruption infringement. Thus, the pregnancy interruption can be performed in one of the following circumstances: “outside of medical institutions or medical practices authorized for this purpose; by a person who does not have the capacity of specialist doctor in Obstetrics and Gynecology and the right of free medical practice in this specialty; if gestational age has exceeded 14 weeks”, the punishment is the imprisonment for six months to three years, or fine and the prohibition to exercise certain rights (Art. 201, Par. 1) [ 37 ].

Article 201, Paragraph 2 specifies that “the interruption of the pregnancy committed under any circumstances, without the prior consent of the pregnant woman, can be punished with imprisonment from 2 to 7 years and with the prohibition to exercise some rights” (Art. 201, Par. 1) [ 37 ].

If by facts referred to above (Art. 201, Par. 1 and Par. 2) [ 37 ] “it has caused the pregnant woman’s physical injury, the punishment is the imprisonment from 3 to 10 years and the prohibition to exercise some rights, and if it has had as a result the pregnant woman’s death, the punishment is the imprisonment from 6 to 12 years and the prohibition to exercise some rights” (Art. 201, Par. 3) [ 37 ]. When the facts have been committed by a doctor, “in addition to the imprisonment punishment, it will also be applied the prohibition to exercise the profession of doctor (Art. 201, Par. 4) [ 37 ].

Criminal legislation specifies that “the interruption of pregnancy does not constitute an infringement with the purpose of a treatment carried out by a specialist doctor in Obstetrics and Gynecology, until the pregnancy age of twenty-four weeks is reached, or the subsequent pregnancy interruption, for the purpose of treatment, is in the interests of the mother or the fetus” (Art. 201, Par. 6) [ 37 ]. However, it can all be found in the phrases “therapeutic purposes” and “the interest of the mother and of the unborn child”, which predisposes the text of law to an interpretation, finally the doctors are the only ones in the position to decide what should be done in such cases, assuming direct responsibility [ 38 ].

Article 202 of the Criminal Code defines the crime of harming an unborn child, pointing out the punishments for the various types of injuries that can occur during pregnancy or in the childbirth period and which can be caused by the mother or by the persons who assist the birth, with the specification that the mother who harms her fetus during pregnancy is not punished and does not constitute an infringement if the injury has been committed during pregnancy or during childbirth period if the facts have been “committed by a doctor or by an authorized person to assist the birth or to follow the pregnancy, if they have been committed in the course of the medical act, complying with the specific provisions of his profession and have been made in the interest of the pregnant woman or fetus, as a result of the exercise of an inherent risk in the medical act” (Art. 202, Par. 6) [ 37 ].

The fact situation in Romania

During the period 1948–1955, called “the small baby boom” [ 39 ], Romania registered an average fertility rate of 3.23 children for a woman. Between 1955 and 1962, the fertility rate has been less than three children for a woman, and in 1962, fertility has reached an average of two children for a woman. This phenomenon occurred because of the Decree No. 463/1957 on liberalization of abortion. After the liberalization from 1957, the abortion rate has increased from 220 abortions per 100 born-alive children in the year 1960, to 400 abortions per 100 born-alive children, in the year 1965 [ 40 ].

The application of provisions of Decrees No. 770 of 1966 and No. 411 of 1985 has led to an increase of the birth rate in the first three years (an average of 3.7 children in 1967, and 3.6 children in 1968), followed by a regression until 1989, when it was recorded an average of 2.2 children, but also a maternal death rate caused by illegal abortions, raising up to 85 deaths of 100 000 births in the year of 1965, and 170 deaths in 1983. It was estimated that more than 80% of maternal deaths between 1980–1989 was caused by legal constraints [ 30 ].

After the Romanian Revolution in December 1989 and after the communism fall, with the abrogation of Articles 185–188 of the Criminal Code and of the Decree No. 770/1966, by the Decree of Law No. 1 of December 26 th , 1989, abortion has become legal in Romania and so, in the following years, it has reached the highest rate of abortion in Europe. Subsequently, the number of abortion has dropped gradually, with increasing use of birth control [ 41 ].

Statistical data issued by the Ministry of Health and by the National Institute of Statistics (INS) in Romania show corresponding figures to a legally carried out abortion. The abortion number is much higher, if it would take into account the number of illegal abortion, especially those carried out before 1989, and those carried out in private clinics, after the year 1990. Summing the declared abortions in the period 1958–2014, it is to be noted the number of them, 22 037 747 exceeds the current Romanian population. A detailed statistical research of abortion rate, in terms of years we have exposed in Table Table1 1 .

The number of abortions declared in Romania in the period 1958–2016


1958	112 100	1970	292 410	1982	468 041	1994	530 191	2006	150 246
1959	578 000	1971	330 000	1983	–	1995	502 840	2007	137 226
1960	774 000	1972	381 000	1984	303 123	1996	456 221	2008	137 226
1961	865 000	1973	376 000	1985	302 838	1997	347 126	2009	115 457
1962	967 000	1974	335 000	1986	183 959	1998	271 496	2010	101 915
1963	1 037 000	1975	359 417	1987	182 442	1999	259 888	2011	101 915
1964	1 100 000	1976	383 000	1988	185 416	2000	257 865	2012	88 135
1965	1 115 000	1977	379 000	1989	193 084	2001	254 855	2013	86 432
1966	973 000	1978	394 000	1990	992 265	2002	247 608	2014	78 371
1967	206 000	1979	404 000	1991	866 934	2003	224 807	2015	70 447
1968	220 000	1980	413 093	1992	691 863	2004	191 038	2016	63 085
1969	258 000	1981	–	1993	585 761	2005	163 459

Source: Pro Vita Association (Bucharest, Romania), National Institute of Statistics (INS – Romania), EUROSTAT [ 42 , 43 , 44 ]

Data issued by the United Nations International Children’s Emergency Fund (UNICEF) in June 2016, for the period 1989–2014, in matters of reproductive behavior, indicates a fertility rate for Romania with a continuous decrease, in proportion to the decrease of the number of births, but also a lower number of abortion rate reported to 100 deliveries (Table (Table2 2 ).

Reproductive behavior in Romania in 1989–2014


Total fertility rate (births per woman)	2.2	1.8	1.6	1.5	1.4	1.4	1.3	1.3	1.3	1.3	1.3	1.3	1.2	1.3	1.3	1.3	1.3	1.3	1.3	1.3	1.4	1.3	1.0	1.36	1.40	1.44
Live births (1000s)	369.5	314.7	275.3	260.4	250.0	246.7	236.6	231.3	236.9	237.3	234.6	234.5	220.4	210.5	212.5	216.3	221.0	219.5	214.7	221.9	222.4	212.2	196.2	201.1	182.3	183.7
Abortion rate (legally induced abortions per 100 live births)	–	315.3	314.9	265.7	234.3	214.9	212.5	197.2	146.5	114.4	110.8	110.0	115.6	117.6	105.8	88.3	73.9	68.5	63.9	57.6	52.2	48.0	52.7	43.7	47.2	42.7

Source: United Nations International Children’s Emergency Fund (UNICEF), Transformative Monitoring for Enhanced Equity (TransMonEE) Data. Country profiles: Romania, 1989–2015 [ 45 ].

By analyzing data issued for the period 1990–2015 by the International Organization of Health , UNICEF , United Nations Fund for Population Activity (UNFPA), The World Bank and the United Nations Population Division, it is noticed that maternal mortality rate has currently dropped as compared with 1990 (Table (Table3 3 ).

Maternal mortality estimation in Romania in 1990–2015


2015	31 [22–44]	56	179	1.1
2010	30 [26–35]	61	202	1.2
2005	33 [28–38]	71	217	1.1
2000	51 [44–58]	110	222	1.5
1995	77 [66–88]	180	241	2.1
1990	124 [108–141]	390	318	5.2

Source: World Health Organization (WHO), Global Health Observatory Data. Maternal mortality country profiles: Romania, 2015 [ 46 ].

Opinion survey: women’s opinion on abortion

Argument for choosing the research theme

Although the problematic on abortion in Romania has been extensively investigated and debated, it has not been carried out in an ample sociological study, covering Romanian women’s perception on abortion. We have assumed making a study at national level, in order to identify the opinion on abortion, on the motivation to carry out an abortion, and to identify the correlation between religious convictions and the attitude toward abortion.

Examining the literature field of study

In the conceptual register of the research, we have highlighted items, such as the specialized literature, legislation, statistical documents.

Formulation of hypotheses and objectives

The first hypothesis was that Romanian women accept abortion, having an open attitude towards this act. Thus, the first objective of the research was to identify Romanian women’s attitude towards abortion.

The second hypothesis, from which we started, was that high religious beliefs generate a lower tolerance towards abortion. Thus, the second objective of our research has been to identify the correlation between the religious beliefs and the attitude towards abortion.

The third hypothesis of the survey was that, the main motivation in carrying out an abortion is the fact that a woman does not want a baby, and the main motivation for keeping the pregnancy is that the person wants a baby. In this context, the third objective of the research was to identify main motivation in carrying out an abortion and in maintaining a pregnancy.

Another hypothesis was that modern Romanian legislation on the abortion is considered fair. Based on this hypothesis, we have assumed the fourth objective, which is to identify the degree of satisfaction towards the current regulatory provisions governing the abortion.

Research methodology

The research method is that of a sociological survey by the application of the questionnaire technique. We used the sampling by age and residence looking at representative numbers of population from more developed as well as underdeveloped areas.

Determination of the sample to be studied

Because abortion is a typical women’s experience, we have chosen to make the quantitative research only among women. We have constructed the sample by selecting a number of 1260 women between the ages of 15 and 44 years (the most frequently encountered age among women who give birth to a child). We also used the quota sampling techniques, taking into account the following variables: age group and the residence (urban/rural), so that the persons included in the sample could retain characteristic of the general population.

By the sample of 1260 women, we have made a percentage of investigation of 0.03% of the total population.

The Questionnaires number applied was distributed as follows (Table (Table4 4 ).

The sampling rates based on the age, and the region of residence


Women in North-West	Urban	37 898	58 839	50 527	54 944	53 962	60 321	316 491
Women in North-West	Rural	36 033	37 667	36 515	41 837	43 597	42 877	238 526
Sample in North-West	Urban	11	18	15	17	16	18	95
Sample in North-West	Rural	11	11	11	13	13	13	72
Women in the Center	Urban	32 661	46 697	46 713	54 031	52 590	59 084	291 776
Women in the Center	Rural	29 052	31 767	29 562	34 402	35 334	35 502	195 619
Sample in the Center	Urban	10	14	14	16	16	18	88
Sample in the Center	Rural	9	9	9	10	11	11	59
Women in North-East	Urban	38 243	50 228	45 924	51 818	49 959	63 157	299 329
Women in North-East	Rural	63 466	51 814	47 524	60 495	67 009	65 717	356 025
Sample in North-East	Urban	11	15	14	16	15	19	90
Sample in North-East	Rural	19	16	14	18	20	20	107
Women in South-East	Urban	31 556	40 879	43 317	53 461	53 756	67 135	290 104
Women in South-East	Rural	34 494	32 446	29 987	37 828	41 068	42 836	218 659
Sample in South-East	Urban	10	12	13	16	16	20	87
Sample in South-East	Rural	10	10	9	11	12	13	65
Women in South Muntenia	Urban	30 480	38 066	40 049	47 820	49 272	64 739	270 426
Women in South Muntenia	Rural	52 771	55 286	49 106	60 496	67 660	74 401	359 720
Sample in South Muntenia	Urban	9	11	12	14	15	19	80
Sample in South Muntenia	Rural	16	17	15	18	20	22	108
Women in Bucharest–Ilfov	Urban	41 314	83 927	90 607	102 972	86 833	98 630	504 283
Women in Bucharest–Ilfov	Rural	5385	7448	7952	9997	9400	10 096	50 278
Sample in Bucharest–Ilfov	Urban	12	25	27	31	26	30	151
Sample in Bucharest–Ilfov	Rural	2	2	2	3	3	3	15
Women in South-West Oltenia	Urban	26 342	31 155	33 493	39 064	39 615	50 516	220 185
Women in South-West Oltenia	Rural	31 223	29 355	26 191	32 946	36 832	40 351	196 898
Sample in South-West Oltenia	Urban	8	9	10	12	12	15	66
Sample in South-West Oltenia	Rural	9	9	8	10	11	12	59
Women in West	Urban	30 258	45 687	39 583	44 808	44 834	54 155	259 325
Women in West	Rural	19 205	20 761	19 351	22 788	24 333	26 792	133 230
Sample in West	Urban	9	14	12	13	14	16	78
Sample in West	Rural	6	6	6	7	7	8	40
Total women		540 381	662 022	636 401	749 707	756 054	856 309	4 200 874
Total sample		162	198	191	225	227	257	1260

Source: Sample built, based on the population data issued by the National Institute of Statistics (INS – Romania) based on population census conducted in 2011 [ 47 ].

Data collection

Data collection was carried out by questionnaires administered by 32 field operators between May 1 st –May 31 st , 2018.

The analysis of the research results

In the next section, we will present the main results of the quantitative research carried out at national level.

Almost three-quarters of women included in the sample agree with carrying out an abortion in certain circumstances (70%) and only 24% have chosen to support the answer “ No, never ”. In modern contemporary society, abortion is the first solution of women for which a pregnancy is not desired. Even if advanced medical techniques are a lot safer, an abortion still carries a health risk. However, 6% of respondents agree with carrying out abortion regardless of circumstances (Table (Table5 5 ).

Opinion on the possibility of carrying out an abortion



Yes, under certain circumstances	70%
No, never	24%
Yes, regardless the situation	6%
Total	100%

Although abortions carried out after 14 weeks are illegal, except for medical reasons, more than half of the surveyed women stated they would agree with abortion in certain circumstances. At the opposite pole, 31% have mentioned they would never agree on abortions after 14 weeks. Five percent were totally accepting the idea of abortion made to a pregnancy that has exceeded 14 weeks (Table (Table6 6 ).

Opinion on the possibility of carrying out an abortion after the period of 14 weeks of pregnancy



Yes, under certain circumstances	64%
No, never	31%
Yes, regardless the situation	5%
Total	100%

For 53% of respondents, abortion is considered a crime as well as the right of a women. On the other hand, 28% of the women considered abortion as a crime and 16% associate abortion with a woman’s right (Table (Table7 7 ).

Opinion on abortion: at the border between crime and a woman’s right



A crime and a woman’s right	53%
A crime	28%
A woman’s right	16%
I don’t know	2%
I don’t answer	1%
Total	100%

Opinions on what women abort at the time of the voluntary pregnancy interruption are split in two: 59% consider that it depends on the time of the abortion, and more specifically on the pregnancy development stage, 24% consider that regardless of the period in which it is carried out, women abort a child, and 14% have opted a fetus (Table (Table8 8 ).

Abortion of a child vs. abortion of a fetus



Both, depending on the moment when the abortion takes place	59%
A child	24%
A fetus	14%
I don’t answer	3%
Total	100%

Among respondents who consider that women abort a child or a fetus related to the time of abortion, 37.5% have considered that the difference between a baby and a fetus appears after 14 weeks of pregnancy (the period legally accepted for abortion). Thirty-three percent of them have mentioned that the distinction should be performed at the first few heartbeats; 18.1% think it is about when the child has all the features definitively outlined and can move by himself; 2.8% consider that the difference appears when the first encephalopathy traces are being felt and the child has formed all internal and external organs. A percentage of 1.7% of respondents consider that this difference occurs at the beginning of the central nervous system, and 1.4% when the unborn child has all the features that we can clearly see to a newborn child (Table (Table9 9 ).

The opinion on the moment that makes the difference between a fetus and a child



Over 14 weeks (the period legally accepted for abortion)	37.5%
From the very first heart beat (18 days)	33.3%
When the child has all organs contoured and can move by himself (12 weeks)	18.1%
When the first encephalon traces are being felt and the child has formed all internal and external organs (seven weeks)	2.8%
At the beginning of the central nervous system, liver, kidneys, stomach (six weeks)	1.7%
When the unborn child has all the characteristics that we can clearly observe to a child after birth	1.4%
When you can clearly distinguish his features (nose, cheeks, eyes) (five weeks)	1.2%
Other	1%
I don’t know	3%
Total	100%

We noticed that highly religious people make a clear association between abortion and crime. They also consider that at the time of pregnancy interruption it is aborted a child and not a fetus. However, unexpectedly, we noticed that 27% of the women, who declare themselves to be very religious, have also stated that they see abortion as a crime but also as a woman’s right. Thirty-one percent of the women, who also claimed profound religious beliefs, consider that abortion may be associated with the abortion of a child but also of a fetus, this depending on the time of abortion (Tables (Tables10 10 and and11 11 ).

The correlation between the level of religious beliefs and the perspective on abortion seen as a crime or a right



		A woman’s right	A crime	Both depending on the moment when it took place	Not know	No
Are you a religious person?	A very religious and practicant person	1%	11%	12%	–	–	24%
	A very religious but non practicant person	4%	7%	15%	–	1%	27%
	A relatively religious and practicant person	5%	6%	13%	–	–	24%
	Relatively religious but non practicant person	6%	4%	13%	2%	–	25%
Total		16%	28%	53%	2%	1%	100%

The correlation between the level of religious beliefs and the perspective on abortion procedure conducted on a fetus or a child



		A fetus	A child	Both depending on the time of abortion	Not know
Are you a religious person?	A very religious and practicant person	2%	8%	14%	–	24%
	A very religious but non practicant person	3%	7%	17%	–	27%
	A relatively religious and practicant person	4%	5%	16%	3%	28%
	Relatively religious but non practicant person	5%	4%	12%	3%	24%
Total		14%	24%	59%	6%	100%

More than half of the respondents have opted for the main reason for abortion the appearance of medical problems to the child. Baby’s health represents the main concern of future mothers, and of each parent, and the birth of a child with serious health issues, is a factor which frightens any future parent, being many times, at least theoretically, one good reason for opting for abortion. At the opposite side, 12% of respondents would not choose abortion under any circumstances. Other reasons for which women would opt for an abortion are: if the woman would have a medical problem (22%) or would not want the child (10%) (Table (Table12 12 ).

Potential reasons for carrying out an abortion



If the child would have a medical problem (genetic or developmental abnormalities of fetus)	55%
If I would have a medical problem	22%
In any of these situations, I would abort	12%
If the child would not be desired	10%
I don’t know	1%
Total	100%

Most of the women want to give birth to a child, 56% of the respondents, representing also the reason that would determine them to keep the child. Morality (26%), faith (10%) or legal restrictions (4%), are the three other reasons for which women would not interrupt a pregnancy. Only 2% of the respondents have mentioned other reasons such as health or age.

A percentage of 23% of the surveyed people said that they have done an abortion so far, and 77% did not opted for a surgical intervention either because there was no need, or because they have kept the pregnancy (Table (Table13 13 ).

Rate of abortion among women in the sample



No	77%
Yes	23%
Total	100%

Most respondents, 87% specified that they have carried out an abortion during the first 14 weeks – legally accepted limit for abortion: 43.6% have made abortion in the first four weeks, 39.1% between weeks 4–8, and 4.3% between weeks 8–14. It should be noted that 8.7% could not appreciate the pregnancy period in which they carried out abortion, by opting to answer with the option “ I don’t know ”, and a percentage of 4.3% refused to answer to this question.

Performing an abortion is based on many reasons, but the fact that the women have not wanted a child is the main reason mentioned by 47.8% of people surveyed, who have done minimum an abortion so far. Among the reasons for the interruption of pregnancy, it is also included: women with medical problems (13.3%), not the right time to be a mother (10.7%), age motivation (8.7%), due to medical problems of the child (4.3%), the lack of money (4.3%), family pressure (4.3%), partner/spouse did not wanted. A percentage of 3.3% of women had different reasons for abortion, as follows: age difference too large between children, career, marital status, etc. Asked later whether they regretted the abortion, a rate of 69.6% of women who said they had at least one abortion regret it (34.8% opted for “ Yes ”, and 34.8% said “ Yes, partially ”). 26.1% of surveyed women do not regret the choice to interrupted the pregnancy, and 4.3% chose to not answer this question. We noted that, for women who have already experienced abortion, the causes were more diverse than the grounds on which the previous question was asked: “What are the reasons that determined you to have an abortion?” (Table (Table14 14 ).

The reasons that led the women in the sample to have an abortion



I did not desired the child	47.8%
Because of my medical problems	13.3%
It was not the right time	10.7%
I was too young	8.7%
Because the child had health problems (genetic or developmental abnormalities of fetus)	4.3%
Because I did not have financial resources (I couldn’t afford raising a child)	4.3%
Because of the pressure of my family	4.3%
The partner/husband did not wanted	4.3%
Other reasons	3.3%
Total	100%

The majority of the respondents (37.5%) considered that “nervous depression” is the main consequence of abortion, followed by “insomnia and nightmares” (24.6%), “disorders in alimentation” and “affective disorders” (each for 7.7% of respondents), “deterioration of interpersonal relationships” and “the feeling of guilt”(for 6.3% of the respondents), “sexual disorders” and “panic attacks” (for 6.3% of the respondents) (Table (Table15 15 ).

Opinion on the consequences of abortion



Nervous depression	37.5%
Insomnia and nightmares	24.6%
Disorders in alimentation	7.7%
Affective disorders	7.7%
Deterioration of interpersonal relationships	6.3%
The feeling of guilt	6.3%
Sexual disorders	3.3%
Panic attacks	3.3%
Other reasons	3.3%
Total	100%

Over half of the respondents believe that abortion should be legal in certain circumstances, as currently provided by law, 39% say it should be always legal, and only 6% opted for the illegal option (Table (Table16 16 ).

Opinion on the legal regulation of abortion



Legal in certain terms	53%
Always legal	39%
Illegal	6%
I don’t know	2%
Total	100%

Although the current legislation does not punish pregnant women who interrupt pregnancy or intentionally injured their fetus, survey results indicate that 61% of women surveyed believe that the national law should punish the woman and only 28% agree with the current legislation (Table (Table17 17 ).

Opinion on the possibility of punishing the woman who interrupts the course of pregnancy or injures the fetus



Yes	61%
No	28%
I don’t know	7%
I don’t answer	4%
Total	100%

For the majority of the respondents (40.6%), the penalty provided by the current legislation, the imprisonment between six months and three years or a fine and deprivation of certain rights for the illegal abortion is considered fair, for a percentage of 39.6% the punishment is too small for 9.5% of the respondents is too high. Imprisonment between two and seven years and deprivation of certain rights for an abortion performed without the consent of the pregnant woman is considered too small for 65% of interviewees. Fourteen percent of them think it is fair and only 19% of respondents consider that Romanian legislation is too severe with people who commit such an act considering the punishment as too much. The imprisonment from three to 10 years and deprivation of certain rights for the facts described above, if an injury was caused to the woman, is considered to be too small for more than half of those included in the survey, 64% and almost 22% for nearly a quarter of them. Only 9% of the respondents mentioned that this legislative measure is too severe for such actions (Table (Table18 18 ).

Opinion on the regulation of abortion of the Romanian Criminal Code (Art. 201)



Reasonable	40.6%	14%	22%
Too small	39.6%	65%	64%
Too big	9.5%	19%	9%
I don’t know	6.6%	2%	3%
I don’t answer	3.7%	–	2%
Total	100%	100%	100%

Conclusions

After analyzing the results of the sociological research regarding abortion undertaken at national level, we see that 76% of the Romanian women accept abortion, indicating that the majority accepts only certain circumstances (a certain period after conception, for medical reasons, etc.). A percentage of 64% of the respondents indicated that they accept the idea of abortion after 14 weeks of pregnancy (for solid reasons or regardless the reason). This study shows that over 50% of Romanian women see abortion as a right of women but also a woman’s crime and believe that in the moment of interruption of a pregnancy, a fetus is aborted. Mostly, the association of abortion with crime and with the idea that a child is aborted is frequently found within very religious people. The main motivation for Romanian women in taking the decision not to perform an abortion is that they would want the child, and the main reason to perform an abortion is the child’s medical problems. However, it is noted that, in real situations, in which women have already done at least one abortion, most women resort to abortion because they did not want the child towards the hypothetical situation in which women felt that the main reason of abortion is a medical problem. Regarding the satisfaction with the current national legislation of the abortion, the situation is rather surprising. A significant percentage (61%) of respondents felt as necessary to punish the woman who performs an illegal abortion, although the legislation does not provide a punishment. On the other hand, satisfaction level to the penalties provided by law for various violations of the legal conditions for conducting abortion is low, on average only 25.5% of respondents are being satisfied with these, the majority (average 56.2%) considering the penalties as unsatisfactory. Understood as a social phenomenon, intensified by human vulnerabilities, of which the most obvious is accepting the comfort [ 48 ], abortion today is no longer, in Romanian society, from a legal or religious perspective, a problem. Perceptions on the legislative sanction, moral and religious will perpetual vary depending on beliefs, environment, education, etc. The only and the biggest social problem of Romania is truly represented by the steadily falling birth rate.

Conflict of interests

The authors declare that they have no conflict of interests.

The Impact of Legalized Abortion on Crime over the Last Two Decades

John J. Donohue III
Steven D. Levitt
John J. Donohue, Steven D. Levitt, The Impact of Legalized Abortion on Crime over the Last Two Decades , American Law and Economics Review (2020) (earlier versions available as NBER Working Paper No. w25863 (2019) HERE and at SSRN.com (also 2019) HERE ).
John M. Olin Program in Law and Economics

Donohue and Levitt (2001) presented evidence that the legalization of abortion in the early 1970s played an important role in the crime drop of the 1990s. That paper concluded with a strong out-of-sample prediction regarding the next two decades: “When a steady state is reached roughly twenty years from now, the impact of abortion will be roughly twice as great as the impact felt so far. Our results suggest that all else equal, legalized abortion will account for persistent declines of 1% a year in crime over the next two decades.” Estimating parallel specifications to the original paper, but using the seventeen years of data generated after that paper was written, we find strong support for the prediction and the broad hypothesis, while illuminating some previously unrecognized patterns of crime and arrests. We estimate that overall crime fell 17.5% from 1998 to 2014 due to legalized abortion— a decline of 1% per year. From 1991 to 2014, the violent and property crime rates each fell by 50%. Legalized abortion is estimated to have reduced violent crime by 47% and property crime by 33% over this period, and thus can explain most of the observed crime decline.

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By Kate Knibbs and Emily Mullin

Supreme Court Upholds Access to Abortion Pill in Unanimous Vote

The Supreme Court just handed down its most important ruling on reproductive rights since its 2022 overturning of Roe v. Wade , the landmark decision that protected the national right to have an abortion . The court today affirmed the US Food and Drug Administration’s approval of the abortion pill mifepristone .

In a 9–0 decision in FDA v. Alliance for Hippocratic Medicine , the justices found that the plaintiffs of a lawsuit that sought to pull the drug off the market lacked standing—that is, they did not have the right to bring the case to court.

“The plaintiffs do not prescribe or use mifepristone. And FDA is not requiring them to do or refrain from doing anything. Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain,” Justice Brett Kavanaugh writes in the decision . “A plaintiff ’s desire to make a drug less available for others does not establish standing to sue. Nor do the plaintiffs’ other standing theories suffice. Therefore, the plaintiffs lack standing to challenge FDA’s actions.”

The Supreme Court’s decision puts an end to a tangle of legal disputes in the lower courts that has caused widespread confusion over the legal status of mifepristone. It means that the drug will remain legal to use in states that permit abortion and can continue to be distributed by mail.

Medical experts and health care providers applauded the court’s decision. “Mifepristone is safe, effective, and a crucial part of expanding abortion access in this post- Roe world,” says Kiki Freedman, CEO and cofounder of abortion telehealth provider Hey Jane, adding that the company will continue to deliver evidence-based, compassionate medication abortion care.

Mifepristone was first approved by the FDA in 2000. It’s used in combination with a second pill, misoprostol, to induce an abortion within the first 10 weeks of pregnancy. It works by blocking a hormone called progesterone that’s needed for a pregnancy to continue, while misoprostol causes uterine contractions. In the United States, pills are now more common than abortion procedures , accounting for more than six out of 10 abortions in 2023, according to the Guttmacher Institute.

Despite mifepristone’s established safety record, a group of antiabortion activists and doctors known as the Alliance for Hippocratic Medicine filed a lawsuit in November 2022 seeking to invalidate the FDA’s approval of the drug, claiming it’s too dangerous to be on the market. In the suit, the alliance argued that mifepristone has led to increased emergency room visits, citing a 2021 study that was retracted earlier this year after an independent review found that its authors came to inaccurate conclusions.

In April 2023, Judge Matthew Kacsmaryk of the Northern District of Texas sided with the alliance and overturned the FDA’s approval of mifepristone, effectively instituting a nationwide ban on the drug’s use. The ruling caused shockwaves as it demonstrated that the courts could revoke a drug’s approval and override the expertise of the FDA.

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But things changed quickly. A week later, an appeals court ruled to keep mifepristone on the market, but rolled back changes that the FDA has made in recent years to make it easier to get the drug, including removing the in-person dispensing requirement. This put telemedicine access to the pill in jeopardy. The FDA and the pharmaceutical company Danco Laboratories (which sells the brand-name version of mifepristone, Mifeprex) sought emergency relief from the Supreme Court, asking to preserve access until it heard the case. The Supreme Court issued a temporary stay , keeping the pill available under the status quo, then later decided to take up the case.

While FDA v. Alliance for Hippocratic Medicine wound through the courts, many states like California and New York enshrined abortion rights by passing shield laws , which protect health care professionals who offer care to pregnant patients in states where abortion is banned. This helped some providers, like longtime medication-abortion advocacy group Aid Access, to mail abortion pills to people who requested them in states like Louisiana and Arkansas.

Those in the pharmaceutical industry worried that if the Supreme Court nullified mifepristone’s approval, it could put virtually any other drug on the market at risk—especially those seen as controversial, such as birth control pills, drugs that prevent HIV infection, or even Covid-19 vaccines.

But when the Supreme Court heard oral arguments for the case in March, the justices questioned whether the plaintiffs were the right party to bring the case to the court. In order to have standing to sue, plaintiffs must prove that they are the aggrieved or injured party. Thursday’s decision makes it clear that the Alliance for Hippocratic Medicine was not harmed in any way because of the availability of mifepristone.

Diane Horvath, a complex family planning specialist and fellow with the American College of Obstetricians and Gynecologists, says the Supreme Court decision is a welcome one, allowing health care providers to continue dispensing abortion pills as they had before. “But it certainly leaves the door open for another case with new plaintiffs,” she says. Since the justices focused on whether the plaintiffs had standing and did not address their claims about mifepristone’s safety, she fears that the fight over the abortion pill is not done yet.

“Despite this win at the court, the situation regarding access to these life-saving medications continues to deteriorate at the state level,” says Elisa Wells, cofounder of the abortion information campaign Plan C Pills.

In Louisiana, which has a near-total abortion ban, state lawmakers recently passed the first bill of its kind to designate both mifepristone and misoprostol as controlled substances . And last month in Arkansas, the state’s attorney general ordered abortion pill providers to stop advertising there .

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News24,(2013). Why abortion should be legal. Retrieved from https://ww.news24.com/MyNews24/Why-abortion-should-be-legal-20131230
Amnesty International,(2018). Facts on Abortion. Retrieved from www.amnesty.org/en/what-we-do/sexual-and-reproductive-rights/abortion-facts/
More than 25 million Abortions are performed every year. Retrieved from www.refinery29.com/en-us/2017/09/174289/unsafe-abortion-statistics-
Kartha Pollitt, Abortion quotes. Retrieved from www.brainyquote.com/topics/abortion
Mesce D; Sines E (2006). Washington, D.C., Population Reference Bureau [PRB], 2006. 58 p. Retrieved from https://www.popline.org/node/563328
https://brightkite.com/essay-on/women-have-the-right-to-abortion
https://essayforum.com/writing/right-abortion-argumentative-paper-6112/
https://www.debate.org/opinions/do-women-have-the-right-to-abortion
https://www.allfamilieshealth.org/abortions/
https://www.bartleby.com/essay/Women-Have-the-Right-to-Abortion- P3RXPEYTJ
https://revcom.us/a/1265/what-is-abortion.htm
https://www.babygaga.com/15-whisper-confessions-of-women-forced-to-have- the-baby-they-didnt-want/

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Supreme Court rejects challenge to abortion pill accessibility

Nina Totenberg

Supreme Court rejects challenge to FDA's approval of mifepristone

The U.S. Supreme Court on Thursday tossed out a challenge to the FDA’s rules for prescribing and dispensing abortion pills. Erin Hooley/Chicago Tribune/Getty Images hide caption

The U.S. Supreme Court on Thursday tossed out a challenge to the FDA’s rules for prescribing and dispensing abortion pills.

The U.S. Supreme Court on Thursday tossed out a challenge to the FDA’s rules for prescribing and dispensing abortion pills .

By a unanimous vote, the court said the anti-abortion doctors who brought the challenge had failed to show they had been harmed, as they do not prescribe the medication, and thus, essentially, had no skin in the game.

The court said that the challengers, a group called the Alliance for Hippocratic Medicine, had no right to be in court at all since neither the organization nor its members could show they had suffered any concrete injury.

Writing for the court, Justice Brett Kavanaugh dismissed every conceivable argument that the anti-abortion doctors had advanced claiming they had a right to sue.

They had contended that there is a statistical possibility that some physicians would be called upon to treat emergency room patients suffering from complications after taking abortion pills. But Kavanaugh noted that federal law explicitly says that doctors cannot be forced to perform or assist in abortions, or to treat patients with complications from mifepristone. Moreover, he said, doctors "have never had standing to challenge FDA drug approvals simply on the theory that use of the drug by others may cause more visits to the doctor."

Similarly, he said that doctors have no generalized right to sue because they object to a general government policy. To illustrate the point, he said that if the government raises the speed limit, emergency room doctors couldn't challenge the policy on grounds that it increased the number of automobile accident cases.

The court’s unanimous decision amounted to a legal off-ramp, leaving the FDA rules in place, without directly addressing the regulations themselves.

The decision also avoided, at least for now, a challenge to the entire structure of the FDA’s regulatory power to approve drugs and continually evaluate their safety — a system that for decades has been widely viewed as the gold standard for both safety and innovation.

The statue Guardian or Authority of Law sits above the west front plaza of the U.S. Supreme Court on June 7, 2024 in Washington, D.C. Among the rulings the court is expected to issue by the end of June are cases about access to abortion pills dispensed by mail, gun restrictions the power of regulatory agencies and former President Donald Trump’s bid to avoid criminal charges for trying to overturn his 2020 election defeat.

What's next up for the Supreme Court? Abortion rights, gun laws and more

Carol Tobias, president of National Right to Life, condemned the decision, saying it deprived women of essential information about the dangers of the abortion pill. "It is sad that because of these FDA decisions, women will not get the information they deserve before making a permanent life or death decision," she said.

"It is a sad day for all who value women's health and unborn children's lives, but the fight to stop dangerous mail-order abortion drugs is not over," said SBA Pro-Life America state policy director Katie Daniel.

As abortion rights advocates were relieved, they know there will be more battles ahead. "This is not a sweeping victory," said NYU law professor Melissa Murray. It "likely is just a resting place, a way station. There will be another challenge to medication abortion."

She says that future challenges could come from conservative states that could reasonably argue that the FDA's accessibility regulations render restrictive state abortion laws moot. After all, she observes, "If you get it through the mail, it doesn't matter what the state is doing as a natter if public law."

Mary Zeigler, a law professor at UC Davis who has written extensively about the history and politics of abortion, also sees a fraught future.

She says that many prominent conservative groups and individuals who served in the first Trump Administration have focused their attention on getting Trump, if he is re-elected, to ban all abortion under the Comstock Act, an 1873 anti-obscenity law that also banned all contraception and abortion materials from the mail.

The law has not been enforced for at least a half century and likely much longer, Zeigler says, adding that "If you had told me that prominent conservative groups were going to be investing in turning the Comstock Act into a ban [on abortion] and making it the cornerstone of what they hoped a second Trump Administration would do, I wouldn't have believed you a few years ago. I would have said that's just way too politically counterproductive. And yet, here we are."

Since the court reversed Roe v. Wade and the right to abortion in 2022, pills have become the most popular abortion method in the U.S. More than half the women who choose to terminate a pregnancy use a combination of pills approved by the FDA, including mifepristone, manufactured by Danco Laboratories and marketed as Mifeprex.

The pill regimen was first approved 24 years ago, and over the past eight years, the agency has approved changes in the dosing regimen and eliminated some restrictions that it found to be unnecessary.

For instance, the pills can now be prescribed during the first 10 weeks of pregnancy, instead of the original seven weeks, and prescriptions can be filled by mail or at pharmacies, instead of at a doctor’s office. The result, according to Danco Labs, is that there have been fewer complications than when the drug was initially approved for just seven weeks in 2000.

Thursday's Supreme Court decision reversed a ruling by the Fifth Circuit Court of Appeals, widely viewed as the most conservative federal appeals court in the country. Of the 61 cases before the court this term, ten are appeals from the Fifth Circuit. The abortion pill case was the third reversal, and there are still seven Fifth Circuit appeals remaining

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What's at stake in the supreme court mifepristone case.

Siding with the FDA in the case were virtually all the major medical associations in the country, as well as almost all the pharmaceutical and bio-tech companies, big and small, that are regulated by the agency, making this the rare case in which a government regulator and the industry it regulates were on the same side. Dr. Jeremy Levin, the CEO of Ovid Therapeutics, one of the many pharmaceutical companies that sided with the FDA, earlier this year called the case “a dagger at the heart of the entire industry.”

For now, though, the prospect of dismantling the regulatory powers of the FDA has been averted. But the direct challenge to abortion pills and their accessibility has not been resolved, and could be revived in a different case.

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Bitter battle over abortion complicates enforcement of new law designed to protect pregnant workers

NEW YORK (AP) — Victoria Cornejo Barrera thought the legal helpline for workers sounded too good to be true.

A month earlier, Cornejo Barrera had been forced to take leave from her job as head custodian at a South Carolina high school after she turned in a doctor’s note asking to be exempt from tasks like climbing ladders and lifting more than 20 pounds because she was pregnant.

She spent a month crying and blaming herself for thinking she could keep her job while pregnant. She used up all her accumulated paid time off because she couldn’t afford to go without a paycheck. Then she got a notice from human resources saying she would have to start paying $600 a month to stay on health insurance while on unpaid leave.

“I was feeling so guilty. I was feeling like my pregnancy was the problem,” Cornejo Barrera said.

Searching for help online, she came across the website run by the legal advocacy organization A Better Balance, explaining about a federal law called the Pregnant Workers Fairness Act that entitled her to the types of accommodations she had been seeking. It had gone into effect in June 2023, a month before she was pushed out of her job.

Was the law really on her side? Cornejo Barrera called the helpline.

A new law’s complicated first year

Nearly 500 workers in similar circumstances have contacted the helpline in the year since the implementation of the Pregnant Workers Fairness Act, which strengthens the rights of workers to seek accommodations for pregnancy-related needs. The experiences of those workers tell a complicated story about the impact of a new law that is still unfamiliar to many employers, according to a report released Tuesday by A Better Balance, the organization that spearheaded a decade-long campaign for the law, which Congress finally passed in December 2022.

Most of those workers swiftly obtained accommodation after learning about their rights and invoking them with their employers, said Dina Bakst, co-founder and co-president of A Better Balance. But many women confronted employers who didn’t know about the law, misunderstood its scope or simply refused to comply, according to the report.

READ MORE: New York judge blocks amendment barring discrimination on gender identity and pregnancy outcomes

A bitter legal battle over whether the law covers abortion is further complicating its enforcement.

The dispute centers on Equal Employment Opportunity Commission regulations that took effect Tuesday detailing how employers should comply with the law, and which included abortion among the pregnancy-related conditions that entitle workers to time off and other accommodations.

On Monday, a federal judge in Louisiana temporarily prohibited the EEOC from enforcing the abortion provision of its rules against employers located in Louisiana and Mississippi, or against the U.S. Conference of Catholic Bishops and three other religious groups that filed a consolidated lawsuit against the EEOC, arguing that the abortion provision is an illegal interpretation of the Pregnant Workers Fairness Act.

Another judge in Arkansas last week dismissed a similar lawsuit filed by Republican attorneys general from 17 states, but Arkansas Attorney General Tim Griffin, who is leading the case, said he is considering legal options to continue pursuing the challenge.

That lawsuit had asked the judge to suspend the EEOC rules in their entirety, a prospect that the American Civil Liberties Union and the National Women’s Law Center, along with more than 20 labor and women’s advocacy groups, warned in amicus briefs could thwart the successful implementation of law. The EEOC’s rules, for example, make clear that employers cannot delay requests by asking pregnant workers for onerous paperwork to back claims of common pregnancy-related limitations such as morning sickness or back pain.

Although the pregnant workers law would remain in place even without the EEOC rules, advocates say it’s a badly needed tool for settling disputes and training employers on compliance. According to A Better Balance, one out of seven workers who contacted its helpline since the law took effect said their employers had ordered them to take leave rather than grant them reasonable accommodations.

Cornejo Barrera was among them, but her employer reversed the decision after she sent her human resources department a letter invoking her rights. Within two days, she shared language from the Pregnant Workers Fairness Act with her supervisor, who then told her she could return to work immediately.

Raquel Robinson, a telecommunication specialist in Ohio, also ultimately prevailed in a similar confrontation with her company. After her daughter was born in October 2022, Robinson was diagnosed with postpartum depression.

“Mentally, I just was not in a good place where I felt like I was good enough to be my daughter’s mom,” she said.

After Robinson’s disability leave ended in July 2023, her therapist told her she was entitled to work from home under the new law. But her company resisted her request for more than a month.

Robinson reached out to A Better Balance for help and the company relented.

Other workers are still fighting to be protected under the law. The EEOC says it has received 1,869 charges so far citing violations of the Pregnant Workers Fairness Act and has resolved more than 450, though it has not provided details on the cases.

The abortion issue complicates the law

The law’s passage in 2022 came after years of campaigning by advocacy groups and women in low-wage jobs who shared stories of being denied even basic accommodations. But Republican lawmakers and conservative religious leaders who had overwhelmingly supported the Pregnant Workers Fairness Act were furious when the EEOC rules explicitly included abortion.

READ MORE: Research uncovers link between hormone and severe morning sickness during pregnancy

Citing numerous court rulings, the EEOC in its regulations said it was conforming to decades of legal precedent establishing that pregnancy-related discrimination laws include abortion.

Mylissa Farmer, the woman at the center of a federal investigation of two hospitals who refused to provide her with an emergency abortion, said her ordeal shows why the Pregnant Workers Fairness Act must include abortion.

Farmer sought emergency treatment after her water broke early at 17 weeks of pregnancy in August 2022. Doctors at hospitals in Missouri and Kansas told Farmer her fetus would not survive, that her amniotic fluid had emptied and that she was at risk for serious infection or losing her uterus but they refused to provide an abortion. She and her husband traveled for hours while she was in labor before a clinic in Illinois provided her with an abortion.

Farmer, who was working a low-wage job as a sales representative, said her supervisor repeatedly contacted her during her ordeal to pressure her to return to work. She said her doctor recommended she take two weeks off to recover but she returned to work after two days because she was afraid of getting fired. But she ended up facing discipline after absences to cope with the physical and mental trauma of losing her pregnancy.

“I was just not able to get the care that I needed at the time and it made it really difficult to even deal with the emotional loss of what we were going through,” said Farmer, who is being represented by the National Women’s Law Center in a complaint to the Centers for Medicare and Medicaid Services.

The Associated Press’ women in the workforce and state government coverage receives financial support from Pivotal Ventures. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

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US Supreme Court preserves access to abortion pill mifepristone

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Biden and other Democrats voice relief, say fight not over
Unanimous ruling written by conservative Justice Kavanaugh

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THE FIGHT OVER MIFEPRISTONE

Reporting by Andrew Chung in New York; Additional reporting by Gabriella Borter and Jim Oliphant; Editing by Will Dunham

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Supreme Court Maintains Broad Access to Abortion Pill

The decision does not eliminate efforts to restrict the availability of the pill.

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By Abbie VanSickle

Reporting from Washington

June 13, 2024

The Supreme Court on Thursday maintained access to a widely available abortion pill, rejecting a bid from a group of anti-abortion organizations and doctors to undo the Food and Drug Administration’s approval of the drug.

In a unanimous decision , written by Justice Brett M. Kavanaugh, the court held that the anti-abortion groups lacked a direct stake in the dispute, a requirement to challenge the F.D.A.’s approval of the pill, mifepristone.

“The plaintiffs do not prescribe or use mifepristone,” Justice Kavanaugh wrote. “And F.D.A. is not requiring them to do or refrain from doing anything.”

He added, “A plaintiff ’s desire to make a drug less available for others does not establish standing to sue.”

The case originally sought to erase the F.D.A.’s approval of mifepristone. But by the time it reached the Supreme Court, the question had been narrowed to whether the agency had acted legally in 2016 and 2021, when it broadened distribution of the pill, eventually including telemedicine and mail options.

The ruling handed a muted victory to abortion rights groups. Even as they praised the decision for averting severe restrictions on the availability of the pill, they warned that the outcome could be short-lived.

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Supreme Court upholds broad access to key abortion pill mifepristone

Ever since the high court eliminated the right to abortion in 2022, medications to terminate pregnancy have grown in importance and been challenged in court.

The Supreme Court on Thursday declined to limit access to a widely used abortion medication, rejecting a challenge from antiabortion doctors two years after the court’s conservative majority overturned Roe v. Wade .

In a unanimous ruling, the court sided with the Biden administration and the manufacturer of mifepristone and reversed a lower court decision that would have made it more difficult to obtain the drug used in more than 60 percent of U.S. abortions . The justices found that the plaintiffs did not have legal grounds to bring the challenge.

Writing for the court , Justice Brett M. Kavanaugh said the anti abortion doctors behind the case do not prescribe or use mifepristone, and the FDA’s relaxed regulation of the medication does not require those doctors to do or refrain from doing anything.

“Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain,” Kavanaugh wrote. Under the Constitution, he added, a group’s “desire to make a drug less available for others does not establish standing to sue.”

Kavanaugh emphasized in his opinion that doctors opposed to abortion are protected by federal conscience laws from having to perform abortion-related care that violates their beliefs, and that they can instead voice objections to the medication through the legislative, regulatory or political processes.

Where is abortion legal and illegal?

Ever since the high court eliminated the nationwide right to abortion in 2022, medications to terminate pregnancy have grown in importance and become a major target of litigation, in part because the pills can be sent by mail, including to states that have severely limited or banned abortions.

Even though the court’s decision was unanimous, it is unlikely to be the end of efforts to restrict access to the pill. The ruling leaves an opening for three states with Republican attorneys general — Missouri, Kansas and Idaho — to quickly try to revive the challenge before a federal judge in Texas who is well-known for his antiabortion views .

After the ruling, abortion opponents pledged to continue their efforts to limit access to mifepristone, promising that this case is not over.

“While we’re disappointed with the court’s decision, we will continue to advocate for women and work to restore common-sense safeguards for abortion drugs,” said the Alliance Defending Freedom’s senior counsel, Erin Hawley, who represented the doctors. “We are grateful that three states stand ready to hold the FDA accountable for jeopardizing the health and safety of women and girls across this country.”

President Biden said in a statement Thursday that the court’s decision “does not change the fact that the fight for reproductive freedom continues. … It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states.”

Nancy Northup, president of the Center for Reproductive Rights, said she felt “both relief and anger” about the court’s decision.

“In the end, this ruling is not a ‘win’ for abortion,” she said in a statement. “It just maintains the status quo, which is a dire public health crisis in which 14 states have criminalized abortion.”

The issue of who has standing to sue over FDA decisions could also resurface if former president Donald Trump , the presumptive Republican nominee in the November election, returns to the White House and appoints an FDA commissioner who reinstates restrictions on the medication — sparking legal challenges from abortion rights groups.

While this decision is a “resounding victory” for reproductive rights advocates, the opinion “sidesteps the core issue of how involved in the FDA decision-making process the courts will be,” said Ameet Sarpatwari, an attorney and assistant professor of medicine at Harvard Medical School.

Before the end of the month, the justices are also set to decide in a separate abortion case from Idaho whether hospitals that receive federal funds must provide emergency abortion care to stabilize patients even in states with strict bans on the procedure.

The high court’s decision on Thursday reversed a ruling from the conservative U.S. Court of Appeals for the 5th Circuit that said that the Food and Drug Administration failed to follow proper procedures or thoroughly explain its reasoning when it loosened regulations for obtaining mifepristone in 2016 and 2021.

A group of antiabortion doctors sued the FDA, saying the agency did not sufficiently consider safety concerns when it removed restrictions starting in 2016 that allowed the use of mifepristone later in pregnancy; permitted medical providers other than doctors to prescribe it; and cleared the way for the medication to be sent directly to patients by mail.

The FDA, considered one of the world’s most stringent regulators, first approved the medication in 2000. The agency has repeatedly found the medication-abortion protocol that includes mifepristone and a second drug, misoprostol, to be a safe and effective alternative to surgical abortions. Leading studies have shown that the changes in regulations that are the focus of the lawsuit do not affect the safety or efficacy of the medication.

In advance of oral argument in March, hundreds of pharmaceutical companies and former FDA officials warned the justices not to second-guess scientific experts, and said a ruling against the FDA would destabilize the regulatory system and jeopardize investments in research and innovation.

The justices did not decide Thursday whether the FDA acted lawfully when it made it easier to obtain mifepristone starting in 2016. Instead, the court issued a procedural ruling, finding that the antiabortion doctors could not challenge FDA approval of a drug just because the use of some medication may require additional visits to a health-care provider.

“Virtually all drugs come with complications, risks, and side effects. Some drugs increase the risk of heart attack, some may cause cancer, some may cause birth defects, and some heighten the possibility of stroke,” Kavanaugh wrote. “Approval of a new drug may therefore yield more visits to doctors to treat complications or side effects.”

Individual physicians and the Alliance for Hippocratic Medicine filed the initial lawsuit in Amarillo, Tex., where the only sitting District Court judge is Matthew Kacsmaryk, a Trump nominee known for his opposition to abortion .

How mifepristone is used

Kacsmaryk’s 2023 ruling would have removed the medication from the market completely, but the 5th Circuit scaled back the decision. It was the first time a judge suspended longtime approval of a medication despite opposition from the FDA and the drug’s manufacturer. Kacsmaryk will now be in position to decide whether the three states are permitted to pursue a separate challenge to the drug without the doctors leading the lawsuit.

When the Supreme Court agreed to review the case, the justices said they would not consider taking mifepristone off the market but would look at the rule changes in 2016 and 2021.

In its opinion Thursday, the court acknowledged the strongly-held objections of the antiabortion doctors but said those beliefs were not sufficient to meet the standard for bringing a case in court because the doctors had not suffered a direct injury.

“We recognize that many citizens, including the plaintiff doctors here, have sincere concerns about and objections to others using mifepristone and obtaining abortions. But citizens and doctors do not have standing to sue simply because others are allowed to engage in certain activities,” wrote Kavanaugh, who was one of five justices in the majority in 2022 who voted to eliminate the nationwide right to abortion after nearly 50 years.

The justices said they would not invent a new rule of “doctor standing.” Allowing doctors or other health-care providers to challenge general safety regulations as unlawfully lax would be “an unprecedented and limitless approach” that would open the door to lawsuits from doctors over numerous policies affecting public health, the court said.

In making their case, the antiabortion doctors said the FDA’s loosening of regulations would cause more pregnant women to suffer complications from mifepristone, and that the doctors would therefore be required — against their consciences — to provide emergency abortion or related treatment.

But the court echoed assurances in its opinion from the Biden administration that federal conscience laws protect doctors from being required to perform abortions or to provide other treatment that violates their consciences. The justices said the doctors had not identified any examples in which they were required to perform an abortion or of a hospital failing to accommodate a doctor’s objections.

The court’s opinion quotes Solicitor General Elizabeth B. Prelogar’s comments at oral argument, including her statement that the protections provide “broad coverage” and “shield a doctor who doesn’t want to provide care in violation of those protections.”

Elizabeth Sepper, a law professor at the University of Texas at Austin, said the Biden administration seemed to embrace a broad reading of those protections as a way to ensure support from as many justices as possible on a court with a 6-3 conservative majority.

When the Supreme Court initially put a lower court decision in the case on hold last April and maintained access to mifepristone while the litigation continued, Justices Clarence Thomas and Samuel A. Alito Jr. dissented. Alito said at the time that the public would not be harmed by reimposing restrictions on the pill. But on Thursday, all nine justices signed on to Kavanaugh’s opinion.

Sepper said the unanimous decision was overbroad in interpreting federal laws that protect doctors from being required to perform certain procedures. Conscience laws have previously been defined as applying to abortions and sterilizations, she said, not as a “general carve-out for anyone who objects to any kind of treatment.”

She said she worries the ruling could embolden providers or institutions to refuse treatments such as vaccines, care for women who have previously had abortions or LGBTQ+ communities. Sepper also said the Supreme Court’s expansive interpretation of the law could spur religiously affiliated hospitals to claim conscience objections to providing abortions in emergency rooms.

“I still think the mid- to long-term effects could be quite devastating for emergency abortion care, particularly in blue states,” Sepper said.

Justin Jouvenal and Caroline Kitchener contributed to this report.

U.S. abortion access, reproductive rights

Tracking abortion access in the United States: Since the Supreme Court struck down Roe v. Wade , the legality of abortion has been left to individual states. The Washington Post is tracking states where abortion is legal, banned or under threat.

Abortion pills: The Supreme Court refused to limit access to the abortion pill mifepristone . Here’s how mifepristone is used and where you can legally access the abortion pill .

Abortion and the election: Voters in about a dozen states could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. Biden supports legal access to abortion , and he has encouraged Congress to pass a law that would codify abortion rights nationwide. After months of mixed signals about his position, Trump said the issue should be left to states . Here’s how Biden and Trump’s abortion stances have shifted over the years.

Reproductive rights: The Senate voted to block a bill to create a federal right to contraception access . Since Roe v. Wade was overturned, far-right conservatives have been trying to curtail birth-control access by sowing misinformation about how various methods work to prevent pregnancy. See how every senator voted on the Right to Contraception Act .

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Why Abortion Should Be Legalized: [Essay Example], 1331 words
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PDF Abstract
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