Abortion in the United States

Abortion is legal throughout the United States and its territories, although restrictions and accessibility vary from state to state. Abortion is a controversial and divisive issue in the society, culture and politics of the U.S., and various anti-abortion laws have been in force in each state since at least 1900.

In a brief to the supreme court, the United Nations special rapporteur on the right to health warned that overturning Roe v Wade and banning or criminalizing abortion would be “irreconcilable” with international human rights laws. ~ Jessica Glenza

QuotesEdit

  • Results: During 1988-1997, the overall death rate for women obtaining legally induced abortions was 0.7 per 100000 legal induced abortions. The risk of death increased exponentially by 38% for each additional week of gestation. Compared with women whose abortions were performed at or before 8 weeks of gestation, women whose abortions were performed in the second trimester were significantly more likely to die of abortion-related causes. The relative risk (unadjusted) of abortion-related mortality was 14.7 at 13-15 weeks of gestation (95% confidence interval [CI] 6.2, 34.7), 29.5 at 16-20 weeks (95% CI 12.9, 67.4), and 76.6 at or after 21 weeks (95% CI 32.5, 180.8). Up to 87% of deaths in women who chose to terminate their pregnancies after 8 weeks of gestation may have been avoidable if these women had accessed abortion services before 8 weeks of gestation.
    Conclusion: Although primary prevention of unintended pregnancy is optimal, among women who choose to terminate their pregnancies, increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help further decrease deaths.
  • Death from illegal abortion was once common in the United States. In the 1940s, more than 1,0000 women died each year of complications from abortion. In 1972, 24 women died of complication of legal abortion and 39 died from known illegal abortions. In 2000, the last year for which complete data are available, there were 11 deaths from legally induced abortion, and no deaths from illegal abortion (abortion induced by a nonprofessional) in the entire United States. The American Medical Associations Council on Scientific affairs has reviewed the impact of legal abortion and attributes the decline in deaths during the country to the introduction of antibiotics to treat sepsis; the widespread use of effective contraception beginning in the 1960s, which reduced the number of unwanted pregnancies; and, more recently, the shift from illegal to legal abortion. The United States has a serious problem with teenage pregnancy. Without legal abortion, there would be almost twice as many teenage births each year.
    • Sacheen Carr-Ellis, Nathalie Kapp; "10. Family Planning". In Berek, Jonathan S. (ed.). "Novak's Gynecology” (14 ed.). (2007) Lippincott Williams & Wilkins. pp.295-296
  • The number of abortion reported each year in the United States-1,313,000 in 2000 according to the Alan Guttmacher Institute-has been decreasing since the 1980s (260). In 2001, the national abortion rate was 16 per1,000 women aged 15 to 44 years. Most women who obtain abortions are unmarried (82% in 2001), and the ratio of abortion to live births s 9 times higher for unmarried women than for married women (261). Use of abortions varies markedly with age. In 2001, 18% of women obtaining abortions were 19 years of age or younger, and 51.3% were 24 years of age or younger. IN 2001, the abortion ratio for women younger than 15 years of age was 744 per 1,000 live births, almost as many abortions as births (Fig. 20.2). The Lowest abortion ratio, 147 per 1,000 live births, is for women aged 30 to 34 years. Legal abortion rates and ratios reached their highest in the early 1980s as they replaced illegal abortions, and both have declined since, especially for the youngest women (Fig. 10.20) (258).
    • Sacheen Carr-Ellis, Nathalie Kapp; "10. Family Planning". In Berek, Jonathan S. (ed.). "Novak's Gynecology" (14 ed.). (2007) Lippincott Williams & Wilkins. p.296
  • In the United States, about 50% of pregnancies are unintended, and about 40% of unintended pregnancies are ended by elective abortion, making it one of the most common surgical procedures done.
  • ABSTRACT: In the United States, more than one half of pregnancies are unintended, with 3 in 10 women having an abortion by age 45 years. In 2008, 1.2 million abortions occurred in the United States, of which 6.2% took place between 13 weeks of gestation and 15 weeks of gestation, and 4.0% took place at 16 weeks of gestation or later. Only 1.3% of abortions are performed at 21 weeks of gestation or later. The proportion of abortions performed in the second trimester, usually defined as between 13 weeks of gestation and 26 weeks of gestation (as calculated from the last menstrual period), has remained stable during the past two decades. The purpose of this document is to provide evidence-based guidelines for the medical and surgical methods of second-trimester termination as well as for the management of associated complications.
  • Recent findings: In recent years, there has been an alarming rise in the number of antiabortion laws enacted across the United States. In total, various states in the union enacted 334 abortion restrictions from 2011 to July 2016, accounting for 30% of all abortion restrictions since the legalization of abortion in 1973. Data confirm, however, that more liberal abortion laws do not increase the number of abortions, but instead greatly decrease the number of abortion-related deaths. Several countries including Romania, South Africa and Nepal have seen dramatic decreases in maternal mortality after liberalization of abortion laws, without an increase in the total number of abortions. In the United States, abortions are incredibly safe with very low rates of complications and a mortality rate of 0.7 per 100 000 women. With increasing abortion restrictions, maternal mortality in the United States can be expected to rise over the coming years, as has been observed in Texas recently.
    • Conti, Jennifer A.; Brant, Ashley R.; Shumaker, Heather D.; Reeves, Matthew F. (November 2016). "Update on abortion policy". Current Opinion in Obstetrics and Gynecology. 28 (6): 517–521. doi:10.1097/GCO.0000000000000324. PMID 27805969. S2CID 26052790.
  • Though serious infection after induced abortion is rare, infections account for one third of abortion-related deaths in the United States. Most fatal cases of infection after induced medical abortion have involved clostridial species. These reported cases share important clinical features that may guide clinicians to earlier recognition and institution of therapy.
  • The Austin boycott is yet one more unconventional tactic used by the pro-life movement in the ongoing debate. For decades, the media have been chronicling the drama unfolding outside of clinics around the nation ranging from routine protest to violence. Pro-choice activists, media pundits, and pro-choice politicians typically discuss these tactics in terms of personal acts of harassment, completely devoid of any political implications. When explaining the magnitude of anti-abortion activity at clinics, pro-choice activists contextualize the debate as a question of women’s rights: the pro-life movement does not believe in a woman’s right to choose. Conversely, pro-life activists see their unconventional activities at clinics as stemming from their belief that abortion is murder and they are simply trying to prevent the wholesale slaughter of innocent children. Both camps draw on simplistic explanatory frames to make sense of the saliency of the abortion issue and breadth of activities occurring at clinics. However, the abortion controversy is anything but simple.
  • If the experience among affiliates of the Planned Parenthood and sales figures from the US manufacturer, Danco Laboratories, LLC, (personal communication, Danco Laboratories, LLC) are indicative, use of medical abortion continues to grow in numbers and as a percentage of first-trimester abortions in the United States. By the end of 2007, about 50% of medically-eligible Planned Parenthood patients up to 56 days of gestation chose medical abortion (representing 26% of all first-trimester abortions), despite the loss of a critical week of eligibility when medical abortion with buccal misoprostol could be provided only through 56 days of gestation. The officially mandated switch from vaginal to buccal misoprostol resulted in no reduction in uptake of the method and no reduction in effectiveness. In February 2008, based on results of a recent clinical trial, Planned Parenthood resumed offering medical abortion from 57 through 63 days of gestation, employing the buccal route.
  • Since 1977 there have been eight murders, 17 attempted murders, 42 bombings, and 186 arsons targeted at abortion clinics and providers across the United States. In some cases, a small group of clinics have been targeted multiple times.
  • In court briefs and reports, defense attorneys, prosecutors, judges, international human rights experts and academics have begun to unpick what a return to illegal abortion might look like in a country with a vast law enforcement apparatus, with the world’s largest incarcerated population, and with women as America’s fastest growing imprisoned demographic.
    “It’s like a thought experiment – to think about what ‘Call Jane’ would look like,” in the modern era, said Cynthia Conti-Cook, a technology fellow with the Ford Foundation. Her work in gender, racial and ethnic justice explores how law enforcement could use the data produced by digital infrastructure – phones, internet browsers, social media – to prosecute people who seek or aid abortions, should Roe v Wade be overturned, and the procedure become illegal in some states once again.
    A single mobile phone could reveal the entire collective, Conti-Cook warned. Just one encounter with law enforcement – a traffic stop, a search, an arrest – could expose the entire network “through digital connections”.
  • Other American historians, such as Leslie J Reagan, the author of When Abortion Was a Crime, have warned of Ceausescu-like regimes where prenatal care becomes about ensuring “all pregnancies are progressing to term”, and authorities monitor menstrual cycles. In Missouri, health department officials have admitted to monitoring periods to identify “failed medical abortions”, part of a bid to close the state’s last abortion clinic.
    In a brief to the supreme court, the United Nations special rapporteur on the right to health warned that overturning Roe v Wade and banning or criminalizing abortion would be “irreconcilable” with international human rights laws. Even so, some states have already instituted bans, such as Texas, which banned the vast majority of abortions.
  • In America, the debate about abortion is often reduced to binary categories. Religious versus secular. Misogynists versus murderers. Even “Christian theocracy” versus, presumably, everyone else.
  • In the 1973 Roe v. Wade decision, the Supreme Court ruled that women, in consultation with their physician, have a constitutionally protected right to have an abortion in the early stages of pregnancy—that is, before viability—free from government interference.
    In 1992, the Court reaffirmed the right to abortion in Planned Parenthood v. Casey. However, the ruling significantly weakened the legal protections previously afforded women and physicians by giving states the right to enact restrictions that do not create an "undue burden" for women seeking abortion.
  • Hispanic women are 60 percent more likely than non-Hispanics to have an unintended pregnancy that they terminate by abortion, but they are less likely than nonwhites to do so. Women who profess no religion have a higher abortion rate than do women who report some religious affiliation; among the latter, Catholics are about as likely to obtain an abortion as are all women nationally, while Protestants and Jews are less likely to do so. One in six abortion patients in 1987 described themselves as born-again or Evangelical Christians; such women are half as likely as other American women to obtain abortions. Unmarried cohabiting women are nine times as likely as married women living with their husbands to have an abortion, and separated women are also at high risk. Other characteristics associated with an above-average likelihood of abortion are current school enrollment, current employment, low income, Medicaid coverage, intention to have no more children and residence in a metropolitan county. Half of all abortion patients in 1987 were practicing contraception during the month in which they conceived, and a substantial proportion of those who were not doing so had stopped using a method only a few months before becoming pregnant. The majority of abortion patients who had stopped using a method prior to becoming pregnant said they had most recently used the pill. Nonuse of a method of birth control among abortion patients is greatest for those who are young, poor, black, Hispanic or less educated.
  • Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than $15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.
  • Roe v. Wade, the 1973 Supreme Court decision that legalized abortion, “gave my profession an almost unlimited license to kill,” Dr. Jefferson testified before Congress in 1981.
    Dr. Jefferson, a surgeon, was speaking in support of a bill, sponsored by Senator Jesse Helms, Republican of North Carolina, and Representative Henry J. Hyde, Republican of Illinois, that sought to declare that human life “shall be deemed to exist from conception.” Had it passed, it would have allowed states to prosecute abortion as murder.
    “With the obstetrician and mother becoming the worst enemy of the child and the pediatrician becoming the assassin for the family,” Dr. Jefferson continued to testify, “the state must be enabled to protect the life of the child, born and unborn.”
  • In a 2003 profile in The American Feminist, an anti-abortion magazine, Dr. Jefferson said, “I am at once a physician, a citizen and a woman, and I am not willing to stand aside and allow this concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged and the planned have the right to live.”
  • Recent estimates find that approximately 1.29 million abortions were performed in the United States in 2003, a 2% decrease from 1.31 million in 2000. Each year in the United States, 2% of women of reproductive age (15 to 44 years) terminate a pregnancy legally. Given the current rate, it is estimated that over one third of women in the United States will have had an abortion by age 45. The abortion rate in 2000 was about 21.3 per 1,000 women. This rate has decreased from 27.4 abortions per 1,000 women in 1990. While nearly all women in the United States have used some form of contraceptive at some point in their lives and contraceptive use has increased considerably since the legalization of abortion, about half of the 6 million pregnancies occurring each year are reportedly unplanned. Roughly half of these unplanned pregnancies, one in five pregnancies overall, are terminated by induced abortion. Women who opt for abortion tend to be never married, in their 20s, live below the federal poverty level, and are mothers of at least one child. Over half of women who have had an abortion used some form of contraception during the month that they became pregnant. Since legalization in 1973, abortion in the United States has become very sage. Yet, worldwide, 19 of the 46 million abortions performed annually are done so illegally. Illegal abortion remains very unsafe and account for some 68,000 deaths globally each year.
  • The landmark 1973 Supreme Court decision in “Roe v. Wade” effectively legalized abortion in the United States. Since that time, federal and state legislators have proposed or enacted hundreds of pieces of legislation aimed at restricting access to abortion or challenging the Court’s “Roe” decision, making induced abortion the most actively litigated and highly publicized area in medicine.
  • Antiabortion legislation seeks to chip away at access to abortion through a variety of means. The federal so-called “partial-birth abortion” ban of 2003 attempted to abolish certain late-second-trimester abortion procedures, but due to its vague language, it would have further reaching effects; at the time of this writing, a Supreme Court case challenging the ban awaits a decision. A number of states have mandated parental notification or consent before a minor is able to obtain an abortion. In some states, women seeking abortions must undergo a waiting period of at least 24 hours or receive state-sanctioned counseling beforehand; in some cases, this counseling contains ideologically charges or scientifically disputed information that s meant to discourage women from ultimately choosing abortion. A handful of states, most notably South Dakota in 2006, have attempted ot pass bans on almost all abortions with the express purpose of challenging “Roe”.
  • Although modern induced abortion is one off the safest medical procedures available, it is regulated like no other area of medicine in the USA. The procedure is currently subject to a multitude of federal and state laws and regulations. This situation was not always the case. From the country’s inception up through the first half of the 19th century, abortion prior to “quickening” was legal and largely unregulated in the USA.
  • Much has changed in the twenty-plus years since “Roe”. Although abortion is not illegal it is available in less than 20 percent of the counties in this country. The ban on federal Medicaid funding and the restrictions imposed by many states, including parental consent laws, waiting periods, and mandatory counseling on fetal development, do not make abortion a realistic option for some women and girls. Many of these restrictions stem from the belief that woman are not responsible decision-makers. They follow from ‘Roe”, which codified both the state’s right to regulate abortion and the physician’s responsibility for it. Within the medical profession itself, doctors who perform abortions are stigmatized. To compound these problems of access and attitude, abortion providers are being driven out by the high costs of protecting their clinics, their staffs, and themselves from violent attacks by abortion foes. The situation could hardly be worse for beleaguered clinics.
  • Abortion clinics operate in a siege situation, and that mentality is not conducive to change. But that hostile climate could be used to create a community, a partnership, between clinic staff and the women who seek their services, much as we in Jane were able to use our illegality to build solidarity. An emphasis on health and reproductive education in abortion counseling would give women the tools they need to act responsibly. Training professional staff to respond to each woman as a full person not only benefits women but also makes the practitioners’ work more rewarding and positively affects morale. Substituting responsive care for a reliance on drugs improves health outcomes and women’s emotional recovery. Although we cannot expect provider associations to police their members, they could promote examples of quality care. In major cities, where a variety of abortion services exists, feminists could evaluate these services and make that information available to women.
  • More than 25 years have elapsed since Dr. Bourne, an eminent London obstetrician, was found not guilty after having performed an abortion on a 14-year-old girl who had become pregnant after a particularly brutal rape. In this country no state has specifically legalized an abortion for pregnancy resulting from rape or incest. It is extremely likely, however, that many victims of such crimes have been aborted upon the medical, or more accurately psychiatric, opinion that the operation is necessary to preserve the patient's life. Our society tends to express vigorous condemnation of criminal abortion until confronted with a personally or socially unacceptable pregnancy.
  • A sea change in attitudes toward abortion occurred during the five years before “Roe v Wade”. By 1971 over half the people questioned in opinion polls favored legalizing abortion. Lawyers challenging abortion statutes, who had previously emphasized the effects of unconstitutionally vague language on medical practitioners, began in the early 1970s to argue on behalf of women’s right to decide when to have a child, Organizations that had been working to reform abortion laws changed their goals, strategies, and often their names to reflect the new movement for repeal of all state abortion statutes, and after 1970 state courts began ruling in favor of women’s right to abortion.
  • This paper examines the content of Post Abortion Syndrome (PAS) claims, the social actors involved and how this social diagnosis bypassed professional dissent and diffused into public policy in the United States. Previous works on the spread of PAS focus on almost exclusively on anti-abortion think tanks and policymakers. Missing from these analyses, however, is an emphasis on the grassroots-level actions undertaken by evangelical crisis pregnancy center (CPC) activists in introducing and circulating PAS claims. The CPC movement introduced PAS claims and provided the fodder for anti-abortion think tanks to construct evidence of pro-life claims. Despite dissent from health professionals and academic researchers, CPC PAS claims successfully diffused into federal and state abortion policy. I draw upon Brown et al.’s social diagnosis framework and Armstrong's five-stage model of diagnosis development to frame this account.
  • “I don’t think the most damaging issue in this country is poverty, as important as the issue is,” Land said, agreeing that the country needs to work to alleviate poverty and that the government has a measure of responsibility in the effort.
    “Yet not a single day has gone by in the last 32 years that I have not personally grieved and prayed for the 4,000 babies -- disproportionately African American -- who have been aborted,” Land continued. “I believe government has a responsibility to protect life. That includes unborn life. I personally will not rest until they are protected.”
    The most dangerous place an American has been over the past 32 years is his or her mother’s womb, Land said, noting there is a 33 percent chance of a child being killed between conception and birth.
  • Compared to other advanced industrialized societies, the contemporary USA is the extreme example of a society inwhich an antiabortion movement arose in response to legalization and ultimately managed to become a leading force in domestic politics.
  • Notwithstanding involvement on the part of Catholic and Protestant clergy and others, physicians were the leading force in the campaign to criminalize abortion in the USA. The American Medical Association (AMA), founded in 1847, argued that abortion was both immoral and dangerous, given the incompetence of many practitioners at that time. According to a number of scholars, the AMA’s drive against abortion formed part of a larger and ultimately successful strategy that sought to put “regular” or university-trained physicians in a position of professional dominance over the wide range of “irregular” clinicians who practiced freely during the first half of the 19th century.
    What followed was a “century of criminalization” characterized by a widespread culture of illegal abortion provision. Thousands of women died or sustained serious injuries at the hands of the infamous “back alley butchers” of that period, and encountering these victims in hospital emergency rooms became a nearly universal experience for US medical residents. However, safe abortions were available to some women, performed by highly skilled laypersons and physicians with successful mainstream practices who were motivated primarily by the desperate situations of their patients. These “physicians of conscience” were instrumental in convincing their medical colleagues of the necessity to decriminalize abortion. By 1970, the AMA reversed its earlier stance and called for the legalization of abortion.
  • Freestanding clinics remain the dominant form of abortion delivery in the USA, while in Europe and Canada, abortions are more evenly spread between clinics and hospitals. Notwithstanding the many benefits of the freestanding clinic model, it also has contributed to the marginalization of abortion services from mainstream medicine in the USA and left clinics more vulnerable to attacks from antiabortion extremists. In contrast, those European countries where abortions are delivered as part of national health care systems have experienced less difficulty in finding providers and far less antiabortion activity at service sites.
  • Liebel and other anti-abortion activists contend that mifepristone is not safe for women to take unsupervised at home and argue that it’s led to many rushing to emergency rooms. But of nearly 4 million women who have taken the drug since 2000, the FDA said, there were reports of 24 associated deaths as of 2018, including two cases of ectopic pregnancy and several cases of severe sepsis. Those deaths, however, could not be causally linked to the drug with certainty because of the patients' use of other drugs or receipt of medical or surgical treatments, or their co-existing medical conditions and information gaps about their health status, the agency said.
  • “Storer himself, for example, believed that abortion was indicated where there was fear of transmitting insanity or epilepsy to the offspring. Thus, “physicians agreed that the embryo’s rights were conditional. What was at the core of their movement, therefore, was a ‘’reallocation’’ of social responsibility for assessing the conditional rights of the fetus against the woman’s right to life, both narrowly and broadly defined. From the late nineteenth century until the late 1960s, it was doctors, not women, who held the right to make that assessment.”
    • Luker, Abortion and the Politics of Motherhood, p.35
  • [L]ittle progress has been made in reducing rates of unintended pregnancy. More than one-third of the 205 million pregnancies that occur annually worldwide are unintended, as are nearly half of all pregnancies in the USA. In contrast to the trend toward liberalization of abortion laws worldwide, women’s reproductive rights in the USA have suffered major setbacks in recent years. The clinic protesters of the 1990s have been joined by pharmacists who refuse to dispense birth control or emergency contraception, the US Supreme Court justice who upheld a federal ban on certain abortion procedures without regard for women’s health, pseudo-scientists who allege that abortion causes long-lasting psychological trauma despite incontrovertible evidence to the contrary, and a conservative White House administration that has left a legacy of hostility to women’s rights that will take many years to undo. Indeed, these countercurrents embody one of the great moral contradictions of our time: that is, while we have simple, safe, and effective technologies to provide women with the means to control their fertility, millions of women across the globe lack access to family planning services and one woman continues to die every 8 minutes from an unsafe abortion.
  • “Mifepristone is the only medication that they require you to receive in the clinic, but then you can self administer it at home. That doesn't make any medical sense,” she said of the FDA requirements under review. “If it is safe for you to take it home, it should also be safe for you to receive it at home and then consume it at home.”
  • It should be obvious why, if the Supreme Court had upheld the law at issue in Whole Woman’s Health, that could have been the death knell for abortion rights. If states can enact regulations whose sole purpose is to drive up the cost of performing abortions, they eventually would be able to drive all abortion clinics out of business. Perhaps Texas might have required all abortion clinics to be built out of solid gold.
    And yet, even in a world of 24-karat surgical centers, the Supreme Court could have claimed that Roe and Casey remain good law. States still would be forbidden from writing a law that states explicitly that “no one may perform an abortion.” But those states would still be free to ban abortion as long as they were sufficiently dishonest about what they were up to.
  • Ever since Roe, the Court has held that the state may impose stricter restrictions on abortions later in pregnancy than it can early in the fetus’s development. Roe divided pregnancy up into trimesters, permitting greater regulation of abortion in the latter two-thirds of the pregnancy. Casey abandoned this framework to focus on “viability,” giving the government broader authority over abortion once a fetus can survive outside of the womb.
    If the Court permits states to impose the same kind of restrictions on pre-viability abortions that those states may currently impose on post-viability abortions, that would severely hobble abortion rights and allow states to forbid most abortions — even if the Court does not explicitly overrule Roe or Casey.
  • Freestanding clinics remain the dominant form of abortion delivery in the United States, whereas in Europe and Canada abortions are more evenly apportioned between clinics and hospitals.6 Notwithstanding the many benefits of the freestanding clinic system in the United States, it has contributed to the marginalization of abortion services from the rest of the medical establishment and has been vulnerable to attacks from anti-abortion extremists.8 In contrast, in European countries where abortions are delivered as part of national health care systems, there has been less difficulty finding abortion providers and far less anti-abortion activity at sites of abortion provision.
  • Members of the National Abortion Federation (NAF) reported an escalation of hostility and targeted activity in 2017. With anti-abortion extremists feeling emboldened by the current political environment, trespassing more than tripled, death threats/threats of harm nearly doubled, and incidents of obstruction rose from 580 in 2016 to more than 1,700 in 2017. We also continued to see an increase in targeted hate mail/harassing phone calls, and clinic invasions, and had the first attempted bombing in many years.
    There were again no acts of extreme violence, with no murders or attempted murders. While we recorded a decrease in burglary, vandalism and general online hate speech, we also recorded a significant increase in activities aimed at disrupting services, intimidating providers and patients, and preventing women from obtaining the health care they need.
  • NAF has been tracking incidents of violence and disruption against abortion providers since 1977. Our comprehensive violence and disruption statistics are an invaluable resource that enables us to detect patterns and trends in anti-abortion criminal activities and report incidents to law enforcement. NAF members submit monthly reports on the violence and disruption they experience.
  • Much of the academic literature that analyzes U.S. state-level restrictions on abortion focuses on parental involvement laws and the extent to which abortion is publicly funded through Medicaid. However, one shortcoming common to all of these studies is that they fail to analyze informed consent laws and other types of anti-abortion legislation that received constitutional protection through the U.S. Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992). In this study, a series of regressions on a comprehensive time series cross-sectional data set provides evidence that several types of state-level anti-abortion legislation result in statistically significant declines in both the abortion rate and the abortion ratio. Furthermore, a series of natural experiments provide further evidence that abortion restrictions are correlated with reductions in the incidence of abortion.
  • In the present day too, as a consequence of a Supreme Court decision, crusades for and against abortion have reached passionate intensity. Forces of total good are arrayed against total evil, the sure sign of a dogma encased in the struggle for absolute power. On both sides what once existed in the shadows of convention and ordinary adjustment is now bathed in the pitiless glare of the apocalyptic.
  • Regardless of their views about the legality of abortion, most Americans think that having an abortion is a moral issue. By contrast, the public is much less likely to see other issues involving human embryos – such as stem cell research or in vitro fertilization – as a matter of morality.
    Asked whether abortion is morally acceptable, morally wrong or not a moral issue, only about a quarter of U.S. adults (23%) say they personally do not consider having an abortion to be a moral issue, according to a survey by the Pew Research Center. Twice as many Americans (46%) say this about using in vitro fertilization. Asked about the morality of medical research that uses embryonic stem cells, more than a third of U.S. adults (36%) say they do not consider such research to be a moral issue. Roughly four-in-ten (42%) say the same about stem cell research that does not involve human embryos.
    The percentage of U.S. adults who consider abortion to be morally wrong (49%) far exceeds the percentage who express this view about in vitro fertilization (12%), non-embryonic stem cell research (16%) or embryonic stem cell research (22%).
    Only 15% of the public thinks that having an abortion is morally acceptable. By comparison, about a third of U.S. adults say they personally view IVF and both forms of stem cell research as morally acceptable practices.
  • There are sizable differences in opinions about the moral acceptability of abortion by partisanship, political ideology and education, but few differences when it comes to gender and age.
    About two-thirds of Republicans and independents who lean toward the Republican Party consider having an abortion morally wrong (64%), compared with 38% of Democrats and Democratic-leaning independents. Similarly, conservatives (67%) are more inclined than either self-described moderates (40%) or liberals (31%) to view having an abortion as morally wrong.
    Those with fewer years of formal schooling also are more inclined to consider abortion morally wrong. A majority of those with a high school degree or less education (58%) say they personally believe having an abortion is morally wrong. This compares with 47% among those with some college education and 39% among those with at least a college degree.
  • In the United States, more than one half of pregnancies are unintended, with 3 in 10 women having an abortion by age 45 years. In 2008, 1.2 million abortions occurred in the United States, of which 6.2% took place between 13 weeks of gestation and 15 weeks of gestation, and 4.0% took place at 16 weeks of gestation or later. Only 1.3% of abortions are performed at 21 weeks of gestation or later. The proportion of abortions performed in the second trimester, usually defined as between 13 weeks of gestation and 26 weeks of gestation (as calculated from the last menstrual period), has remained stable during the past two decades.
  • Second-trimester abortion is an important component of comprehensive women’s health care, and women seek termination later in pregnancy for a variety of medical and social reasons. Circumstances that can lead to second-trimester abortion include delays in suspecting and testing for pregnancy, delay in obtaining insurance or other funding, and delay in obtaining referral, as well as difficulties in locating and traveling to a provider. Poverty, lower education level, and having multiple disruptive life events, have been associated with higher rates of seeking second-trimester abortion. In addition, major anatomic or genetic anomalies may be detected in the fetus in the second trimester and women may choose to terminate their pregnancies (47-95%). The identification of major anatomic or genetic anomalies in the fetus through screening and diagnostic testing most commonly occurs in the second trimester, although first-trimester screening and chorionic villus sampling can enable first-trimester diagnosis of aneuploidy. Some obstetric and medical indications for second-trimester termination include preeclampsia and preterm premature rupture of membranes, among other conditions. Additional indications for uterine evacuation in the second trimester are pregnancy failure before 20 weeks of gestation and fetal demise. In 2005, the U.S. fetal mortality rate was 6.22 fetal deaths at 20 weeks of gestation or more per 1,000 live births and fetal deaths, and this rate was higher for teenagers; women aged 35 years and older; and among non-Hispanic black, Hispanic, and American Indian or Alaska Native women.
  • In 1974 and 1975 the Senate Judiciary Committee held hearings on two variants of a proposal called the Human Life Amendment to the Constitution designed to effect reversal of the Supreme Court’s decision on abortion. Prolife forces, the advocates of the Human Life Amendment, were unable to secure more than a committee hearing from the Senate and not even that from the House of Representatives. Undeterred, they turned their attention to the prospective presidential candidates as the 1976 campaign drew near.
    Jimmy Carter, former governor of Georgia, shed the status of a dark horse regional candidate by virtue of his showing the Iowa primary in which he succeeded in identifying himself with the pro-life cause. Thereafter he had to exercise considerable ingenuity obscuring his position on the Human Life Amendment, a proposal he could not endorse without forfeiting the hope of nomination by a Democratic National Convention. In an editorial the Jesuit weekly ‘’America’’ accused Cater of “indifference” to the issue of abortion manifested by a “response . . . [that] has shifted constantly from the Iowa primary through the platform hearings to the post-convention maneuverings (‘’America’’ 1976, 42). Such criticism led Carter, complaining that he was “in trouble with the Catholics,” to seek advice from the president of the University of Notre Dame, Theodore Hesburgh, who urged him to sidestep the question by pointing out that the Constitution gave the president no part in the process of amending the constitution (Hesburgh 1990, 271-72).
  • Results: The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate.
    Conclusions: The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health.
  • Results: The pregnancy-associated mortality rate among women who delivered live neonates was 8.8 deaths per 100,000 live births. The mortality rate related to induced abortion was 0.6 deaths per 100,000 abortions. In the one recent comparative study of pregnancy morbidity in the United States, pregnancy-related complications were more common with childbirth than with abortion.
    Conclusion: Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.
  • The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities.
  • Results
    The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8–1.7 deaths per 100,000 plastic surgery procedures, 0–1.7deaths per 100,000 dental procedures, 0.6–1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007–2011 was about equal to the abortion-related mortality rate.
    Conclusions
    The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health.
  • 1994-5: The Roper Center for Public Opinion Research: Researchers S.K. Henshaw & K. Kost used a different measurement of abortion data: the "abortion index." For a given group, an abortion index of 1.0 indicates that women in the group have an per-capita number of abortions equal to the U.S. average; a value of 2.0 indicates that they are twice as likely to have an abortion.
    They sampled women at a group of abortion clinics and determined that the abortion index by religion was for:
    *Protestants: 0.69;
    *Followers of a religion other than Judaism and Christianity: 0.78;
    *Roman Catholics: 1.01;
    *Jews: 1.08;
    * Women who do not follow an organized religion: 4.02.
    The researchers found that only 18.0% of abortion patients identified themsleves as "Born-again/Evangelicals," This compares to 46% of the general population. Also, 82% of abortion patients identified as other than "Born-again/Evangelicals" compared with 54% of all Americans. Born-again/Evangelicals are thus very much under-represented among those seeking an abortion.
  • Interpreting abortion data relating to religion:
    These data need to be interpreted carefully. The abortion index is influenced by many variables, including:
    *The percentage of women in the religious group who are sexually active.
    *The percentage of sexually active women who do not use an effective contraceptive method.
    *The frequency of their sexual activity.
    *The type of sexual activity -- whether it is liable to result in pregnancy.
    *The percentage of pregnant women who wish to terminate the pregnancy.
    *The percentage of pregnant women who choose to have an abortion.
    *Truthfullness: These data show what the women say, not necessarily what they do or are. For example, twice as many adults "say" that they go to religious services regularly than actually do go.
    For example, the average Roman Catholic teenager might be less likely to have access to accurate and comprehensive birth control information. All other factors being equal, this would increase the index for Roman Catholics. Similarly, conservative Protestant denominations (fundamentalist and other evangelicals) composed largely of born-again members, are very actively involved in reducing abortion access in the U.S. Their members might be too ashamed or embarrased to admit that they belong to these groups,
  • A diversity of views exists within the U.S. and Canada concerning abortion access. Many pro-life and pro-choice groups have been organized with opposing goals. Surprisingly, they agree on a few very important points.
    *They both want to see the abortion rate decline.
    * In those cases where they feel that an abortion is acceptable, they are both concerned that it present a minimal health risk to the woman.
    * Once human personhood is attained by the embryo or fetus, both pro-life and pro-choice supporters are concerned that his/her life be preserved, except in very unusual circumstances.
    Unfortunately, the two sides cannot agree on when personhood is attained. Most pro-life groups believe it happens at conception and are thus generally opposed to all elective abortions. Pro-choice groups typically believe that it happens later in gestation or at birth, and are thus generally supportive to a woman’s access to affordable, safe, elective abortions.
    • Religious Tolerance, [www.religioustolerance.org/abo_hist1.htm "Current beliefs by various religious and secular groups"]
  • In the United States, legislation regarding abortion has varied with the times. Before 1800, no statutes addressed the subject of abortion. The first antiabortion legislation appeared in the 1820s; the preservation of pregnant women's health was the motivating force. During this time, the mortality rate from abortion was high, while the mortality rate from childbirth was less than 3%. By 1900, abortion in the United States at any time during pregnancy was a crime, with the exception of therapeutic abortion performed to save the mother's life.
    During the 1950s, the practice of medicine came under increasing scrutiny, and guidelines were set to define the indications for therapeutic abortion. The guidelines allowed therapeutic abortion if (1) pregnancy would "gravely impair the physical and mental health of the mother," (2) the child born was likely to have "grave physical and mental defects," or (3) the pregnancy was the result of rape or incest (Mcfarlane, 1993). In the United States, the legalization of abortion by Roe v Wade in 1973 upheld the fundamental right of a woman to determine whether to continue her pregnancy.
    • Roche, Natalie E. (28 September 2004). "Therapeutic Abortion". eMedicine. Archived from the original on 14 December 2004. Retrieved 19 June 2011.
  • US statistics indicate that the vast majority of abortions are elective. Therapeutic abortion is rare. The ability to define therapeutic abortion performed for maternal indications is difficult because of the subjective nature of decisions made about potential morbidity and mortality in pregnant women. A variety of medical conditions in pregnant women have the potential to affect health and cause complications that may be life threatening.
    Prenatal screening in the form of prenatal diagnostic screening continues to improve the antepartum diagnosis of fetal anomalies. The decision to continue or terminate a pregnancy complicated by fetal anomalies is a difficult decision. The most difficult decisions are associated with anomalies that are unpredictable or highly variable in their expression.
    • Roche, Natalie E. (28 September 2004). "Therapeutic Abortion". eMedicine. Archived from the original on 14 December 2004. Retrieved 19 June 2011.
  • Abortion, it's beautiful, it's beautiful abortion is legal. I love going to an abortion rally to pick up women, 'cause you know they are fucking. . . When a woman gets pregnant, it's a choice between the woman and her girlfriends. One girlfriend goes, 'Child, you should have that baby — that man got some good hair.' And the other girlfriend says, 'Child, why we even talking about this — ain't we supposed to go to Cancun next week? Get rid of that baby!' [That] is how life is decided in America.
    • Chris Rock, comedian, in his stand-up comedy routine, February 2005 [1].
  • No one is thinking about these hardships when they put these bans on. People have other children, people have health issues, people have all types of things and they are spending every dime just to go somewhere else because this basic need isn’t accessible in their own state. But there are people fighting for them, no matter what laws are being passed or what the restrictions are, and we are doing everything we can to be able to service these patients. They need to know that we're going to continue to fight for them.
  • Efforts to ban abortion in America have been given considerable momentum by the powerful involvement of militant fundamentalists’ who have made an alliance with conservative political groups. Evangelical moral and religious fervor has been combined with sophisticated political strategies, influential television programming, marketing expertise, and extensive funding.
  • Some abortion policies in the U.S. are based on the notion that abortion harms women’s mental health. The American Psychological Association (APA) Task Force on Abortion and Mental Health concluded that first-trimester abortions do not harm women’s mental health. However, the APA task force does not make conclusions regarding later abortions (second trimester or beyond) and mental health. This paper critically evaluates studies on later abortion and mental health in order to inform both policy and practice.
  • No issue since the Vietnam conflict or maybe since Prohibition, has so plagued the American moral conscience as has abortion. The 1973 Supreme Court ruling on Roe v. Wade has plunged this county into what seems to be an endless-and nearly hopeless-polarization of extreme positions such that the American public has begun to lose confidence that any moral middle ground can be found. Many in society are numbed by the frequent revision of abortion laws at the federal and state levels, congressional proposals to prevent legal constraints on abortion, Republican executive attempts to establish “gag rules,” and the latter’s recent reversal by President Clinton. We are told in nearly every survey that a majority of the American people believes that the Supreme Court went too far when it granted a Fourteenth Amendment right to abortion. The abortion of 1.6 million fetuses each year becomes even more complex and debatable when public funds are used to finance these medical procedures.
  • The Catholic campaign against abortion legalization in the United States began as a human rights cause that was rooted in the assumptions of New Deal liberalism. At the time of the New Deal, abortion was illegal throughout the nation except when it was necessary to save a woman’s life, and the sale of contraception was still illegal in some states. Although the laws against abortion and contraception had been passed in the late nineteenth century, long before the rise of New Deal liberalism, Catholics viewed this legislation as evidence of a concern for human life that they thought accorded well with the principles of the New Deal social welfare state. Thus, when a few non-Catholic doctors began calling for the liberalization of abortion laws in the 1930s, and when a much larger number of Protestants and Jews advocated the repeal of the laws against birth control, Catholics reacted against both campaigns by appealing to the values of New Deal liberalism.
  • Because the initial abortion law liberalization campaigns of the mid-to-late 1960s sought only modest changes in state abortion laws in order to allow abortion in cases of rape and incest, suspected fetal deformity, and dangers to the health of the mother, few Protestants—and even fewer evangelicals—joined the right-to-life campaign to lobby against these early liberalization proposals. Having recently rejected the Catholic position on contraception (evangelicals had once opposed birth control, but they generally accepted it after the early 1960s), they were reluctant to endorse a Catholic-led antiabortion campaign that seemed to rely on the same natural-law arguments that Catholics had used against contraceptives.
  • When abortion law reformers ceased calling for a modest liberalization of existing abortion laws and began demanding a repeal of almost all restrictions on abortion, some evangelicals reacted in horror and decided that the right-to-life movement was worthy of more consideration than they had initially thought. The removal of almost all legal restrictions on first and second-trimester abortions in New York in 1970 was particularly troubling, since it quickly led to nearly 200,000 legal abortions per year in New York’s hospitals. Two months after the enactment of New York’s new abortion policy, Christianity Today published an editorial titled, “War on the Womb,” which argued, for the first time, that human personhood probably began “at the very moment or very soon after the sperm and egg meet” [97]. In previous editorials, Christianity Today, like other evangelical magazines, had avoided taking the Catholic position that human life began at conception, but its outrage over “abortion on demand” pushed it closer to the Catholic view. The magazine no longer published editorials endorsing abortion in exceptional circumstances. In 1971, it encouraged readers to join right-to-life organizations—even though these organizations, at the time, were overwhelmingly Catholic.

"Report of the APA Task Force on Mental Health and Abortion" (13 August 2008)Edit

"Report of the APA Task Force on Mental Health and Abortion" (PDF). Washington, DC: American Psychological Association. 13 August 2008. Archived (PDF) from the original on 15 June 2010.

  • Although the U.S. Supreme Court legalized abortion in the United States more than 35 years ago (Roe v. Wade, 1973), it continues to generate enormous emotional moral, and legal controversy. Over the last two decades, one aspect of this controversy has focused on the effects of abortion of women’s mental health. Public debate on this issue can be traced to 1987, when then President Ronald Reagan directed then-Surgeon General C. Everett Koop to prepare a Surgeon General’s report on the public health effect (both psychological and physical) of abortion. After conducting a comprehensive review of the scientific literature, Dr. Koon declined to issue a report; instead, he sent a letter to President Reagan on January 9, 1989, in which he concluded that the available research was inadequate to support any scientific findings about the psychological consequences caused by abortion. In subsequent testimony before Congress, Dr. Koop stated that his letter did not focus on the physical health risks of abortion because “obstetricians and gynecologists had long since concluded that the physical sequelae of abortion were no different than those found in women who carried to term or who had never been pregnant”. Dr. Koop also testified that although psychological responses following abortion can be “overwhelming to a given individual,” the psychological risks following abortion were “miniscule” from a public health perspective.
    • p.5
  • Almost all abortions (92% according to the 2002 National Survey of Family Growth) in the United States are of unintended pregnancies, pregnancies that are not induced for therapeutic reasons. A late term induced abortion of an intended pregnancy may have very different implications for mental health than a first-trimester induced abortion of an unintended pregnancy.
    • p.7
  • ”How prevalent are mental health problems among women in the United States who have had an abortion?” This question focused attention on the extent to which abortion poses a threat to women’s mental health, i.e., is associated with a clinically significant mental disorder (see Wilmoth et al., 1992 for a discussion of this issue). In order to answer this question, research must have several key characteristics. First, the research must be based on samples of women representative of the women to whom one wants to generalize. Thus, to address whether abortion poses a threat to the mental health of women in the United States requires a study based on a nationally representative sample of women in the United States. Highly selected samples, biased samples, samples with considerable attrition or underreporting, or samples of women in other cultures and social contexts are not appropriate for answering this question. As will be discussed below, sampling problems are a serious concern in abortion research. Second, an adequate answer to the prevalence question also requires a clearly defined and agreed-ipon definition of a “mental health problem” and a valid, reliable, and agreed-upon measurement of that problem. Feelings of sadness or regret with the normal range of emotion are not clearly defined and agreed-upon mental health problems. Mental health outcomes that meet established criteria for clinically significant disorders are. Third, researchers must know the prevalence of the same mental health problem in the general population of U.S. women who share characteristics similar to the abortion group, e.g., women who are of a similar age and demographic profile. Such information is essential for interpreting the significance of findings. For example, if 15% of women in a nationally representative sample who had an abortion were found to meet diagnostic criteria for depression, the meaning of this would be more a cause for concern is the base rate for clinical depression among women in the general population f a similar age and demographic profile was 5% than if it was 25%.
    • p.8
  • Women obtain abortions for different reasons. The vast majority of abortions are of unintended pregnancies-either mistimed pregnancies that would have been wanted at an earlier or latter date or unwanted pregnancies that were not wanted at that time or at any time in the future. Approximately half of women in the United States will face an unintended pregnancy during their lifetime, and about half of those who unintentionally become pregnancy resolve the pregnancy through abortion. The reasons that women most frequently cite for terminating a pregnancy include not being ready to care for a child (or another child) at that time, financial inability to care for a child, concern for or responsibility to others (especially concerns related to caring for a future child and/or for existing children), desire to avoid single parenthood, relationship problems, and feeling too young or immature to raise a child. Some pregnancies are terminated because they are a consequence of rape or incest. Very few (<1%) women cite coercion from others as a major reason for their abortion. A very small percentage of abortion are of planned and wanted pregnancies. Women who terminate wanted pregnancies typically do so because of fetal anomalies or risks to their own health.
    • p.9
  • Unwanted pregnancy and abortion do not occur in a social vacuum. The current sociopolitical climate of the United States stigmatizes some women who have pregnancies (e.g., teen mothers) as well as women who have abortions. It also stigmatizes the nurses and physicians who provide abortions. From a sociocultural perspective, social practices and messages that stigmatize women who have abortions may directly contribute to negative psychological experiences post abortion.
    The psychological implications of stigma are profound. Experimental studies have established that stigmatization can create negative cognitions, emotions, and behavioral reactions that can adversely affect social, psychological, and biological functioning. Effects, and behavioral reactions that can adversely affect social, psychological, and biological functioning. Effects of perceived stigma include cognitive and performance deficits, increased alcohol consumption, social withdrawal and avoidance, increased depression and anxiety, and increased physiological stress responses. Societal stigma is particularly pernicious when it leads to “internalized stigma associated with abortion (e.g., who see themselves as tainted, flawed, or morally deficient) are likely to be particularly vulnerable to later psychological distress.
    • pp.11-12

Randall Herbert Balmer, “Thy Kingdom Come”, (June 26, 2006)Edit

  • Why, then, is the Religious Right, which claims allegiance to the scriptures, not working to outlaw divorce?
    The answer, I suspect, is that the issue of abortion has served the Religious Right very effectively for more than two decades. Although the Religious Right was slow to pick up on abortion as a political issue, it proved to be a potent one for them during the 1980s, in part because Reagan championed the pro-life cause-despite the fact that as governor of California, he had signed into law a bill legalizing abortion. Reagan kept the antiabortion rhetoric alive throughout his presidency, repeatedly promising an amendment to the Constitution that would outlaw abortion. He never delivered on that promise: nor did his vice president and successor as president, George H.W. Bush, who in 1980 has campaigned against Reagan for his party’s presidential nomination as a pro-choice Republican. Although both men coveted the support of the Religious Right, neither made good on his promise to outlaw abortion.
    • Chapter One: Strange Bedfellows, p.11
  • The real question for the Religious right and the Republican party is how serious they are about reducing (and even eliminating) abortion itself, especially when everyone acknowledges that legal sanctions will not work. Wouldn’t the energies of the Religious right be more productively directed toward campaigns to encourage abstinence, contraception, and adoption, similar to campaigns directed against smoking or alcohol and spousal abuse? Even better, the Religious Right want to consider the links between abortion rates and the availability of contraception or the economic plight of mothers-to-be facing medical and child-care costs. Surely such initiatives would do more than a legal ban to make abortion rare and unthinkable. The Religious Right might also want to consider the fat that by the time Bill Clinton, a defender of reproductive choice, left office, the abortion rate had fallen to its lowest level since 1974, a year after the Roe decision.
    Curiously although the leaders of the Religious Right have been advocating a legal ban on abortion at least since 1980, they have been remarkably silent about the details of their proposals. Will gynecologists be required to report every fertilized egg implanted in the uterus to some government registry so that each pregnancy can be monitored? Which agency would be responsible for such oversight-the federal Bureau of Investigation or some new entity? (Given the Religious Right’s professed aversion to government, the latter option seems unlikely). Will the government require that a law-enforcement official be present at every obstetrics examination, or merely somewhere on the premises? Will it be a federal, state, or local official? What about miscarriages? How will officials determine whether or not a miscarriage occurred naturally?
    • pp.19-20
  • My party, the Democratic Party, has utterly botched the abortion issue, I’ll not deny that. In their efforts to assert the importance of women’s rights and prerogatives, many Democrats have elevated abortion to an intrinsic entitlement and, in so doing, have refused to acknowledge the moral implications of abortion itself. This imperious position has alienated key constituencies once associated with the Democratic Party, especially Roman Catholics. It has also functioned to marginalize many evangelical voters in the Democratic Party-on that issue alone.
    • p.21

“Abortion and Women of Color: The Bigger Picture” (August 6, 2008)Edit

Susan A. Cohen, “Abortion and Women of Color: The Bigger Picture”, Guttmacher Policy Review, Volume 11, Issue 3, (August 6, 2008)

  • This much is true: In the United States, the abortion rate for black women is almost five times that for white women. Antiabortion activists, including some African-American pastors, have been waging a campaign around this fact, falsely asserting that the disparity is the result of aggressive marketing by abortion providers to minority communities.
  • The truth is that behind virtually every abortion is an unintended pregnancy. This applies to all women—black, white, Hispanic, Asian and Native American alike. Not surprisingly, the variation in abortion rates across racial and ethnic groups relates directly to the variation in the unintended pregnancy rates across those same groups.
  • Abortion rates have been declining in the United States for a quarter of a century, from a high of 29.3 per 1,000 women aged 15–44 in 1981 to an historic low (post-Roe v. Wade) of 19.4 in 2005. The overall number of abortions has been falling too, dropping to 1.2 million in 2005. Currently, about one-third of all abortions are obtained by white women, and 37% are obtained by black women. Latinas comprise a smaller proportion of the women who have abortions, and the rest are obtained by Asians, Pacific Islanders, Native Americans and women of mixed race (see chart).
  • These patterns of abortion rates mirror the levels of unintended pregnancy seen across these same groups. Among the poorest women, Hispanics are the most likely to experience an unintended pregnancy. Overall, however, black women are three times as likely as white women to experience an unintended pregnancy; Hispanic women are twice as likely. Because black women experience so many more unintended pregnancies than any other group—sharply disproportionate to their numbers in the general population—they are more likely to seek out and obtain abortion services than any other group. In addition, because black women as a group want the same number of children as white women, but have so many more unintended pregnancies, they are more likely than white women to terminate an unintended pregnancy by abortion to avoid an unwanted birth.

"From Privacy to Autonomy: The Conditions for Reproductive and Sexual Freedom" (1990)Edit

Copelon, Rhonda "From Privacy to Autonomy: The Conditions for Reproductive and Sexual Freedom". in Fried, Marlene Gerber (ed.). “From Abortion to Reproductive Freedom: Transforming a Movement” (1990). South End Press. ISBN 9780896083875.

  • Since 1973 the Court decision in “Roe v. Wade” has survived numerous assaults. For about a decade following the 1873 decision, the “fetal personhood” campaign, spearheaded by the Catholic Church and later joined by Protestant New Right fundamentalists, held center stage.
    Right-to-life advocates argue for the subservience of women to the fetus, pitting images of innocent and helpless souls against those of selfish, unnatural, and murderous feminimity. Their goal is not simply to save fetuses but to return woman to her “proper place”-to assure that motherhood remains her primary preoccupation. Their campaign has had some terrible successes in the Court, particularly in the decisions in “Harris v. McRae”, permitting legislatures to deny abortion funding to poor women and “Baird v. Bellotti”, predicating a teenage girl’s rights ton parental approval or a judicial shaming ceremony. In 1983, however, a number of fetal rights efforts initiated at the outset of the Reagan administration’s effort to have the Court water down “Roe”, although its position was substantially adopted by Justice Sandra Day O’Connor in her dissenting opinion.
    • p.28
  • The Reagan Presidency provided the mechanism for the ultimate attack on “Roe v. Wade”-the appointment of over one-half of the federal judiciary and almost one-half of the Justices of the Supreme Court who were chosen because of their allegiance to the overruling of “Roe” and the dismantling of the modern right of privacy, as well as most of the rights protected by the Bill of Rights.
    The Reagan administration cloaked its right wing agenda in the argument that the Court had no power to protect rights not articulated in the text of the Constitution or intended by the framers. While parading as the “jurisprudence of original intent,” the practical implications of resuscitating the framers’ intent as the measure of the Constitution explain its popularity on the Right. When the “founding fathers” are sacralized as the fount of wisdom, we are not reminded that they lived in a thoroughly patriarchal society, preserved slavery in the Constitution, and mocked the idea of the vote for women. Even the Radical Republicans who framed principle of quality after the Civil War did not envision school desegregation or the equality of women. In contrast to the originalist school, defenders of the modern Court’s decisions argue that the Constitution is a document for the ages and that the broad principles it expresses are to be given new meaning in light of the historical evolution of the society as well as of the new, lived meaning of human rights.
    • p.29
  • The first challenge to the criminal abortion laws through litigation and reform bills in state legislatures envisioned abortion as a doctor’s professional prerogative. Then in 1969 in New York, the first feminist challenge to the original abortion laws was filed, putting women’s right to control their bodies and lives at center stage. Whereas in the legislatures women had to break into an ongoing dialogue between male legislators and experts, in the courts it was easier to focus attention on their experience, need, and entitlement to control reproduction. This transformed a social reform movement for legal abortion led by doctors, family planners, and population controllers into a human rights struggle. As Ellen Willis wrote: “It was the feminist demand for an “unconditional right to abortion” that galvanized women and “created effective pressure for legislation.”
    The claim of privacy played a central role in early abortion rights advocacy. The first legal cases involved doctors who challenged the imposition of criminal sanctions as an interference with the privacy of the doctor-patient relationship. The appeal to privacy also reflected the more liberal orientation of some feminist abortion advocates and a more cautious approach to litigation.
    • p.32
  • The core idea of the right to abortion-that women should be in control of decision making over their reproduction-employs the notion of non-interference by the state to reinforce rather than undermine women’s autonomy. In this respect it is a progressive demand. But, as it has been elaborated by many pro-choice advocates and by the Court, it is still a limited and deeply flawed basis for reproductive freedom. There has emerged a sharp tension between two notions of privacy: the liberal idea of privacy as a the negative and qualified right to be left alone (so long as nothing too significant is at stake), and the more radical ideal of privacy as the positive liberty of self-determination and an aspect of equal personhood. Both practically and theoretically, the privacy doctrine is double-edged, having within it the tendency to constrain as well as to expand reproductive rights.
    • p.33
  • The face that abortion rights have been qualified by fetal viability since “Roe v. Wade” is attributable, of course, to political compromise but also to the combined defects of a negative theory of privacy and a truncated view of women’s personhood. To limit a woman’s right-whether it be to decide on an abortion or refuse Caesarean surgery in childbirth-in the interest of viable yet still physically dependent potential life denies her full moral and physical autonomy.
    • p.36

“Racism, Birth Control, and Reproductive Rights" (1990)Edit

Angela Davis, “Racism, Birth Control, and Reproductive Rights" in Fried, Marlene Gerber (ed.). “From Abortion to Reproductive Freedom: Transforming a Movement” (1990). South End Press. ISBN 9780896083875.

  • The ranks of the abortion rights campaign did not include substantial numbers of women of color. Given the racial composition of the larger women’s liberation movement, this was not at all surprising. When questions were raised about the absence of racially oppressed women in both the larger movement and in the abortion rights campaign, two explanations were commonly proposed in the discussions and literature of the period: women of color were overburdened by their people’s fight against racism, and/or they had not yet become conscious of the centrality of sexism. But the real meaning of the almost lily0white complexion of the abortion rights campaign was not to be found in ostensibly myopic or underdeveloped consciousness among women of color. The truth lay buried in the ideological underpinnings of the birth control movement itself.
    The failure of the abortion rights campaign to conduct a historical self-evaluation led to a dangerously superficial appraisal of Black people’s suspicious attitudes toward birth control in general. Granted, when some Black people unhesitatingly equated birth control with genocide, it did appear to be an exaggerated-even paranoid-reaction. Yet white abortion rights activists missed a profound message, for underlying these cries of genocide were important clues about the history of the birth control movement. This movement, for example, had been known to advocate involuntary sterilization-a racist form of mass “birth control.” If ever women would enjoy the right to plan their pregnancies, legal and easily accessible birth control measures and abortions would have to be complemented by an end to sterilization abuse.
    • p.16
  • When Black and Latina women resort to abortions in such large numbers, the stories they tell are not so much about the desire to be free of their pregnancy, but rather about the miserable social conditions which dissuade them from bringing new lives into the world.
    Black women have been aborting themselves since the earliest days of slavery. Many slave women refusing to bring children into a world of interminable forced labor, where chains and floggings and sexual abuse for women were the everyday conditions of life. A doctor practicing in Georgia around the middle of the last century noticed that abortions and miscarriages were far more common among his slave patients than among the white women he treated.
    Why were self-imposed abortions and reluctant acts of infanticide such common occurrence during slavery? Not because Black women had discovered solutions to their predicament, but rather because they were desperate. Abortions and infanticides were acts of desperation, motivated not by the biological birth process but by the oppressive conditions of slavery. Most of these women, no doubt, would have expressed their deepest resentment had someone hailed their abortions as a stepping stone toward freedom.
    • p.17
  • During the early abortion rights campaign, it was too frequently assumed that legal abortions provided a viable alternative to the myriad problems posed by poverty. As if having fewer children would create more jobs, higher wages, better schools, etc. This assumption reflected the tendency to blur the distinction between “abortion rights” and the general advocacy of “abortions”. The campaign often failed to provide a voice for women who wanted the “right” to legal abortions while deploring the social conditions that prohibited them from bearing more children.
    • p.17
  • The abortion rights activists of the early 1970s should have examined the history of their movement. Had they done so, they might have understood why so many of their Black sisters adopted a posture of suspicion toward their cause. They might have understood how important it was to undo the racist deeds of their predecessors, who had advocated birth control as well as compulsory sterilization as a means of eliminating the “unfit” sectors of the population. Consequently, the young white feminists might have been more receptive to the suggestion that their campaign for abortion rights include a vigorous condemnation of sterilization abuse, which had become more widespread than ever.
    It was not until the media decided that the casual sterilization of two Black girls in Montgomery, Alabama, was a scandal worth reporting that he Pandora’s box of sterilization abuse was finally flung open. But by the time the case of the Relf sisters broke, it was practically too late to influence the politics of the abortion rights movement. It was the summer of 1973 and the Supreme Court decision legalizing abortions had already been announced in January.
    • pp.21-22

“Abortion Debate” (2008)Edit

Farrell, Courtney (2008). “Abortion Debate”. ABDO Publishing Company. ISBN 978-1-61785-264-0.

  • When a woman gets an abortion, she is intentionally ending her pregnancy. Since abortion ends a developing human life, it is a sensitive subject. Some people are so opposed to abortion that they believe it should be illegal. Others believe a woman should have the right to make the choice of whether to have an abortion.
    The question of abortion is a question about rights. Activists choose sides in the conflict depending on whose rights they most passionately defend. The fetus, the pregnant woman, her male partner, and the couple’s parents all have advocates who defend their rights. In this debate, we see democracy in action.
    Almost half of the pregnancies that occur in the United States are not planned. Approximately 40 percent of these pregnancies end in abortion. In other cases, mothers who may have been troubled by their pregnancies grow to love their babies. Still, 10 percent of newborn babies are reported as unwanted. Some situations are resolved by adoptive parents raising the baby. Other babies, often those of drug addicts or rape victims, are abandoned at hospitals. These babies receive care as wards of the state and eventually are put up for adoption. Children with physical and emotional disabilities are not likely to be adopted and are raised in orphanages.
    Should abortion be a choice? Opinions differ, but one-third of U.S. women will have had an abortion by age 45.
    • Chapter 1 “A Sensitive Subject”, pp. 6–7.
  • A 1327 English law made abortion legal at any time during pregnancy. In England, abortion was still legal by 1670, but the American colonies had different rules. In the colonies, abortion was illegal, though it did not carry as severe a penalty as murder.
    • p.18
  • Records from early America reveal a society quite different from the morally strict one often portrayed in stories. Although the colonies were founded by stern religious groups sex before marriage was not uncommon. Records detailed marriages and births in the colonies. They also revealed that, before 1680, 3 percent of newly married women gave birth within six months of their marriage, and 8 percent had babies in fewer than nine months from their wedding day. This trend continued over time, and from 1760-1800, one-third of all brides gave birth to their first child in less than nine months of marriage. There was little dishonor in this, and even when unmarried women had babies, they could become “respectable” by marrying the baby’s father.
    Colonial law stated that a single woman could say the name of her baby’s father while she was in labor, and the court would automatically believe her. This practice stemmed from the danger of dying in childbirth in a time before Cesarean surgical births were possible. In the deeply religious colonies, it was believed a woman would never lie before possibly meeting God.
    If the father of the baby was already married, or unwilling to marry the mother, the couple faced disgrace. Although the father would be ordered to pay child support, many women were desperate to avoid dishonor.
    • ”Abortion From Past to Present”, pp.19-20
  • In colonial times, surgical abortions were so dangerous, women almost never survived them. But many substances to bring about abortions were known. Depending on the amount used, these could accidentally kill both the mother and the fetus, kill only the fetus, or fail to work at all.
    • ”Abortion From Past to Present”, p.20
  • During the 1800s, American cities were growing. Many young people left their rural villages and traveled to cities in search of work. This trend had the side effect of removing many young people form the influence of their families. When single women became pregnant, there was no less pressure from the community for the issue to be resolved by marriage.
    Although many churches opposed it, abortion was legal in most places in America during the nineteenth century. Midwives often prescribed herbs that would cause abortions, and advertisements for tonics that promised to cure “menstrual blockages” were common in publications of the time. American courts first took up the issue in 1812, in the “Commonwealth v. Bangs” case. In “Bangs”, the Massachusetts Supreme Court pronounced abortion legal, but only before quickening-the time when the mother could feel the fetus moving. At this point society had not addressed the question of the rights of the unborn. Laws were passed primarily to protect women’s lives. Many women were injured or killed each year either by abortion-inducing drugs or by surgical abortions performed by inept folk healers.
    • ”Abortion From Past to Present”, pp.21-22
  • In response to an 1859 AMA resolution against abortion, state laws began banning abortion. At this point in time, there was no pro-life movement. Abortion was banned mainly because it was unsafe. By 1890, abortion was illegal throughout most of the United States. However, despite a ban in Michigan, in 1882 doctors in that state reported that 17 to 32 percent of all pregnancies were still aborted.
    • ”Abortion From Past to Present”, pp.22-23
  • By 1900, abortion was illegal in all states except Kentucky, though it was only allowed in cases when it was necessary to maintain the life or health of the mother. These special cases were called “therapeutic abortions.” However, it was up to the physician to determine when an abortion was necessary. Some doctors interpreted the law loosely, especially in cases involving wealthy women or those with connections to the medical profession.
    Although abortion was illegal, enforcement of the law was weak, and women were rarely brought to trial. In 1904, a Chicago doctor reported that 10 to 13 percent of all pregnancies in the city were ending in abortion.
    • ”Abortion From Past to Present”, p.23
  • Since all legal abortions were supposed to be therapeutic, hospitals limited the number of abortions they would perform. If an abortion was necessary to preserve the woman’s health, she was often required to be made sterile to prevent her from ever getting pregnant again. Therapeutic abortions for poor women were denied more often than those for wealthy ones.
    • p.32
  • Despite the pill, many unintended pregnancies still ended in illegal abortions. Women often died as a result of illegal abortions, often performed by abortionists who were not doctors. The problem was worse for women of color. In the early 1960s in New York City, one out of four child-birth related deaths among white women was caused by abortion but abortion caused half of such deaths among nonwhite women.
    • pp.33-34

"Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives" (2005)Edit

Finer, Lawrence B.; Frohwirth, Lori F.; Dauphinee, Lindsay A.; Singh, Susheela; Moore, Ann M. (2005). "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives" (PDF). Perspectives on Sexual and Reproductive Health. 37 (3): 110–18. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID 16150658. Archived (PDF) from the original on 17 January 2006.

  • RESULTS: The reasons most frequently cited were that having a child would interfere with a woman’s education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%). Nearly four in 10 women said they had completed their childbearing, and almost one-third were not ready to have a child. Fewer than 1% said their parents’ or partners’ desire for them to have an abortion was the most important reason. Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents.
    CONCLUSIONS: The decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons. The themes of responsibility to others and resource limitations, such as financial constraints and lack of partner sup-port, recurred throughout the study.
    • p.110
  • Public discussion about abortion in the United States has generally focused on policy: who should be allowed to have abortions, and under what circumstances. Receiving less attention are the women behind the statistics—the 1.3 million women who obtain abortions each year1—and their reasons for having abortions. While a small proportion of women who have abortions do so because of health concerns or fetal anomalies, the large majority choose termination in response to an unintended pregnancy. However, “unintended pregnancy” does not fully capture the reasons and life circumstances that lie behind a woman’s decision to obtain an abortion. What personal, familial, social and economic factors lead to the decision to end a pregnancy?
    The research into U.S. women’s reasons for having abortions has been limited. In a 1985 study of 500 women in Kansas, unreadiness to parent was the reason most often given for having an abortion, followed by lack of financial resources and absence of a partner. In 1987, a survey of1,900 women at large abortion providers across the country found that women’s most common reasons for having an abortion were that having a baby would interfere with school, work or other responsibilities, and that they could not afford a child. Since 1987, little research in this area has been conducted in the United States, but studies done in Scandinavia and worldwide have found several recur-ring motivations: economic hardship, partner difficulties and unreadiness for parenting. An extensive literature (both quantitative and qualitative) examines how women make the decision to have an abortion or a birth. Here, we focus on women who have already made the decision to have an abortion.
    Why revisit this topic? One compelling reason is that the abortion rate declined by 22% between 1987 and 2002, and another is that the demographic characteristics of reproductive-age women in general and of abortion patients in particular have changed since 1987. For example, the proportion of abortion patients who have already had one or more children has increased, as have the proportions who are aged 30 or older, who are nonwhite and who are cohabiting. In addition, between 1994 and 2000, the proportion of women having abortions who were poor in-creased. Because social and demographic characteristics may be associated with motivations for having an abortion, it is important to reassess the reasons why women choose to terminate a pregnancy.
    A better understanding of these motivations can inform public opinion and prevent or correct misperceptions. Like-wise, a fuller appraisal of the life circumstances within which women decide to have an abortion bears directly on the issue of public funding for abortions and provides evidence of how increasing legal and financial constraints on access to abortion may affect women’s lives.
    • p.110
  • Most women in every age, parity, relationship, racial, income and education category cited concern for or responsibility to other individuals as a factor in their decision to have an abortion. In contrast to the perception (voiced by politicians and laypeople across the ideological spectrum) that women who choose abortion for reasons other than rape, incest and life endangerment do so for “convenience,”our data suggest that after care-fully assessing their individual situations, women base their decisions largely on their ability to maintain economic stability and to care for the children they already have.
    In addition, the topic of women’s limited resources, such as financial constraints and lack of partner support, regularly appeared in the survey and interview responses. A large majority of women cited financial hardship, often along with other reasons. Financial problems, exacerbated by other forms of instability, limit women’s ability to provide sufficient support to additional children. The concept of responsibility is inseparable from the theme of limited resources; given their present circumstances, respondents considered their decision to have an abortion the most responsible action. The fact that many women cited financial limitations as a reason for ending a pregnancy suggests that further restrictions on public assistance to families could contribute to a continued increase in abortions among the most disadvantaged women.
    Although these concerns appeared among all groups, different groups of women gave diverse reasons for having abortions. Younger women who had not begun their child-bearing often reported that they were unprepared for the transition to motherhood, while older women, the large majority of whom were already mothers, regularly cited their responsibility to children or other dependents as a key factor behind the decision to have an abortion.
    Only a small proportion of women cited concerns about their own health. However, the qualitative results showed that these concerns encompassed not just risks to future health, but also the health burden of pregnancy itself. They further revealed how health concerns are linked to the concept of responsibility: Some women saw the physical bur-den of pregnancy and its associated health conditions as threatening their ability to fulfill responsibilities to dependents. Others underscored the importance of appropriate birth spacing for their own health and for the health and economic security of their children.
    • p.117-118
  • In light of the public debate over the morality of abortion, it is notable that the women in our survey emphasized their conscious examination of the moral aspects of their decisions. Although some described abortion as sinful and wrong, many of those same women, and others, described the indiscriminate bearing of children as a sin, and their abortion as “the right thing” and “a responsible choice.” Respondents often acknowledged the complexity of the decision, and described an intense and difficult process of deciding to have an abortion, which took into account the moral weight of their responsibilities to their families, them-selves and children they might have in the future.
    • p.118
  • Some advocates have used highly selective samples to claim that the majority of women having abortions are coerced into the decision. Such claims suggest that women lack control over their own lives, but our findings attest that women independently make the decision to have an abortion. The proportion of women citing influence from partners or parents is small (and has declined since 1987), and fewer than 1% of respondents indicated that this influence was their most important reason.
    • p.118
  • The fact that an increasing proportion of women having abortions are poor underscores the importance of public assistance for family planning programs as an effective means of reducing the incidence of both unintended pregnancy and abortion.
    • p.118

"Abortion Incidence and Services in the United States in 2000" (2003)Edit

Finer, L.B.; Henshaw, S.K. (2003). "Abortion Incidence and Services in the United States in 2000". Perspectives on Sexual and Reproductive Health. 35 (1): 6–15. doi:10.1363/3500603. PMID 12602752. Archived from the original on 22 January 2016.

  • RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15-44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
  • Induced abortion, one of the most frequently performed surgical procedures in the United States, is experienced by a substantial proportion of American women. More than one-fifth of all pregnancies end in abortion, a reflection of the fact that almost half of U.S. pregnancies are unintended. Trends in abortion may reflect a number of factors, such as variations in the underlying incidence of unintended pregnancy and changes in how women resolve unplanned pregnancies and in the availability or accessibility of abortion services. Therefore, regular and accurate estimates of abortion incidence and service provision are essential for monitoring trends in reproductive behavior.
    After remaining fairly steady for most of the 1980s, the number of abortions in the United States declined from a high of 1.61 million in 1990 to 1.36 million in 1996, the last year for which comprehensive abortion incidence data were collected. The abortion rate declined from 29.3 per 1,000 women aged 15-44 in 1980 and 27.4 in 1990 to 22.4 in 1996. The abortion ratio (the proportion of pregnancies ending in abortion) also fell during the early and mid-1990s. These declines meant that in the mid-1990s, measures of abortion reached the lowest levels since the 1970s.
  • Meanwhile, a continuing decline in the number of providers could result in more limited access to abortion services. The number of U.S. abortion providers fell from a high of 2,900 in 1982 to about 2,000 in 1996, and the proportion of counties without a provider increased from 77% in 1978 to 86% in 1996. A 1997 survey of obstetricians and gynecologists who perform abortions indicated that 57% were aged 50 or older, fueling the perception that the number of providers will decline drastically as current providers reach retirement age. However, some evidence indicates that training opportunities for providers have begun to increase.
  • The number of abortions in the United States declined 3% between 1996 and 2000, from 1.36 million to 1.31 million. This was the lowest number of abortions since 1976. The abortion rate also declined through 2000, reaching 21.3 abortions per 1,000 women 15-44 in that year. This figure represents a 5% drop over the four-year interval and is the lowest rate since 1974. The abortion ratio declined to 24.5 abortions per 100 pregnancies ending in abortion or live birth in 2000; this also represents a 5% drop since 1996 and the lowest figure since 1974. Including estimated miscarriages, 21% of all pregnancies in 2000 ended in abortion (not shown).
    The number of abortions and abortion rates vary widely by region and state of occurrence. Six states that account for 40% of women aged 15-44—California, Florida, Illinois, New Jersey, New York and Texas—accounted for 55% of all abortions in 2000. Rates were highest in New Jersey and New York, and were relatively high (above 30 per 1,000 women 15-44) in California, Delaware, Florida and Nevada. The states with the fewest abortions—South Dakota, North Dakota and Wyoming—are largely rural states and have relatively small populations. The lowest rates were in Kentucky, South Dakota and Wyoming; Idaho, Mississippi, Missouri, Utah and West Virginia also had low rates (seven or fewer per 1,000 women 15-44). Among the 25 states with the largest populations of women 15-44, the lowest abortion rate was in Kentucky.
    Between 1996 and 2000, the abortion rate declined in every region of the country, but changes varied by region and, even more so, by state. The abortion rate declined in 35 states and the District of Columbia; the greatest percentage decreases occurred in Kentucky and Wyoming. Percentage changes are most meaningful in states with the greatest number of abortions, since small absolute changes in states with few abortions can result in large percentage shifts. Among the states reporting at least 10,000 abortions in 1996, the largest declines occurred in Massachusetts and Missouri. The abortion rate increased in 15 states. The largest percentage increase occurred in Delaware, and the largest increase among states with at least 10,000 abortions in 1996 occurred in Kansas (15%).
  • A total of 1,819 providers performed at least one abortion in 2000—11% fewer than in 1996. In comparison, the number of providers declined by 14% from 1992 to 1996. The number of providers in 2000 was 37% lower than the all-time high of 2,908 in 1982 (not shown).
  • Abortion providers were located in 404 of the 3,141 U.S. counties in 2000. Overall, 87% of counties had no provider of abortions. More than 90% of counties in the Midwest and South had no abortion provider; outside of these regions, the only states with no provider in at least 90% of counties were Idaho, Montana, Utah and Wyoming.
    Although the vast majority of counties had no provider, only 34% of women aged 15-44 in 2000 lived in counties with no abortion providers, because many of these have relatively small populations. However, nearly half of women in the Midwest (49%) and South (45%) lived in counties that lacked abortion services. In 19 states in these regions, at least half of women lived in counties without an abortion provider. However, in six states in the same regions—Delaware, Florida, Illinois, Maryland, Michigan and Texas (and the District of Columbia)—fewer than one-third lived in counties with no provider. Fewer than one in five women in the Northeast and West lived in counties without an abortion provider; the proportion was less than one-third in 13 states in these regions and more than one-half in only three.
  • The proportion of counties with no abortion provider in 2000 (87%) changed little compared with that in 1996 (86%), but remained higher than the proportion in 1978 (77%). In addition, the proportion of counties with no provider of 400 or more abortions per year has changed little over time, indicating that the drop in counties with providers has been concentrated in those where providers perform fewer than 400 abortions per year.
    Most abortion providers are located in metropolitan areas: 94% of all providers and 99% of those who performed 400 or more abortions in 2000 (not shown). Even so, 61% of counties in metropolitan areas had no abortion provider, and 70% had no large provider. Of nonmetropolitan counties, 97% had no provider, and virtually all lacked a provider of at least 400 abortions per year.
    Overall, the proportion of women living in a county without a provider increased from 27% in 1978 to 30% in 1985 and 34% in 2000. However, figures based on comparable metropolitan classifications indicate that the proportion of women with no provider in their county increased from 1978 to 1996 in both metropolitan and nonmetropolitan counties, but changed only slightly between 1996 and 2000. There was no change during the 1990s in the proportion of women in metropolitan areas living in counties with no large provider, although the levels were slightly greater than those in 1978 and 1985. Almost all women in nonmetropolitan counties have lived without a large abortion provider.
  • Between 1996 and 2000, the U.S. abortion rate fell 5%, a decline less than half as steep as that seen between 1992 and 1996 (12%). The number of abortion providers continued to decline between 1996 and 2000, at a rate slightly lower than that during 1992-1996. The 1996-2000 period saw the continuing consolidation of abortion provision at clinics, particularly specialized clinics; only 7% of abortions in 2000 were performed in nonclinic facilities. This trend may be partially due to increasing legal constraints on the circumstances under which abortions may be performed, such as zoning rules and state licensing and inspection requirements. Specialized clinics may be better able to deal with new restrictions than physicians' offices and nonspecialized clinics, which may not be willing or able to undertake the expenses and time required to comply with them. This factor may be most relevant in South Carolina and Mississippi, where new licensing laws have created burdensome requirements for small providers; at least one South Carolina provider has reportedly closed in response to the new regulations.
  • For most American women, access to abortion is directly tied to where they live. Only 3% of nonmetropolitan counties have a provider, and almost none of those providers performed more than 400 abortions in 2000. Of metropolitan counties, only 30% have a large abortion provider. Surprisingly, although the proportion of nonmetropolitan counties with a provider has declined, the proportion of women in nonmetropolitan counties with a provider appears to have increased slightly, probably because of population shifts toward counties with providers. In metropolitan areas, the proportion of women living in counties with providers has changed little.
    The Northeast and West are characterized by higher abortion rates and greater access to providers than are the Midwest and South, and also by more supportive laws regarding abortion. In some states, abortion decreases may be due to regulatory requirements placed on women seeking abortion. For example, in Wisconsin, the imposition of a two-day delay law may have contributed to the 21% decline in the abortion rate (although women there may increasingly have gone to Illinois, particularly Chicago, to obtain abortions). In other states, rates may decline because many women travel out of state to have abortions. This may occur when the barriers to obtaining an abortion—such as gestational limits or other restrictions, or expense—are lower in neighboring states.
  • In the past, the U.S. abortion rate has been distinctly higher than the rate in other industrialized countries. Although the U.S. rate (21.3 per 1,000 women 15-44) is still higher than those in many western European countries, it is now within the range of rates in a few other developed countries, such as Sweden (18.7) and Australia (22.2). Furthermore, U.S. rates vary by women's ethnicity and socioeconomic standing; the rate among white non-Hispanic women is in the middle range of other developed countries, but other ethnic groups have higher rates. Moreover, poor and near-poor women have rates roughly twice as high as their wealthier counterparts.
    This article has documented current levels of abortion and abortion service provision. More research needs to be done both to understand why abortion service provision is changing and the impact on women of the small number and geographic concentration of providers. In addition, further work is needed to determine the causes of declines in the abortion rate. Increasing use of emergency contraception appears to have been a major contributor in recent years: An estimated 51,000 pregnancies were averted by emergency contraception in 2000, accounting for 43% of the decrease in abortions since 1994. Contraceptive use trends through 1995—improvements in use (e.g., a shift to greater use of long-acting, highly effective methods) and reductions in the proportion of women using no method—may have continued. The abortion rate decline between 1994 and 2000 was greatest among teenagers. Both a decline in sexual activity among adolescents and increased use of contraceptives at first intercourse contribute to decreasing pregnancy and abortion rates among adolescents.
  • With more than one in five U.S. pregnancies ending in abortion, it is clear that American women are becoming pregnant far more often than they desire. More than half of these pregnancies occur among women who had difficulty using contraceptive methods effectively or who experienced method failure, and nearly half occur among the minority of sexually active women who use no contraceptives, reflecting the high rate of pregnancy among this group.37 The challenge of reducing U.S. abortion rates without increasing unintended births requires action on several fronts, but foremost among these are increasing (and increasing the effectiveness of) contraceptive use by sexually active women and their partners, improving access to contraceptive services for those who are disadvantaged and ensuring the availability of a broader range of more-effective and user-friendly contraceptive methods.

"Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives" (2005)Edit

Finer, L.B.; Frohwirth, L.F.; Dauphinee, L.A.; Singh, S.; Moore, A. M. (2005). "Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives". Perspectives on Sexual and Reproductive Health. 37 (3): 110–18. doi:10.1111/j.1931-2393.2005.tb00045.x. PMID 16150658. Archived from the original on 7 January 2012.

  • RESULTS: The reasons most frequently cited were that having a child would interfere with a woman's education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%). Nearly four in 10 women said they had completed their childbearing, and almost one-third were not ready to have a child. Fewer than 1% said their parents' or partners' desire for them to have an abortion was the most important reason. Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents.
    CONCLUSIONS: The decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons. The themes of responsibility to others and resource limitations, such as financial constraints and lack of partner support, recurred throughout the study.
  • Public discussion about abortion in the United States has generally focused on policy: who should be allowed to have abortions, and under what circumstances. Receiving less attention are the women behind the statistics—the 1.3 million women who obtain abortions each year1—and their reasons for having abortions. While a small proportion of women who have abortions do so because of health concerns or fetal anomalies, the large majority choose termination in response to an unintended pregnancy.2 However, "unintended pregnancy" does not fully capture the reasons and life circumstances that lie behind a woman's decision to obtain an abortion. What personal, familial, social and economic factors lead to the decision to end a pregnancy?
    The research into U.S. women's reasons for having abortions has been limited. In a 1985 study of 500 women in Kansas, unreadiness to parent was the reason most often given for having an abortion, followed by lack of financial resources and absence of a partner.3 In 1987, a survey of 1,900 women at large abortion providers across the country found that women's most common reasons for having an abortion were that having a baby would interfere with school, work or other responsibilities, and that they could not afford a child.4 Since 1987, little research in this area has been conducted in the United States, but studies done in Scandinavia and worldwide have found several recurring motivations: economic hardship, partner difficulties and unreadiness for parenting. An extensive literature (both quantitative and qualitative) examines how women make the decision to have an abortion or a birth. Here, we focus on women who have already made the decision to have an abortion.
    Why revisit this topic? One compelling reason is that the abortion rate declined by 22% between 1987 and 2002, and another is that the demographic characteristics of reproductive-age women in general and of abortion patients in particular have changed since 1987. For example, the proportion of abortion patients who have already had one or more children has increased, as have the proportions who are aged 30 or older, who are nonwhite and who are cohabiting. In addition, between 1994 and 2000, the proportion of women having abortions who were poor increased. Because social and demographic characteristics may be associated with motivations for having an abortion, it is important to reassess the reasons why women choose to terminate a pregnancy.
  • Respondents to the structured survey of reasons for abortion were not substantially different from a nationally representative sample of abortion patients surveyed in 2000 in terms of age, marital status, parity, income, education, race or gestation. Twenty percent were 19 or younger, and 57% were in their 20s. Seventy-two percent had never been married, and 59% had had at least one child. Some 60% were below 200% of the federal poverty line, including 30% who were living in poverty (not shown). More than half had attended college or received a college degree. Thirty-one percent of respondents were black, and 19% were Hispanic. (Four percent completed the questionnaire in Spanish.) Sixty-one percent were at fewer than nine weeks of gestation, and 85% were at fewer than 13 weeks.
    However, the characteristics of abortion patients had changed between 1987 and 2000, and these changes were reflected in the 1987 and 2004 surveys of reasons for abortion. For example, the proportion who were mothers increased from 48% to 61% in the nationally representative surveys carried out in 1987 and 2000; a similar increase (from 42% to 59%) was seen between the 1987 and 2004 surveys of reasons. The median age of respondents was 23.0 in the 1987 survey of reasons and 24.1 in 2004 (not shown). Fifty percent of women were below 200% of the federal poverty level in the 1987 survey of reasons, while in 2004, 60% were below this level. Also, the proportion who were Hispanic rose from 7% in 1987 to 19% in 2004.
  • Reasons in 2004. Among the structured survey respondents, the two most common reasons were "having a baby would dramatically change my life" and "I can't afford a baby now" (cited by 74% and 73%, respectively). A large proportion of women cited relationship problems or a desire to avoid single motherhood (48%). Nearly four in 10 indicated that they had completed their childbearing, and almost one-third said they were not ready to have a child. Women also cited possible problems affecting the health of the fetus or concerns about their own health (13% and 12%, respectively). Respondents wrote in a number of specific health reasons, from chronic or debilitating conditions such as cancer and cystic fibrosis to pregnancy-specific concerns such as gestational diabetes and morning sickness.
    The most common subreason given was that the woman could not afford a baby now because she was unmarried (42%). Thirty-eight percent indicated that having a baby would interfere with their education, and the same proportion said it would interfere with their employment. In a related vein, 34% said they could not afford a child because they were students or were planning to study.
  • [T]he proportion of women indicating that they had completed their desired childbearing increased substantially (and significantly) between 1987 and 2004, from 28% to 38%. To assess whether this shift was due to a change in mothers' propensity to give this reason (in addition to the change in population composition described earlier), we stratified this analysis by both survey year and whether the woman had any children. The findings showed that mothers in 2004 were more likely to report this reason than were mothers in 1987 (not shown). Thus, the overall increase likely reflected both a rise in the proportion of abortion patients who were already mothers and an increased tendency of mothers to give this reason.
  • Financial difficulties. Higher proportions of women who were unmarried or cohabiting, nonwhite, poorer and unemployed said they could not afford to have a child now, compared with their respective counterparts. This reason was also more commonly given by young teenagers and women aged 20–24. Some of these social and demographic characteristics likely have overlapping influence. For example, young women are likely to be unmarried, and poor women are likely to be unemployed. In the multivariate analysis, marital status and both economic variables remained significant: Women who were married, who were in the highest income category and who were employed had reduced odds of saying they could not afford a baby (odds ratios, 0.4–0.6).
  • A cross-cutting theme was women's responsibility to children and other dependents, as well as considerations about children they may have in the future. Most women in every age, parity, relationship, racial, income and education category cited concern for or responsibility to other individuals as a factor in their decision to have an abortion. In contrast to the perception (voiced by politicians and laypeople across the ideological spectrum) that women who choose abortion for reasons other than rape, incest and life endangerment do so for "convenience,"13 our data suggest that after carefully assessing their individual situations, women base their decisions largely on their ability to maintain economic stability and to care for the children they already have.
    In addition, the topic of women's limited resources, such as financial constraints and lack of partner support, regularly appeared in the survey and interview responses. A large majority of women cited financial hardship, often along with other reasons. Financial problems, exacerbated by other forms of instability, limit women's ability to provide sufficient support to additional children. The concept of responsibility is inseparable from the theme of limited resources; given their present circumstances, respondents considered their decision to have an abortion the most responsible action. The fact that many women cited financial limitations as a reason for ending a pregnancy suggests that further restrictions on public assistance to families could contribute to a continued increase in abortions among the most disadvantaged women.
  • In light of the public debate over the morality of abortion, it is notable that the women in our survey emphasized their conscious examination of the moral aspects of their decisions. Although some described abortion as sinful and wrong, many of those same women, and others, described the indiscriminate bearing of children as a sin, and their abortion as "the right thing" and "a responsible choice." Respondents often acknowledged the complexity of the decision, and described an intense and difficult process of deciding to have an abortion, which took into account the moral weight of their responsibilities to their families, themselves and children they might have in the future.

"Transforming the Reproductive Rights Movement: The Post-Webster Agenda" (1990)Edit

Mariene Gerber Fried, “Transforming the Reproductive Rights Movement: The Post-Webster Agenda”, in Fried, Marlene Gerber (ed.). “From Abortion to Reproductive Freedom: Transforming a Movement” (1990). South End Press. ISBN 9780896083875.

  • No matter how we try to control the clinic battles, we remain in a structurally defensive position. In the year and a half since Operation Rescue came to town, we have tried nearly everything-from holding a demonstration away from the clinics; to counter-demonstrating on the other side of the street; to interposing our bodies between the anti-abortionists and the clinic. Our level of organization at the clinics is impressive-a 3,000-person phone tree; hundreds of trained escorts and clinic coordinators who communicate with beepers and special codes. Despite all of this, it is not our show. Our efforts have been directed at figuring out what they are doing and how to foil them. It is not surprising, then, that even when we “win,” it doesn’t feel like victory. Most disturbing, however, is the siege mentality at the clinics. It is painful to witness what women must face in order to exercise their right to make reproductive choices. Some women will not push their way through demonstrators to get into a clinic. Some will not even come at all if they anticipate harassment by anti-abortionists. It is painful even when the women are undaunted by the harassment, even when they and we fight back: a young man accompanying his girlfriend for an abortion escorts her to the clinic wielding a baseball bat. He says to the anti-abortionists, “You mess with her, you’re in trouble.” The girlfriend of a woman coming to the clinic punches one of the blockaders who tries to top her. It is painful even when the effects are radicalizing-often women having abortions become politically active after having had to confront anti-abortion demonstrator. It is still disturbing and angering.
    Is this “safe and legal” abortion?
    • pp.1-2
  • Abortion campaigns offer unprecedented opportunities for alliances between activists and groups fighting for the rights of poor women, yet many of these opportunities have been missed. The women’s movement has a history of trading away the rights of women of color and working-class women in favor of gains for more privileged women. Because of this history, we must consciously and aggressively make clear that we are not about to repeat this pattern in the present or future. Steps must be taken to develop a multi-racial and class-conscious movement for abortion rights. One way to do this is to acknowledge the fact that poor women have consistently borne the brunt of the attack on abortion rights. For poor women, the legal right to abortion is empty, and choice an abstraction. Without access to abortion services, it is as if “Roe v. Wade” never happened.
    • p.6
  • While I understand the urgency individuals and groups feel about the need to protect some ground, this is a dangerous approach. It is a strategy that trades away the most basic aspect of abortion rights-the fact that abortion is fundamentally a woman’s right to decide, at any point in pregnancy, for any reason. Going for what we think we can get right now helps to legitimize the view that there are morally acceptable and morally unacceptable abortions and that those decisions are best made by someone other than the pregnant women. Feminists need instead to be arguing for the right of every woman to make her own decision.
    • pp.7-8
  • In many cities, activists find themselves caught among a variety of political tendencies. Abortion clinics are not political organizations although they have become they key political battlefield. Clinic workers have taken on heroic qualities, since going to work sometimes involves fighting one’s way through an angry mob. Nonetheless, their stake in this is to continue providing services, some for profit, others not. There are many clinic directors who view pro-choice demonstrators in almost the same way they view anti-abortion militants-as disruptions to their business as usual. While clients and clinic escorts have been generally supportive of pro-choice demonstrators, we have been told repeatedly by some clinic directors that the safety and privacy of their patients and their ongoing ability to operate are compromised by direct confrontations with anti-abortionists.
    • p.10

“The Racist History of Abortion and Midwifery Bans” (July 1, 2020)Edit

Michele Goodwin, “The Racist History of Abortion and Midwifery Bans”, ACLU, (July 1, 2020)

  • Following the Supreme Court’s decision in June Medical Services v. Russo this week, it is worth reflecting on the racist origins of the anti-abortion movement in the United States, which date back to the ideologies of slavery. Just like slavery, anti-abortion efforts are rooted in white supremacy, the exploitation of Black women, and placing women’s bodies in service to men. Just like slavery, maximizing wealth and consolidating power motivated the anti-abortion enterprise. Then, just as now, anti-abortion efforts have nothing to do with saving women’s lives or protecting the interests of children. Today, a person is 14 times more likely to die by carrying a pregnancy to term than by having an abortion, and medical evidence has shown for decades that an abortion is as safe as a penicillin shot—and yet abortion remains heavily restricted in states across the country.
  • Prior to the Civil War, abortion and contraceptives were legal in the U.S., used by Indigenous women as well as those who sailed to these lands from Europe. For the most part, the persons who performed all manner of reproductive health care were women — female midwives. Midwifery was interracial; half of the women who provided reproductive health care were Black women. Other midwives were Indigenous and white.
  • Abortion was an expedient way to frame their campaign to create monopolies on women’s bodies for male doctors. The American Medical Association explicitly contributed to this cause through its exclusion of women and Black people.
    Today, as people debate whether anti-abortion platforms benefit Black women, the clear answer is no. The U.S. leads the developed world in maternal and infant mortality. The U.S. ranks around 50th in the world for maternal safety. Nationally, for Black women, the maternal death rate is nearly four times that of white women, and 10 to 17 times worse in some states.

“The Moral Property of Women” (2002)Edit

Gordon, Linda (2002). “The Moral Property of Women”. University of Illinois Press. ISBN 0-252-02764-7. “Ch.2 The Criminals”

  • Abortion was much more common than infanticide, however, practiced most often by the married and frequent in all classes. In 1862, when the wife of a Confederate general, William Dorset Pender, wrote him that she was, unfortunately, pregnant, he wrote her pious phrases about “God’s will” but also sent her pills that his camp surgeon had thought might “relieve” her.
    • p.24
  • In 1871 Dr. Martin Luther Holbrook wrote that American women were “addicted” to the wicked practice and that it was especially widespread in New England, where the decline in the birth rate was most pronounced. One antiabortion propagandist, in a style clearly intended to repel and frighten, wrote: “Nowadays, if a baby accidentally find a lodgement in the uterus, it may perchance have a knitting-needle stuck in its eyes before it has any.”
    • p.24-25
  • In 1872 the New York Times called abortion “The Evil of the Age.” The Times” estimated that there were two hundred full-time abortionists in New York City, not including doctors who performed abortions occasionally. It may be that tens of thousands of abortions were done in New York City alone in the 1870s, one judge estimating, probably exaggeratedly, one hundred thousand a year in the 1890s. In 1904 a physician estimated six to ten thousand a year in Chicago. In the 1890s doctors were estimating two million abortions a year in the United States-they too were probably exaggerating, but the numbers represented their anxiety. In 1921, when statistics on these matters were more reliable, a Stanford University study calculated that one out of every 1. To 2.3 pregnancies ended in abortion, of which at least 50 percent were illegal. Among a thousand women who went to a birth control clinic in the Bronx, New York, in 1931032, 3 percent had had at least one illegal abortion, a proportion that applied to Catholics as well as Protestants and Jews.
    • p.25
  • In 1881 the Michigan Board of Health estimated one hundred thousand abortions a year in the United States, with just six thousand deaths, or a 6 percent mortality rate. There is some misunderstanding about abortion safety today because the campaign for legalized abortion has understandably emphasized the dangers of illegal abortion. In fact, illegal abortions in this country have an impressive safety record. The Kinsey investigators, for example, were impressed with the safety and skill of the abortion they surveyed. Studies of maternal mortality in the late 1920s and early 1930s found that 13-14 percent resulted from illegal abortion (meaning, of course, that 86-87 percent resulted from child-birth). Legal abortion had made that ratio even more uneven today in the United States, when eleven times more women die in childbirth than from abortions.
    This does not mean that abortions were pleasant. They were painful and frightening, and anxiety was worse because they were “gotten in sin” and, often, in isolation. The physical risk was heightened by the illegality, just as it is today.
    • p.25
  • The criminalization of abortion also increased women’s anxiety. Before the nineteenth century, few people considered abortion wrong is performed in the first few months of pregnancy. The first modern legislation banning abortion altogether did not originate in catholic canon law, as is widely believed, but in the secular law of England in 1803. Until then the Protestant churches had gone along with the Catholic tradition that before “quickening”-the moment at which the fetus was believed to gain life-abortion was permissible. U.S. courts upheld this interpretation until at least 1845. The Catholic Church was a follower, not a leader, in restricting abortion, only legislating to prohibit it in 1869, well after most stated in the United States of America had outlawed all abortion during the Civil War period. Throughout the nineteenth century, most American women seemed to share the belief that before quickening, taking action to “bring on menstruation” was in no way reprehensible.
    • p.25
  • Stories of men dosing their pregnant girlfriends with abortifacients come from all periods of American history. In Maryland in 1652, Susanna Warren, a single woman made pregnant by “prominent citizen” Captain Mitchell, said that he prepared for her a “potion of Phisick,” put it in an egg, and forced her to take it.” It didn’t work and she brought charges against him. Slaves commonly practiced abortion. An antebellum doctor found abortion four times as frequent among blacks as among whites, noting that “all country practitioners are aware of the frequent complaints of planters from this subject.” Though the doctor may have been underestimating the prevalence of abortion among whites, abortion among slaves was undoubtedly not only a tool of self-preservation but also a form of resistance.
    • pp.26-27
  • We have more information about the commercialization of abortion in the later nineteenth century because the New York Times embarked on a series of investigative reports about it. The professional abortionists who advertised in the papers were often medical imposters-that is, they lacked medical degrees, though many “doctors” did too, having purchased their degrees from diploma mills. Frequently abortionists used several aliases, sometimes to avoid old prosecutions, sometimes to operate several establishments simultaneously under different names. Sometimes the advertisements would feature a woman’s name, as a woman seeking help would be more likely to approach another woman, although the abortionist might be male.
    • p.28-29
  • When the medical establishment undertook a campaign against abortion in the second half of the nineteenth century, its very vehemence served as a further indication of the prevalence of illegal abortions. In 1857 the American medical Association (AMA) initiated a formal investigation of the frequency of abortion. Seven years later the AMA offered a prize for the best popular antiabortion tract. Medical attacks on abortion grew in number and virulence until, by the 1870s, both professional and popular journals were virtually saturated with the issue. Physicians bemoaned the widespread lay acceptance of abortion before quickening; in order to break that sympathy, they adopted a new vocabulary that described abortion in terms designed to shock and repel, such as “antenatal infanticide.” Physicians attempted to frighten women away from abortion by emphasizing its dangers. Their common assertion that there was “no” safe abortion may have betrayed ignorance, but more likely it was an exaggeration justified by what they believed was a higher moral purpose. Yet occasionally even antiabortion doctors allowed the truth to slip out, revealing despite themselves why their campaign remained ineffective. It is sucha simple and comparatively safe matter for a skillful and aseptic operator to interrupt an undesirable pregnancy at an early date,” wrote Dr. A. L. Benedict of Buffalo, New York, an opponent of abortion, “That the natural temptation is to comply with the request.
    • p.30

“Contraceptive Use Among U.S. Women Having Abortions in 2000-2001” (November/December 2002)Edit

Rachel K. Jones, Jacqueline E. Darroch, Stanley K. Henshaw; “Contraceptive Use Among U.S. Women Having Abortions in 2000-2001” Volume 34, Issue 6, (November/December 2002)

  • Some 45 of every 1,000 women aged 15–44 in the United States had an unintended pregnancy in 1994 (the latest year for which data are available). The high level of unintended pregnancy can be attributed to three factors: the failure of couples at risk of unintended pregnancy to practice contraception, incorrect or inconsistent use of contraceptive methods, and method failure among those practicing contraception correctly and consistently.
    Approximately one-half of unintended pregnancies end in abortion. A substantial minority of women having abortions—42% in 1994–1995 and 49% in 1987—became pregnant because they and their partners were not using a contraceptive method. It is unknown, however, what proportion of pregnancies among method users were due to inconsistent or incorrect contraceptive use and what proportion were accounted for by method failure.
    • p.294
  • More than half of women obtaining abortions in 2000 (54%) had been using a contraceptive method during the month they became pregnant. This figure is slightly lower than the proportion of women having abortions in 1994 who had been contraceptive users (58%), but slightly higher than the proportion reported in 1987 (51%). In 2000, approximately 15% of women had been using the most effective methods—1% used long-acting methods (sterilization, the IUD, implants or injectables) and 14% the pill. Twenty-eight percent of all women having abortions had used the male condom, down from 32% in 1994 (the only method to decline by more than three percentage points). Withdrawal and periodic abstinence had been used by roughly one in 10 women having abortions.
    • p.296
  • Women using no contraceptive method made up a larger proportion of women having abortions than of all women at risk of unintended pregnancy (46% vs. 7%), mainly because the likelihood of pregnancy is extremely high among fertile, sexually active women when they do not use a contraceptive method. In contrast, a substantially lower proportion of women having abortions than of all women at risk of unintended pregnancy had used sterilization and other long-acting methods (1% vs. 41%), which reflects the very high rates of use-effectiveness of these methods. Pill users were underrepresented among women having abortions, whereas women using condoms and withdrawal were overrepresented. These patterns reflect the fact that women using oral contraceptives are more successful in avoiding accidental pregnancy than are those who rely on barrier or nonprescription methods.
    • p.296
  • The proportion of women having abortions who had not been using a contraceptive when they became pregnant varied across social and demographic subgroups from 37% to 54% (Table 2). Bivariate analyses reveal that adolescents and women aged 20–24 were significantly more likely than women aged 30 or older to be nonusers (47–50% vs. 44%). Decreases in income and education are associated with in-creased contraceptive nonuse: Women with family incomes below 300% of the federal poverty level were more likely than women with higher incomes not to be using a method of birth control in the month they became pregnant (45–52% vs. 40%), and women with less than a college degree were significantly more likely than college graduates to be nonusers (41–54% vs. 37%). Blacks, Hispanics and women of other races and ethnicities were more likely than whites to be nonusers (50–52% vs. 39%). Union status was barely associated with nonuse of contraception. Women who were the most likely to be nonusers were also the most likely never to have used a contraceptive method. For example, adolescents were more likely than women aged 30 or older to have never practiced contraception (12–19% vs. 7%).
    • pp.296-297
  • On the basis of our survey findings, we estimate that of the 1.3 million women who underwent induced abortions in 2000, 608,000 had not been using a contraceptive method around the time they became pregnant, 610,000 had been using a method but not consistently or correctly, and 95,000 had thought they were using the method perfectly but became pregnant because of method failure.* Although these estimates are based solely on women’s retrospective reports and perceptions of why they became pregnant, they raise issues that are common among all contraceptive users and thus need to be addressed.
    • p.301
  • Method failure rates during perfect use are quite low for oral contraceptives and male condoms (0.1–0.5% and 3%, respectively, in the first year of use). Previous research has found that some women overreport compliance with contraceptive regimens, and women having abortions may have overreported perfect method use. Nonetheless, the potential number of unintended pregnancies due to method failure is quite large. In 1995, 10 million women were using the pill, and eight million the condom. If all 10 million women using the pill did so perfectly over the full year, 0.1–0.5%, or 10,000–50,000 users, would have become pregnant. Similarly, if all eight million condom users used the method perfectly for the year, 3%, or 240,000, would have become pregnant. These estimates confirm the validity of the number of abortions that women attributed to method failure during perfect use (95,000). This finding underscores the importance of providing women and their partners with information and services they need to select methods with which they are most likely to be successful, as well as the continuing need for development of additional method choices.
    • p.301
  • Nearly one-fifth of all women having abortions—one in three nonusers and one in five condom users—were not using a contraceptive method or were using it inconsistently because of a perceived low risk of pregnancy. Some of these women may have assumed they were having intercourse in a “safe time” in their menstrual cycle; others may have thought their risk of pregnancy was low because they were postpartum or breastfeeding. Furthermore, some may have simply perceived the risk of becoming pregnant to be low, and some may have thought they or their partner was sterile. The frequency of perceived low risk for pregnancy among women who had abortions shows that women and their partners need accurate information about the probability of conception when contraception is not used, the variability of fertility cycles and the importance of consistent contraceptive use.
    • p.302
  • Twenty-seven percent of contraceptive nonusers and 13% of condom users—or 16% of all women having abortions— became pregnant because they were not expecting to have sex. Ambivalence about contraception had been experienced by 22% of nonusers, and small proportions of pill and condom users indicated that they did not care or they “didn’t feel like” using their method. Very few women indicated that ambivalence about childbearing intentions had directly influenced their contraceptive use, but among women who had used condoms in the month they became pregnant, those who intended to have a child or more children were more likely than those who did not to report inconsistent condom use or condom breakage or slippage.
    • p.302

"Induced abortion: an overview for internists" (2004)Edit

Grimes, DA; Creinin, MD (2004). "Induced abortion: an overview for internists". Annals of Internal Medicine. 140 (8): 620–26. doi:10.7326/0003-4819-140-8-200404200-00009. PMID 15096333.

  • Most internists' practices include large numbers of patients who have had or will seek induced abortion. Although abortion rates are declining, were they to remain stable, an estimated 43% of all U.S. women would have had one or more induced abortions during their reproductive years. More than 30 million U.S. women now share this experience.
  • Several important demographic and medical trends are evident over the past 3 decades. The proportion of teenage patients having abortions has declined, as has the proportion of married women. Women have been obtaining abortions at progressively earlier gestational ages and by suction, rather than sharp, curettage. As of 1999, over half of all women having abortions were mothers of one or more children. A nationwide survey by the Alan Guttmacher Institute indicated that in 2000 and 2001, most women older than 17 years of age reported a religious affiliation: 43% Protestant, 27% Catholic, 8% other, and 22% no religious affiliation. Forty-six percent of women had not used a contraceptive method in the month in which they conceived; inconsistent use of contraceptive method was the main cause of pregnancy among those using contraception.
  • Access to abortion clinics remains a problem: Clinics cluster in metropolitan areas. About one third of women of reproductive age live in the 87% of U.S. counties without an abortion provider. Among the nation's 276 metropolitan areas, 86 have no provider. About a quarter of women have to travel 50 miles or more to reach a clinic; this geographic barrier hinders both service provision and follow-up in case of complications.
  • Unlike most other operations, the cost of abortion has dropped dramatically over the past 3 decades. The current charges are below market value for several reasons. First, the Hyde Amendment cut off federal payment of nearly all abortions for poor women in 1977, and clinics have intentionally tried to keep the price within reach of women of limited means. Seventeen states, including California and New York, currently use state funds to pay for medically necessary abortions; 33 states and the District of Columbia prohibit funding of medically necessary abortions, except in extraordinary cases. Nationwide, only a quarter of women receive services billed directly to public or private insurance. Second, competition between clinics in cities has kept costs low. In 2001 and 2002, the average self-paying woman was charged $372 for a surgical abortion at 10 weeks. Adjusted for the increase in the consumer price index over the past 3 decades, the charge should be several times higher. In general, clinics set medical and surgical abortion prices to be similar so as to eliminate financial reasons for women to choose between the methods.

"The limitations of U.S. statistics on abortion" (1997)Edit

"The limitations of U.S. statistics on abortion". Issues in Brief. New York: The Guttmacher Institute. 1997. Archived from the original on 4 April 2012.

  • There are few authoritative data to support claims regarding how many late-term abortions are performed, and little understanding of the complexities involved in securing such data. This Issues in Brief describes how abortion data are obtained, what they consist of and why they have inherent limitations.
  • Termination of pregnancy is one of the most frequently performed surgical procedures in the United States. There were 1.5 million abortions in 1992, and the incidence is estimated to have declined to 1.4 million in 1994. Although abortion incidence is the subject of some academic research and much anecdotal reporting, nationally valid data are available from only two sources: the federal Centers for Disease Control and Prevention (CDC) and The Alan Guttmacher Institute (AGI).
    The CDC initiated its enumeration of abortions in 1969, two years after Colorado became the first state to liberalize its abortion law. AGI began its collection of information in 1974, the year after the Supreme Court handed down its ruling in Roe v. Wade that the Constitution protects a woman's decision to terminate her pregnancy prior to the viability of the fetus. After viability, ruled the Court, abortion could be prohibited except when it was necessary to preserve the woman's life or he alth. The CDC collects abortion statistics yearly. AGI, dependent on private funding, has had to limit its data collection in recent times to every four years.
  • The data collected by the CDC and AGI are complementary, but have different emphases. The CDC, consistent with its federal function, focuses particular attention on the safety of the procedure, while AGI concerns itself with the availability of abortion services throughout the country.
    The methods of data collection differ as well. The CDC collects most of its information indirectly, mainly through reports from state health departments. Reports for the 45 states that collect information on abortion and the District of Columbia vary in completeness, with some lacking information on as many as 40-50% of the abortions that occur in the state.
  • [T]he only national data on the incidence of abortion by weeks of gestation come from the CDC reports, which are dependent on state-generated information that is often incomplete. States also vary in their methods of recording gestational age: Some use the number of weeks that have elapsed since the woman's last menstrual period (which overstates the length of gestation), and others record the physician's estimate of gestational age. In addition, individual states, over time, have changed their reporting format, making it difficult to observe trends and make comparisons.
    The CDC reports group all abortions after 20 weeks of gestation into one category. After the CDC figures are adjusted for underreporting, approximately 16,450 procedures, or roughly 1% of all abortions in 1992, were estimated to have been performed beyond 20 weeks since the woman's last menstrual period.
  • In 1987 and 1995, AGI collected information nationally on the socioeconomic characteristics of approximately 10,000 women obtaining abortions. The results of the 1995 survey show that the women who are most likely to obtain an abortion have an annual income of less than $15,000, are enrolled in Medicaid, are aged 18-24, are nonwhite or Hispanic, are separated or never-married, live with a partner outside marriage and have no religious affiliation. Catholics are as likely as the general population of women to terminate a pregnancy, Protestants are less likely to do so, and Evangelical Christians are the least likely to do so.
  • Data have also become more difficult to collect over time as harassment has escalated at abortion clinics or at the offices of physicians for whom abortion is a large part of their medical practice. The violence and fear engendered by some protests probably increases the reluctance of providers to report abortions to the state health authorities or even to respond to private inquiries from AGI.
    In addition, the most difficult data to obtain are from private practitioners who perform a small number of abortions. Should the nonsurgical methods that are currently being introduced on a trial basis gain widespread acceptance in physicians' offices, the completeness of abortion data would be likely to decrease further.
    Because information from providers is not likely to improve and, indeed, may erode further, perhaps inquiries regarding abortion should be addressed to the women themselves. However, women are often reluctant to report having had an abortion. In fact, under reporting of abortion is a common problem in surveys around the world, a factor that then hinders the gathering of information on the number of pregnancies that women experience, especially unintended pregnancies.

“Management of unintended and abnormal pregnancy: comprehensive abortion care” (April 27, 2009)Edit

Stanley K. Henshaw, ”Unintended pregnancy and abortion in the USA: Epidemiology and public health impact” in Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds) “Management of unintended and abnormal pregnancy: comprehensive abortion care”. (April 27, 2009) Oxford: Wiley-Blackwell. ISBN 978-1-4051-7696-5.

  • About half of US women with unintended pregnancies choose to resolve them by abortion. In general these women believe that, given their life circumstances, taking responsibility for a new baby would be a mistake. The demographic characteristic most associated with the decision to terminate an unintended pregnancy is marital status: in 2001, 58% of unmarried women with unintended pregnancies decided on abortion, whereas only 27% of married women did so. Evidently the security of having a committed partner and the financial resources of a marriage allow most married women to continue their unplanned pregnancies.
  • Women of all education levels have occasion to seek abortion services, but college graduates have a lower abortion rate than less-educated women. Some 41% of abortions are obtained by women with some post-high school education but who are not college graduates.
    Never-married women obtain the bulk of abortions (67%); married women account for only 17%. The abortion rate is higher among never-married women (35 per 1,000) than among previously married or currently married women. The high rate among never –married women results partly form their young age compared with the other marital groups.
    Women living with a partner to whom they are not married account for 25% of abortions but only about 10% of women in the population. Their abortion rate is almost two times that of other unmarried women. Thus, cohabitating is one of the strongest risk factors for abortion.
    A majority (61%) of women having abortions in 2004 had had at least one birth, and one third had had two or more. When age is taken into account, women who have children are substantially more likely than women without children to have an abortion, and the highest abortion rate is found women with four or more children. Such women may have difficulty using contraception and thus may have unplanned children as well as abortions.
  • The high relative abortion rate of low-income women is reflected in the abortion rate according to Medicaid coverage. Twenty-four per cent of abortion patients say they are covered by Medicaid (although not necessarily for the abortion per se, except in the states that allow Medicaid to pay for abortion services), while only 9% of all US women of reproductive age have Medicaid coverage (as of 2000). Thus, the abortion rate of women with Medicaid coverage is three times as high as that of other women.
    Women covered by Medicaid have a number of attributes that may contribute to their relatively high risk of abortion: they are disproportionately non-White, unmarried, and poor, all characteristics associated with high abortion rates. In addition, many women on Medicaid are covered by that program because of a prior accidental pregnancy that they carried to term and are prone to unplanned pregnancy.
  • More than half (62%) of all induced abortions in the USA occur at eight weeks’ gestation or earlier, counting from the first day of the last menstrual period (LMP) or two weeks before the estimated date of conception. Approximately 12% o abortions are performed past 12 weeks LMP, including 1.4% past 20 weeks LMP. In most developed countries other than England and Wales, somewhat fewer abortions take place after 12 weeks LMP, probably because women respond more promptly to unwanted pregnancies and because restrictions in some countries make later abortions more difficult to obtain. Moreover, most other countries provide universal health insurance that covers abortion services. In contrast, women in the USA may be delayed by difficulty gaining access to abortion services and acquiring money to pay for the procedure.
    In all countries with relevant statistics, teenagers obtain abortions later in gestation on average than do older women. In the USA in 2004, 27% of abortions obtained by women younger than age 15 years were past 12 weeks LMP as were 17% among women aged 15 to 19 years, compared with 11% among women aged 20 and older. Abortions generally occur earlier with age until age 40, after which a few women are delayed because they mistake pregnancy for the menstrual changes of menopause.
    The delay among younger women probably reflects their inexperience in recognizing the symptoms of pregnancy, their reluctance to accept the reality of their situation, lack of knowledge of where to seek advice and services, and their hesitation to confide in adults. In addition, teenagers may have more difficulty paying for abortions, and minors may be affected by parental consent or notification requirements. In the USA laws requiring minors to either consult their parents or obtain a court order permitting the abortion cause some teenagers to experience delay in obtaining abortions.
  • Both first and second trimester abortions can be provided safely in clinics and physicians’ offices. The proportion of US abortions performed in hospitals has declined from more than 50% in 1973 to 5% in 2005. The number of hospitals where abortions are performed has dropped sharply, as has the average number of abortions per hospital provider. A tabulation of data on approximately 300,000 abortions in 14 states in 1992 indicates that, even after 20 weeks LMP, 83% were performed outside of hospitals. Near universal agreement as to the safety of second trimester abortion outside of hospitals is further demonstrated by the finding that in 2001 about 55% of abortion clinics offered the service at 18 weeks LMP or later.
  • Despite the large number of women who need abortion care, services are less available than for other common medical conditions. A significant but unknown number of women continue unwanted pregnancies because of lack of access to an abortion provider.
  • Harassment by antiabortion activists adds to the difficulty women experience in accessing abortion services and the challenges of providing services. In 2000, 80% of large nonhospital facilities (400 or more abortions a year) in the USA experienced picketing. Picketing was much less common among low-volume providers, only 10% of providers that performed fewer than 30 abortions reported being picketed. Other forms of harassment were also fairly common. Of large providers, 28% reported one or more incidents of picketing with physical contact or blocking of patients, and 18% reported vandalism [33]. These activities impede access for women who might be intimidated by aggressive protestors.
    The stigmatization of abortion also undoubtedly affects many women, although this factor is difficult to measure. Fear of the disapproval of relatives or others in the community may inhibit many women who would choose to end their pregnancies. Some women in the USA remain unaware that abortion services are legal and available.
  • [T]he legalization of abortion in the USA, which began in several states in 1967 and culminated in the “Roe v. Wade” Supreme Court decision in 1973, brought significant health and social benefits. Before the laws changed, illegal abortions had been common. From a survey in North Carolina in 1967, researchers estimated that 829,000 abortions were occurring in the country as a whole, which is about 80% of the number of legal abortions that took place in 1975, when legal abortion services were available in all states. Other studies based on the change in the birthrate after legalization suggest that the number of illegal abortions was around 600,000 to 700,000 per year. Legalization converted those abortions to safe procedures and allowed additional women, some at high risk of complications of pregnancy and childbirth, to avoid unwanted childbearing.
    Over the decade spanning 1958 through 1967, more than 3,4000 women died from induced abortions, almost all illegal. The number rose during the 1950s and reached at least 430 in 1961, then fell during the 1960s when more physicians started providing abortions. The number of deaths fell rapidly after abortion was legalized, form 251 in 1966 to 14 in 1976. In recent years, the number of deaths has ranged between 4 and 12 per year according to the Centers for Disease Control and Prevention (CDC). During the five years from 2000 to 2004, only 43 deaths were related to legal abortion an two to illegal abortion, for a mortality rate of 0.7 per 100,000 legal abortions.
    In the 10 years between 1970 and 1980, legal abortion in the USA is estimated to have prevented 1,500 pregnancy related deaths and thousands of other complications.
  • Although contraceptive use increases after abortion, women remain at elevated risk of having another abortion because they are sexually active, willing to terminate an unintended pregnancy by abortion, have difficulty using contraceptive methods effectively, and probably become pregnancy more easily than other women. In 2004, 47% of US women obtaining abortions had had a prior induced abortion: 27% had had one, 12% two, and 8% three of more prior abortions. From 1973 until reaching a high of 49% in 1997, this percentage increased each year along with the proportion of women in the population who had had abortions and were therefore at risk of an additional abortion. In 1994, about 30% of all US women aged 15 to 44 years had had one or more induced abortions, and the abortion rate among the women who had had a previous abortion was about twice that of women who had ever had an abortion Canadian statistics show that approximately 25% of teenage abortion patients will have another abortion within the next four years. An analysis of the NFSG found that 42% of US women who had a repeat abortion did so within two years of the prior abortion.
  • The high rate of repeat abortion does not mean that large numbers of women are relying on abortion as their primary means of birth control. A woman who used only abortion to limit her number of children to two would have more than 30 abortions during her lifetime. No evidence indicates that American women have such large numbers of abortions.
    On the contrary, women tend to improve their contraceptive use after having an abortion. According to the 2001 Guttmacher Institute survey of 10,683 abortion patients, 46% of women having a first abortion had used no contraceptive method during the month they became pregnant. If they had continued to use o method, on the order of 85 to 90% of second abortion would have occurred among women who had used no method because of the high pregnancy rate of non-users. In fact, the distribution of method use was similar to that of women having a first abortion, indicating that women who have an abortion improve their contraceptive use to about the same level as the women generally. The Guttmacher Institute analysis found little difference between first and subsequent abortions in the reasons for non-use or inconsistent use of contraception.
    A number of studies have sought risk factors for repeat abortion but gew have been identified. The best predictors of repeat abortion are factors that reflect exposure to risk, most notably age; the older a woman is the more opportunity she has had to experience two unintended pregnancies that end in abortion. A logistic regression analysis of the Guttmacher patient survey found that women having second or higher order abortions are also more likely to have existing children, controlling for age and other demographic variables. An analysis of the NSFG in the same report found that almost half (47%) of women who have multiple abortions also have unintended births, another consequence of unintended pregnancy and therefore a risk factor for abortion. Other studies have found that women who have a second or higher order abortion engage in more frequent sexual intercourse than women having a first abortion.

“Abortion patients in 1994–1995: characteristics and contraceptive use” (1996)Edit

Henshaw SK and Kost K, “Abortion patients in 1994–1995: characteristics and contraceptive use”, Family Planning Perspectives, 1996, 28(4)

  • Annual national data describing women having abortions in the United States cover only basic demographic characteristics—age, race, ethnicity, marital status, and prior births and abortions—as well as the procedure used for the abortion and the length of the pregnancy. This information is collected by most states, and it is compiled and published at the national and state levels by the Centers for Disease Control and Prevention (CDC). However, some states have no abortion reporting system, and the CDC reports understate the number of abortions performed. The Alan Guttmacher Institute (AGI) conducts periodic surveys of all abortion providers throughout the country and uses the results together with the CDC data to estimate the number of abortions nationwide and the abortion rate according to a variety of characteristics.
    • p.140
  • Although white women obtain 61% of abortions, their abortion rate, reflected by an index of 0.8, is well below that of women of other races. The index for black women is 2.2, or nearly triple that of white women, and the differential has increased since 1987. The index for women of races other than black or white is 1.6, but this may be inflated by the inclusion of some Hispanic women in this group (as explained in the methodology section). In the 1987 survey, which classified all Hispanic women as white or black, the age-standardized abortion rate for women of “other” races was only slightly above that of all women (1.1); the 1994—1995 index would be about the same as the 1987 rate if Hispanics were excluded from this group.
    Hispanic women have a much higher abortion rate than non-Hispanics, but their rate is not as high as that of black women. The index for Hispanics is reduced some-what when standardized for age (from 1.9 to 1.8), but is still roughly twice that of non-Hispanic women (0.9). The age-standardized index for Hispanics has increased substantially from its 1987 level of 1.4.
    • p.143
  • As expected, a large majority (89%) of women having abortions live in counties classified by the federal government as metropolitan, and metropolitan women are twice as likely as nonmetropolitan women to have abortions (indices of 1.1 and 0.6, respectively). The comparatively low abortion index of nonmetropolitan women may reflect their difficulty in gaining access to abortion services, which are unavailable in the counties where 85% of nonmetropolitan women reside. The limited availability of abortion facilities is indicated by the finding that 43% of the patients surveyed traveled outside their home county for abortion services (not shown). In 1987, by contrast, 39% of abortions took place outside the woman’s county of residence.
    • p.144
  • The patterns of contraceptive use among abortion patients may or may not mirror the use patterns of all women at risk of unintended pregnancy. Each contraceptive method entails a different probability of becoming pregnant, and women’s method choice often differs by their socioeconomic and demographic characteristics. Consequently, users of each method may differ in their likelihood of carrying an unexpected pregnancy to term or of having an abortion. For example, women who use only periodic abstinence may, for religious or other reasons, be more likely than users of other methods to carry an unexpected pregnancy to term.
    • p.144
  • Poverty status is strongly associated with contraceptive use; 64% of the women whose family income is at least twice the federal poverty level were using a method, compared with 49% of those with an income under the poverty level. Of the racial and ethnic groups, white non-Hispanic women are the most likely to have been using a method (67%), while Hispanic women are the least likely (45%).
    • p.145
  • Among the women who experienced contraceptive failure, the methods used differ little among the racial or ethnic groups. The largest differences are that black women are more likely than nonblack and Hispanic women to have used the condom and less likely to have used withdrawal. Age differences are marked: Whereas 76% of women younger than 18 had used condoms, only 49% of women 30 or older had used this method. Pill use peaked (at 25%) among women aged 20—29, while use of “other” methods (mainly the diaphragm, sponge, spermicides and periodic abstinence) increased sharply with age, from 1% of women younger than 18 to 24% of those 30 and older. Possibly because age is correlated with income, the proportion who used other methods also increased as family income as a proportion of the poverty level rose. Otherwise, there is little association of method used with poverty status.
    • p.146
  • Between 1987 and 1994—1995, condom use among abortion patients who were using a method when they became pregnant increased dramatically among all women, regardless of race, ethnicity, age or poverty status; the increase was greatest among black and Hispanic women. In the same time period, pill use declined among abortion patients who had a contraceptive failure. This decline occurred primarily among blacks and Hispanics, but substantial decreases also took place among women of all ages except those 30 and older, and among those of all income levels except the highest.
    • p.146
  • The risk of unintended pregnancy leading to abortion varies widely among demographic subgroups. The factors associated with high risk are relatively young age (18—24), being separated or divorced, cohabiting while unmarried, being Hispanic or of a minority race, having a low income, being covered by Medicaid and having had four or more births. Factors that are associated with low abortion rates include being a born-again or Evangelical Christian, being aged 35 or older, having high income, living in a nonmetropolitan county, being married and identifying with a religion other than Catholicism.
    • p.147
  • To further lower the abortion rate, the focus should continue to be on reducing the number of couples who use no contraceptive method at all. Most of those who were not using a method had used one in the past and conceived within a very short period after discontinuing use. Thus, it is very important for couples to avoid lapses in method use and to immediately adopt another method when they discontinue one.
    Next in importance would be to improve the effectiveness with which condoms are used, since one-third of abortion patients experienced the failure of this method. Because most of these failures probably resulted from inconsistent use, the need for protection at every act of intercourse should be stressed.
    • p.147

"The Accessibility of Abortion Services in the United States" (1991)Edit

Henshaw, S.K. (1991). "The Accessibility of Abortion Services in the United States" (PDF). Family Planning Perspectives. 23 (6): 246–63. CiteSeerX 10.1.1.360.6115. doi:10.2307/2135775. JSTOR 2135775. PMID 1786805. Archived (PDF) from the original on 24 March 2016. Retrieved 25 October 2017.

  • METHODS: In 2001–2002, The Alan Guttmacher Institute surveyed all known abortion providers in the United States, collecting information on their delivery of abortion services and on the number of abortions performed.
    RESULTS: A minority of abortion providers offer services before five weeks from the last menstrual period (37%) or after 20 weeks (24% or fewer), but the proportions have increased since 1993. Providers estimate that one-quarter of women having abortions in nonhospital facilities travel 50 miles or more for services, and that 7% are initially unsure of their abortion decision. The majority of providers (59%) say that these clients usually receive abortions during a single visit. An average self-paying client was charged $372 for a surgical abortion at 10 weeks in 2001, up from $319 in 1997; only 26% of clients receive services billed directly to public or private insurance. Early medical abortions are becoming increasingly available but are more expensive than surgical abortions. More than half (56%) of providers experienced antiabortion harassment in 2000, but types of harassment other than picketing have declined since 1996.
    • p.16
  • Unintended pregnancies and induced abortions are common and occur among women of all social and economic groups. Yet the availability and accessibility of abortion services have long been a concern for reproductive health professionals, as women seeking an abortion have a fairly narrow time period during which they can obtain the procedure. Measures of availability have generally declined since 1982: The number of abortion providers in the United States has fallen by 37%, and the proportion of women who live in counties with no abortion provider has increased from 28% to 34%.2 In 2000, 86 of the country’s 276 metropolitan areas and almost all nonmetropolitan areas had no abortion provider.
    Accessibility is harder to measure than availability, because of the variety of possible barriers, both tangible and intangible. Besides distance from a provider, cost is the most obvious tangible barrier. The provision of specific services, such as second-trimester pregnancy termination, can determine accessibility for individual women. Among the barriers that are less tangible, and therefore more difficult to quantify, are women’s lack of accurate information about the legality of abortion and about where and how to obtain abortion care, misinformation about abortion, intimidation by protesters, state-required waiting periods and mandated counseling topics that may not be relevant to a woman’s personal situation, and antiabortion attitudes among family or friends.
    • p.16
  • Providers typically set a minimum and maximum gestation at which they are willing and able to perform an abortion. These limits are expressed as the number of weeks since the woman’s last menstrual period (LMP). Thirty-seven percent of facilities that offer abortion services provide either surgical or medical abortions at four weeks or less LMP (Figure 1), often for any pregnancy that can be confirmed by ultrasound or even a pregnancy test. This represents a sharp increase from the level of 7% reported in 1993 (not shown). Eighty-two percent of abortion facilities perform abortions at six weeks LMP (Figure 1). Abortion clinics are more likely than other types of facilities to offer abortions at five and six weeks LMP.
    More than 90% of all abortion providers offer services at 8–10 weeks LMP. However, the proportion drops with each additional week of gestation after eight weeks LMP (typically four weeks after the woman’s first missed period) and declines steeply after 12 weeks. At 20 weeks, for example, only 33% of all providers offer abortion services, and at 21 weeks, 24% still do so.
    Hospitals and abortion clinics are much more likely than other providers to offer services past 12 weeks. At 13–15 weeks LMP, a higher proportion of abortion clinics than of hospitals perform abortions, while at 17–23 weeks LMP, the reverse is true. (Many hospitals, however, provide very few abortions and do so only in extraordinary circumstances, such as when the fetus has an abnormality or the pregnancy poses severe health risks to the woman.) After 24 weeks LMP, the number of providers offering abortion services again drops off sharply. Only 2% of all abortion providers (approximately 11 hospitals and 19 abortion clinics) provide abortions at 26 weeks.
    • p.18
  • Respondents estimated that 8% of women having abortions in nonhospital facilities travel more than 100 miles to obtain this service, and that an additional 16% travel 50–100 miles.* Travel patterns appear to have changed little over time. In both 1993 and 1997, providers also reported that 24% of clients traveled at least 50 miles, including 8% and 7%, respectively, who traveled more than 100 miles.
    The proportion traveling long distances varies by geographic region. In the East South Central and the West North Central states, 43% and 37%, respectively, of women travel at least 50 miles to obtain an abortion, including 14–15% who travel more than 100 miles. In contrast, only 11% of women in the Middle Atlantic states travel 50 miles or more.
    • p.18
  • Fifty-nine percent of nonhospital providers nationally and 60% of providers in states that do not require in-person advance counseling said that their clients usually obtain abortions in a single visit, while 15% and 14%, respectively, said that this never happens. Single-visit service is highly associated with caseload: All facilities that provided 5,000 or more abortions in 2000 usually perform abortions in a single visit, compared with only 20% of facilities providing fewer than 30 abortions (not shown).
    • p.19
  • We asked each nonhospital provider to indicate the usual charges that a woman would incur at that location for an abortion (with local anesthesia) at various gestations, including fees for any services always required for an abortion client, even if these are not billed through the provider (e.g., laboratory tests). On average, surveyed facilities charge $468 for a surgical abortion at 10 weeks LMP (Table 1). The lowest average charge ($364) is reported by specialized abortion clinics, and the highest average charge ($632) is reported by physicians’ offices.
    • p.19
  • As a pregnancy advances into the second trimester, the abortion procedure becomes more complex, because it requires more time and more skill on the part of the clinician, and charges increase. At 16 weeks, the mean and median charges ($774 and $650, respectively) are more than half again the amounts at 10 weeks (Table 1). At 20 weeks, the mean and median charges increase to $1,179 and $1,042, respectively. In the second trimester, charges vary relatively little by type of provider, but the range remains wide, with some providers charging 2–5 times the average.
    • p.19
  • One-third of abortion facilities provided early medical abortions in the first half of 2001, and this proportion was increasing rapidly. An estimated 37,000 early medical abortions occurred in this time period; 35,000 of them were provided by nonhospital facilities. One-quarter of early medical abortions in nonhospital facilities were performed using methotrexate, which was available before the Food and Drug Administration (FDA) approved mifepristone in September 2000. However, 82% of medical abortion providers were using mifepristone—although some of these used methotrexate as well. Both drugs are used in conjunction with misoprostol, a prostaglandin that is administered with- in several days of the mifepristone or methotrexate to cause contractions and expel the products of conception.
    The FDA-approved labeling specifies a fairly restrictive protocol for abortion using mifepristone: use within the first seven weeks of gestation; a mifepristone dose of 600 mg; misoprostol administered orally in the physician’s office; and a follow-up visit to the provider for an examination to confirm that the pregnancy has been completely terminated. However, experts who have reviewed published studies have concluded that more convenient and less-expensive procedures are equally safe and effective.
    • p.20
  • The great majority of providers of early medical abortion used a dose of 200 mg of mifepristone (83%), and most permitted the client to take the misoprostol at home rather than requiring her to return to the abortion facility to receive it (84%). Both practices were more common among providers that did 50 or more medical abortions than among less-experienced providers.
    Most providers (74%) reported that counseling for medical abortion takes more time than does counseling for surgical abortion. A large minority (43%) said that fewer than 10% of early medical abortion clients called with questions or problems, but one-third reported that 20% or more did so. Calls from one-fifth or more of clients were less common among the more experienced providers.
    • p.21
  • Many women seeking abortion face harassment by anti-abortion protesters; this also affects a facility’s ability to offer services. Each year, 56% of all nonhospital providers experience at least one of five types of harassment—picketing; picketing coupled with physical contact with or blocking of clients; vandalism (such as jamming of locks or other physical damage); picketing of the homes of staff; and bomb threats. Harassment is much more common in facilities with large abortion caseloads than in smaller facilities: The proportion experiencing one or more incidents ranges from 10% among facilities performing fewer than 30 abortions to 70% among those providing 400–990 abortions and to 100% of clinics providing 5,000 or more.
    • p.22
  • Picketing is by far the most common type of antiabortion activity, reported by 80% of large providers (Table 5). Some 14–28% of large providers experience more extreme forms of harassment. A majority (61%) of facilities experience picketing at least 20 times a year. Other types of harassment usually occur fewer than five times per year at any one facility.
    Since 1996, all of these forms of harassment except picketing have become less common. The proportions of large providers reporting picketing with physical contact, vandalism and picketing of staff members’ homes have fallen by about half since 1992, when these activities were at their height. The proportion of large providers reporting bomb threats has fallen steadily, from 48% in 1985 to 15% in 2000.
    • p.22
  • For many women, barriers to abortion services are significantly more common than are obstacles to other common types of reproductive health care. For example, only 13% of U.S. counties have an abortion provider, while obstetric-gynecologic care is available in half of all counties. In 1997, 85% of counties had at least one publicly funded family planning clinic. Depending on the circumstances of any given woman needing abortion services, she may have to cope with gestational limits, a long distance from a provider (the effects of which may be exacerbated if she needs to make two trips or is undecided about whether to have an abortion), travel and other expenses that may not be covered by insurance, a lack of choice of method of early medical abortion and antiabortion protesters. These are the potential barriers for which we have information; other factors, including restrictive legislation and attitudes, may also pose important problems for some women.
    Gestational limits reduce the number of abortion providers available to specific women. Women frequently encounter such barriers when they seek an abortion during the second trimester. Many providers offer services only up to 12 or 14 weeks, because later abortions require more cervical dilation and greater skill on the clinician’s part, the risk of complications is greater than with earlier abortions and the demand is less. When a fetal anomaly is discovered late in the second trimester, the woman may find that facilities where the pregnancy can be terminated are difficult to locate and are far from her home. Nonetheless, the number of facilities where second-trimester abortions are performed has increased in recent years.
    A woman who discovers an unintended pregnancy at less than six weeks LMP may find that an abortion provider she contacts will not provide services then, but will ask her to wait until six weeks or later. Studies in the 1970s found a higher rate of continuing pregnancies after very early procedures. Recent research has shown, however, that with high-resolution ultrasound and careful examination of the products of conception, early surgical abortions can be performed without an elevated risk of ectopic pregnancy or incomplete abortion, and that an increasing number of providers perform such early abortions. In addition, providers of surgical abortion increasingly are offering early medical abortion.
    • p.22
  • Providers estimate that 8% of women who have abortions travel more than 100 miles to do so, a proportion that has not changed in recent years. Women who are able to over-come the barrier of distance may nevertheless suffer con- sequences. In a survey conducted in 1987–1988, half of a national sample of women who were having an abortion at 16 weeks LMP or later cited difficulty in making arrangements as a cause of delay.24
    • p.23
  • Another factor affecting access is the fee that clients pay, which averages $372 at 10 weeks. This is a minimum figure, because many clients have additional expenses, such as for other services (intravenous sedation or general anesthesia), transportation, time lost from work and increased costs if the pregnancy is at a later gestation. Nonhospital providers directly bill Medicaid or other insurance for only 26% of their abortion clients, and for only 8% in states where Medicaid does not cover abortion. Whether because of Medicaid funding restrictions, a lack of insurance coverage, women’s hesitancy to use insurance coverage for abortion or providers’ inability to bill directly, most women pay directly for their abortion care.
    While the cost of an abortion may seem moderate to some, many low-income women are likely to find it substantial. Between 18% and 35% of Medicaid-eligible women who would have abortions instead continue their pregnancies if public funding is unavailable.26 The lack of Medicaid coverage may be the public policy that has the greatest impact on the number of women who want an abortion but are not able to obtain one. In addition, a woman’s need to secure funds often causes abortions to be delayed; one study found that 22% of Medicaid-eligible women who had a second-trimester abortion would have terminated their pregnancy in the first trimester if Medicaid had covered abortion services.
    • p.23
  • A majority of providers charge more for medical abortion than for surgical abortion at six weeks. This may reflect the cost of the drug, the greater amount of counseling time required for medical abortion than for surgical abortion, the number of calls from clients with problems or questions, and the greater perceived need for active follow-up of medical abortion clients, to ensure that the abortion was completed without complications. As providers gain experience with early medical abortion, however, these services may become more routine, and the additional expenses for medical abortion could fall.
    • p.23
  • Picketing remains prevalent at abortion facilities, especially at those with large caseloads. Other types of harassment have declined over time but have not disappeared. This decrease may reflect the impact that federal legislation to protect access to medical facilities has had in deterring illegal antiabortion activity, as well as the fact that by September 2000, 15 states had laws protecting access to clinics that provide reproductive health services. Nevertheless, a majority of clinics reported being picketed at least 20 times a year, and many women seeking abortion are exposed to the stress of noisy and sometimes threatening protesters.
    • p.23

"Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008" (10 May 2016)Edit

Jerman, Jenna; Jones, Rachel K.; Onda, Tsuyoshi (10 May 2016). "Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008" – via www.guttmacher.org.

  • Abortion is common in the United States and is a critical component of comprehensive reproductive health care. However, information about individuals who have abortions is limited. For example, population-based surveys, which are used to obtain information about many aspects of reproductive and sexual health, do not adequately measure the prevalence of abortion, and only about half of abortions provided in the United States are captured by these types of surveys. While the Centers for Disease Control and Prevention (CDC) publishes annual abortion statistics, including selected demographic characteristics of abortion patients, this information is limited and incomplete, as it is collected from individual state health departments with variable abortion-reporting requirements. For example, the CDC does not report abortion data from California, New Hampshire or Rhode Island, and the accuracy of abortion information can vary substantially by state over time. To address these limitations, the Guttmacher Institute periodically collects information from U.S. abortion patients, and the results of the most recent survey are summarized in this report.
  • The abortion rate declined 13% between 2008 and 2011, and while there is little evidence to suggest that the state abortion regulations passed during that time period were responsible for the drop in abortions, restrictions passed in some states in more recent years have been particularly onerous. These include waiting periods that may require patients to visit the clinic twice, requirements that abortion clinics meet the standards of ambulatory surgical centers or acquire hospital admitting privileges for their clinicians, and bans on the use of private insurance and plans purchased through state exchanges to pay for abortion services.
  • The proportion of abortions accounted for by adolescents declined significantly between 2008 and 2014—by 32%. In particular, the proportion accounted for by 15–17-year-olds declined 44% over this period, and that among 18–19-year-olds dropped by 25%. The 2014 abortion index of 0.4 for the former group indicates that they were substantially underrepresented among abortion patients relative to their representation in the larger population of women.
  • Relationship status can be a proxy for exposure to sexual activity, and can also influence individuals’ and couples’ childbearing goals. The distribution of abortion patients and abortion indices varied by relationship status. About 14% of abortion patients were married, and an additional 31% were cohabiting. A slight majority were not living with a partner in the month they became pregnant (46% had never married and 9% had been previously married).
    The 2014 abortion index of 0.4 for married patients indicates that they were substantially underrepresented among abortion patients relative to all women of reproductive age. Cohabiting women were overrepresented by a factor of 2.1, meaning they had an abortion rate twice the national average. The abortion index for never-married, noncohabiting patients was slightly higher than average (1.2). The abortion indices for most relationship statuses remained unchanged from 2008, with the exception of that for cohabiting women, which declined from 2.6 to 2.1.
  • Disparities in reproductive health outcomes by race and ethnicity are well documented,18–20 and may be an important indicator of systemic barriers to preventive services. No racial or ethnic group made up the majority of abortion patients in 2014. Overall, 39% were white, 28% black, 25% Hispanic, 6% Asian or Pacific Islander, and 3% of other background. The racial and ethnic composition of patients was quite similar in 2008.
  • Educational goals are often cited as a reason to delay childbearing, as many individuals wish to complete their schooling and better position themselves economically before having children.21 In 2014, some 9% of abortion patients aged 20 or older had less than a high school degree, and the overwhelming majority—91%—had graduated from high school; more than one in five had a college degree. The proportion of patients aged 20 or older who had not graduated from high school declined significantly over the six-year period (from 12% to 9%).
  • How individuals achieve their desired family size—including the timing and spacing of any births—is often part of a complicated calculus, and decisions regarding pregnancy outcomes are made in the context of existing and planned children. In 2014, it continued to be the case that the majority of abortion patients (59%) had had at least one previous birth, including one-third who had had two or more; 41% of abortion patients had had no prior births. These proportions were largely unchanged from 2008.
  • Over the last few decades, abortion and unintended pregnancy have become increasingly concentrated among poor patients. This trend continued through 2014, when there was a significant increase in the proportion of abortion patients accounted for by this group: Forty-nine percent of patients had family incomes of less than 100% of the federal poverty level, while 42% were in this group in 2008. An additional 26% of patients in 2014 had incomes that were 100–199% of the poverty threshold. (We refer to patients in the lowest and middle categories as poor and low income, respectively.) The increase in poor abortion patients was countered by a decrease in the proportion of patients in the highest income group (200% or more of the federal poverty level), from 31% to 25% over the six-year period.
  • The majority of abortion patients indicated a religious affiliation: Seventeen percent identified as mainline Protestant, 13% as evangelical Protestant and 24% as Roman Catholic, while 8% identified with some other religion. Thirty-eight percent of patients did not identify with any religion. The proportion of women who identified as mainline Protestant declined by 24% since 2008, whereas the proportion with no affiliation increased by 38%. The proportion identifying as Catholic decreased by 15% from the earlier survey, though this change was only marginally significant.
    The abortion index for Catholic women showed that their relative abortion rate was nearly the same as that for all women (1.1). Mainline Protestants were slightly underrepresented among abortion patients (0.8), while evangelical Protestants had an abortion rate that was half of the national average. Patients with no affiliation were overrepresented among abortion patients, having a relative abortion rate of 1.8. The abortion index had declined slightly for mainline Protestants, and had increased slightly for those with no affiliation.
  • Unintended pregnancy is not limited to heterosexual women. Sexual minority women may have an elevated risk for unintended pregnancy because of differences in sexual health knowledge or behaviors, or because of a higher prevalence of risk factors such as previous exposure to abuse. The vast majority of abortion patients identified as heterosexual or straight (94%). Four percent of patients said they were bisexual, while only 1% identified as “something else” and 0.3% as homosexual, gay or lesbian. Respondents who indicated “something else” could write in a more specific response; 12 of the 81 who answered affirmatively indicated “pansexual,” which was the only response provided by more than one respondent.
  • While fewer abortion patients were uninsured in 2014 than in 2008, there were no significant changes in how patients paid for their abortions. Regardless of insurance coverage, 53% of patients reported that they paid for the abortion themselves. Medicaid was the second-most-common method of payment, reported by 24% of patients; the overwhelming majority of these patients (96%) lived in the 15 states that allow state funds to be used to pay for abortions (not shown). Fifteen percent of patients reported that they used their private insurance to pay for the procedure, and 14% relied on some type of financial assistance. Notably, most patients with private health insurance (61%) paid out of pocket for their abortion (not shown). Eight percent relied on more than one payment method, most commonly paying themselves and getting financial assistance. While there were shifts in type of payment between 2008 and 2014—in particular, a decrease in the proportion who were self-paying and an increase in reliance on Medicaid—the changes were not statistically significant.
  • In many ways, abortion patients in 2014 were quite similar to those in 2008. As in the earlier survey, the majority of patients were in their 20s, unmarried and nonwhite, and had graduated high school, had at least one previous birth and had a religious affiliation. However, smaller proportions of patients in 2014 were adolescents and were uninsured, and a larger proportion were poor.
    The percentage of abortion patients accounted for by adolescents has been declining for decades, but the 32% drop between 2008 and 2014 was particularly notable. A comparable drop was seen in the teenage birthrate, which declined 40% during this period, meaning that fewer teenagers were getting pregnant in 2014 than in 2008. There were no significant changes in sexual activity or contraceptive use patterns among adolescents during this time period, and economists speculate that increased educational opportunities, the media and the economy may have influenced these trends. Understanding the reasons behind these declines could have important policy implications, and more research is needed to better understand the range of factors influencing these patterns.
  • Poor women continue to account for a disproportionate share of abortion patients, and this representation increased from 42% to 49% over the six-year period, mostly driven by an increase in the population of women of reproductive age who are poor. The abortion index for poor women changed little, and disparities in abortion rates by income did not increase between 2008 and 2014. Still, it is now the case that 75% of abortion patients are low income, having family incomes of less than 200% of the federal poverty level.

"Patterns in socioeconomic characteristics of women obtaining abortions in 2000–2001" (2002)Edit

Jones RK, Darroch JE and Henshaw SK, "Patterns in socioeconomic characteristics of women obtaining abortions in 2000–2001", “Perspectives on Sexual and Reproductive Health”], 2002, 34(5):226–235

  • Abortion is a common experience among U.S. women. Nevertheless, because abortion is a sensitive topic for many people, it is commonly underreported in national surveys, and representative information about women who have abortions is limited. Most states and the District of Columbia collect data on the characteristics of women who have abortions as part of their vital statistics systems; the Centers for Disease Control and Prevention (CDC) tabulates and publishes these data in summary form. However, this information is limited to a few basic demographic characteristics.
    Accurate national information describing women who have abortions may dispel, or confirm, stereotypes that arise when people are reluctant to talk openly about their abortion experiences. In addition, given that abortion rates decreased throughout the 1990s, identifying the groups of women in which the decrease was below average or in which no decrease occurred can help policymakers and family planning providers determine which groups of women at which point in their lives need greater assistance preventing unintended pregnancies.
  • Between 1994 and 2000, the abortion rate fell by 11%, from 24 to 21 per 1,000 women aged 15-44; in 2000, 25% of all pregnancies (excluding miscarriages) ended in abortion. Subgroups of women varied, often dramatically, in their rates of abortion, reflecting differences in rates of pregnancy and in the proportions of pregnancies ending in abortions.
    Age. Almost one in every five women (19%) who had an abortion in 2000-2001 were adolescents, more than half (56%) were in their 20s and a quarter (25%) were 30 or older. The proportion aged 15-19 had decreased slightly, from 21% in 1994. Most teenagers having abortions in both years were aged 18-19 (12% of all women having abortions), while only 1% were younger than 15.
    Women aged 20-24 have a higher abortion rate than any other age-group (47 abortions per 1,000), and women aged 40 or older have an exceptionally low rate (four per 1,000). Adolescents also have a higher-than-average abortion rate—25 per 1,000 women aged 15-19. The relatively high adolescent abortion rate is largely attributable to a high level of abortion among women aged 18-19 (39 per 1,000); the rate among 15-17-year-olds is 15 per 1,000.
  • Two-thirds of women having abortions in 2000 had never been married, one in six were currently married and another one in six were separated, divorced or widowed when they became pregnant. The proportion of women having an abortion who had never been married increased from 64% in 1994 to 67% in 2000.
  • Despite their high pregnancy rate (99 per 1,000), married women have a low abortion rate because they carry the overwhelming majority of their pregnancies (92%) to term. Previously married and never-married women are much less likely than married women to become pregnant, but more than four out of 10 of their pregnancies end in abortion.
  • Although 19% of unmarried U.S. women aged 15-44 are living with their partners, these women accounted for 31% of abortions among unmarried women in 2000, up from 21% in 1994. Abortion rates changed little for unmarried, cohabiting women between 1994 and 2000, following a steep rate of decline in their abortion rates between 1987 and 1994. Rates declined substantially (20%) among unmarried women who were not cohabiting between 1994 and 2000. The 1994-2000 pattern represents a dramatic slowdown in the rate of decrease among cohabiting women and an increasing rate of decline for noncohabiting, unmarried women. In all three years, cohabiting women had high abortion rates.
  • A large proportion (73%) of all women having abortions had been pregnant before: Some 48% had had a previous abortion, including 36% who had experienced both a previous birth and an abortion and 12% who had experienced only a previous abortion. It is also worth noting that 52% of women having abortions in 2000 intended to have (more) children in the future, and 22% were unsure of their birth intentions (not shown).
  • Abortion services are concentrated in cities, so it is often easier for women residing in metropolitan counties to obtain these services. Nine in 10 women obtaining abortions reside in metropolitan areas, compared with eight in 10 women aged 15-44. Women in metropolitan counties and those in nonmetropolitan counties had similar rates of decline in abortion between 1994 and 2000, but the abortion rate among women living in metropolitan counties in 2000 was still twice that among women residing in nonmetropolitan counties (24 vs. 12 per 1,000).
  • Poverty. Women with incomes below 200% of poverty made up 30% of all women of reproductive age, but accounted for 57% of all women having abortions in 2000: Twenty-seven percent of abortions were obtained by women living below the poverty line, and another 31% by women with incomes of 100-199% of poverty. The concentration of economically disadvantaged women among those having abortions was greater in 2000 than in 1994, when 50% of women obtaining abortions had incomes of less than 200% of poverty.
  • Medicaid. About one-quarter of women obtaining abortions were covered by Medicaid for general health care. The abortion rate among all women with Medicaid coverage (57 per 1,000) was three times the rate among women not covered by Medicaid. Between 1994 and 2000, the abortion rate among Medicaid recipients increased, whereas the rate among women who were not receiving Medicaid declined.
    The increase in abortion rates among women with Medicaid coverage between 1994 and 2000 was an abrupt change from the 1987-1994 period, when abortion rates for this group declined substantially. Women with Medicaid coverage in 1987 had 71 abortions per 1,000, and by 1994 this rate had decreased by 29%, a decline that was larger than that for women with no Medicaid coverage.
  • Race/ethnicity. Of women obtaining abortions, 41% were non-Hispanic white, 32% were non-Hispanic black and 20% were Hispanic. The remaining women were Asian or Pacific Islander (6%) or Native American (1%). Between 1994 and 2000, the proportion of women obtaining abortions who were Asian or Pacific Islander increased.
    The lowest abortion rate of all the racial and ethnic groups examined was among white women (13 per 1,000), while the highest rate was among black women (49 per 1,000). Hispanic and Asian women had abortion rates slightly higher than average (33 and 31 per 1,000, respectively). Between 1994 and 2000, abortion rates fell for all groups but Asians; the drop was largest (20%) among white women.
    White women also had a lower pregnancy rate than any of the other racial or ethnic groups and, with only 18% of pregnancies ending in abortion, were the most likely to carry their pregnancies to term.
    Black women's high abortion rate reflects both their high pregnancy rate and the high proportion of conceptions (43%) that ended in abortion. Hispanic women had the highest pregnancy rate of all the racial and ethnic groups (132 per 1,000); one-quarter of pregnancies ended in abortion.
  • Education. Among women aged 20 or older, those who had not graduated from high school accounted for 13% of abortions. High school graduates made up 30% of women having an abortion, and those with at least some college, 57%.
    The abortion rate among college graduates (13 per 1,000) was lower than average; moreover, women with college degrees were the only educational group to show a higher-than-average decline in abortion rates (30%) between 1994 and 2000. The relatively small proportion of pregnancies among college graduates that ended in abortion (21%) and the below-average pregnancy rate account for their low abortion rate. Women with some college had a pregnancy rate that was lower than average, but 38% of their pregnancies ended in abortion in 2000, resulting in the highest abortion rate of any educational group (26 per 1,000).
  • Religious affiliation. The majority of women older than 17 who obtained an abortion reported a religious affiliation. The highest proportion (43%) identified themselves as Protestant. Twenty-seven percent of women having an abortion identified themselves as Catholic, and 8% as a member of another religion; 22% reported no religious affiliation. Thirteen percent identified themselves as "born-again" or evangelical, three-fourths of whom were Protestant (not shown).
    Women affiliated with "other" religions and those who did not identify with any religion had the highest abortion rates (31 and 30 per 1,000, respectively). Women with no religious affiliation experienced the largest decline in abortion of all the groups examined (35%).
  • Information gathered from this nationally representative sample reveals that the typical woman having an abortion is between the ages of 20 and 30, has never married, has had a previous birth, lives in a metropolitan area, and is economically disadvantaged and Christian. However, women who have abortions are diverse, and unintended pregnancy leading to abortion is common in all population subgroups.
    Although the national abortion rate decreased by 11% between 1994 and 2000, not all population groups participated equally in the decline, and some groups experienced increases. As a result, women having abortions are increasingly those who are never-married, low-income, nonwhite and Hispanic, and have already had at least one child.
    Birthrates changed little between 1994 and 2000, and limited data suggest that no change occurred in the proportion of births that were unintended. Information from women who gave birth in 17 states in 1999 reveals that between one-third and one-half of these births were unintended. Comparable information gathered in nine of the states in 1993 suggests that the proportion of births that were unintended changed little between 1993 and 1999. If these dynamics apply to all women, then the decrease in abortion between 1994 and 2000 reflects decreases in both the overall rate of unintended pregnancy and the proportion of women with unintended pregnancies who have abortions.
  • Abortion rates among adolescents have been declining since the late 1980s. Parental involvement laws for minors took effect in eight states between 1994 and 2000. It is unlikely that these restrictions account for much of the decline in adolescent abortion rates during this time period because these states account for only 17% of female adolescents, and abortion rates also declined during this time period for other groups not affected by such restrictions. The pregnancy rate for adolescents aged 15-19 fell from 91 per 1,000 in 1994 to about 72 per 1,000 in 2000. The proportion of adolescent pregnancies ending in abortion was similar in both years—35% in 1994 and 34% in 2000, indicating that adolescent abortion rates did not decline between 1994 and 2000 because more teenagers were carrying their pregnancies to term. The decline in adolescent pregnancy may be a continuation of a trend toward more consistent use of contraceptives and use of more effective methods as well as decreases in sexual activity among at least some subgroups.
  • Economically disadvantaged women, who had high abortion rates in both 1994 and 2000, were the only group we examined whose abortion rate increased substantially during this period. Given that poverty is susceptible to measurement error, actual changes in abortion rates by poverty status may have been less drastic than our analysis suggests. Nonetheless, our findings demonstrate that abortion rates increased for economically disadvantaged women and women on Medicaid, while they decreased for middle- and higher-income women.
  • The decline in the number of women covered by Medicaid, and the parallel increase in the number with no insurance, was not accompanied by increased funding for free or low-cost family planning services. In fact, funding for Title X, the largest source of public funding for contraceptive services for women not covered by Medicaid, remained stable between 1994 and 1999 once inflation is taken into account. As a result, economically disadvantaged women may have had more difficulties accessing family planning services during this time period.
  • Black and Hispanic women are more likely than white women to be economically disadvantaged, and this partially explains their higher abortion rates. Within all three racial and ethnic groups, there is a clear association between poverty status and abortion, the abortion rate being higher among poor and low-income women than among those with incomes greater than 200% of poverty. However, economic status, as measured by poverty status, does not explain all the differences between racial and ethnic groups. Except in the lowest poverty-status group, black women have the highest abortion rates, followed by Hispanic women, and the lowest rates occur among white women. In 1994, the higher abortion rate among black women reflected primarily a rate of unintended pregnancy much higher than those among white and Hispanic women, as well as a somewhat higher proportion of unintended pregnancies ending in abortion. Black, Hispanic and white women at risk of unintended pregnancy have roughly similar levels of contraceptive use, but nonpoor black women using reversible methods have higher levels of contraceptive failure than do similar white and Hispanic women. Thus, the high levels of abortion among black women across economic statuses also point to a need for greater assistance in preventing unintended pregnancies.

“Contraceptive Use Among U.S. Women Having Abortions in 2000-2001” (November/December 2002)Edit

Rachel K. Jones, Jacqueline E. Darroch, Stanley K. Henshaw; “Contraceptive Use Among U.S. Women Having Abortions in 2000-2001” Volume 34, Issue 6, (November/December 2002)

  • Some 45 of every 1,000 women aged 15–44 in the United States had an unintended pregnancy in 1994 (the latest year for which data are available). The high level of unintended pregnancy can be attributed to three factors: the failure of couples at risk of unintended pregnancy to practice contraception, incorrect or inconsistent use of contraceptive methods, and method failure among those practicing contraception correctly and consistently.
    Approximately one-half of unintended pregnancies end in abortion. A substantial minority of women having abortions—42% in 1994–1995 and 49% in 1987—became pregnant because they and their partners were not using a contraceptive method. It is unknown, however, what proportion of pregnancies among method users were due to inconsistent or incorrect contraceptive use and what proportion were accounted for by method failure.
    • p.294
  • More than half of women obtaining abortions in 2000 (54%) had been using a contraceptive method during the month they became pregnant. This figure is slightly lower than the proportion of women having abortions in 1994 who had been contraceptive users (58%), but slightly higher than the proportion reported in 1987 (51%). In 2000, approximately 15% of women had been using the most effective methods—1% used long-acting methods (sterilization, the IUD, implants or injectables) and 14% the pill. Twenty-eight percent of all women having abortions had used the male condom, down from 32% in 1994 (the only method to decline by more than three percentage points). Withdrawal and periodic abstinence had been used by roughly one in 10 women having abortions.
    • p.296
  • Women using no contraceptive method made up a larger proportion of women having abortions than of all women at risk of unintended pregnancy (46% vs. 7%), mainly because the likelihood of pregnancy is extremely high among fertile, sexually active women when they do not use a contraceptive method. In contrast, a substantially lower proportion of women having abortions than of all women at risk of unintended pregnancy had used sterilization and other long-acting methods (1% vs. 41%), which reflects the very high rates of use-effectiveness of these methods. Pill users were underrepresented among women having abortions, whereas women using condoms and withdrawal were overrepresented. These patterns reflect the fact that women using oral contraceptives are more successful in avoiding accidental pregnancy than are those who rely on barrier or nonprescription methods.
    • p.296
  • The proportion of women having abortions who had not been using a contraceptive when they became pregnant varied across social and demographic subgroups from 37% to 54% (Table 2). Bivariate analyses reveal that adolescents and women aged 20–24 were significantly more likely than women aged 30 or older to be nonusers (47–50% vs. 44%). Decreases in income and education are associated with in-creased contraceptive nonuse: Women with family incomes below 300% of the federal poverty level were more likely than women with higher incomes not to be using a method of birth control in the month they became pregnant (45–52% vs. 40%), and women with less than a college degree were significantly more likely than college graduates to be nonusers (41–54% vs. 37%). Blacks, Hispanics and women of other races and ethnicities were more likely than whites to be nonusers (50–52% vs. 39%). Union status was barely associated with nonuse of contraception. Women who were the most likely to be nonusers were also the most likely never to have used a contraceptive method. For example, adolescents were more likely than women aged 30 or older to have never practiced contraception (12–19% vs. 7%).
    • pp.296-297
  • On the basis of our survey findings, we estimate that of the 1.3 million women who underwent induced abortions in 2000, 608,000 had not been using a contraceptive method around the time they became pregnant, 610,000 had been using a method but not consistently or correctly, and 95,000 had thought they were using the method perfectly but became pregnant because of method failure.* Although these estimates are based solely on women’s retrospective reports and perceptions of why they became pregnant, they raise issues that are common among all contraceptive users and thus need to be addressed.
    • p.301
  • Method failure rates during perfect use are quite low for oral contraceptives and male condoms (0.1–0.5% and 3%, respectively, in the first year of use). Previous research has found that some women overreport compliance with contraceptive regimens, and women having abortions may have overreported perfect method use. Nonetheless, the potential number of unintended pregnancies due to method failure is quite large. In 1995, 10 million women were using

the pill, and eight million the condom. If all 10 million women using the pill did so perfectly over the full year, 0.1–0.5%, or 10,000–50,000 users, would have become pregnant. Similarly, if all eight million condom users used the method perfectly for the year, 3%, or 240,000, would have become pregnant. These estimates confirm the validity of the number of abortions that women attributed to method failure during perfect use (95,000). This finding underscores the importance of providing women and their partners with information and services they need to select methods with which they are most likely to be successful, as well as the continuing need for development of additional method choices.

    • p.301
  • Nearly one-fifth of all women having abortions—one in three nonusers and one in five condom users—were not using a contraceptive method or were using it inconsistently because of a perceived low risk of pregnancy. Some of these women may have assumed they were having intercourse in a “safe time” in their menstrual cycle; others may have thought their risk of pregnancy was low because they were postpartum or breastfeeding. Furthermore, some may have simply perceived the risk of becoming pregnant to be low, and some may have thought they or their partner was sterile. The frequency of perceived low risk for pregnancy among women who had abortions shows that women and their partners need accurate information about the probability of conception when contraception is not used, the variability of fertility cycles and the importance of consistent contraceptive use.
    • p.302
  • Twenty-seven percent of contraceptive nonusers and 13% of condom users—or 16% of all women having abortions— became pregnant because they were not expecting to have sex. Ambivalence about contraception had been experienced by 22% of nonusers, and small proportions of pill and condom users indicated that they did not care or they “didn’t feel like” using their method. Very few women indicated that ambivalence about childbearing intentions had directly influenced their contraceptive use, but among women who had used condoms in the month they became pregnant, those who intended to have a child or more children were more likely than those who did not to report inconsistent condom use or condom breakage or slippage.
    • p.302

"Abortion Incidence and Service Availability in the United States, 2017" (2019)Edit

Jones, Rachel K.; Witwer, Elizabeth; Jerman, Jenna (2019)."Abortion Incidence and Service Availability in the United States, 2017". Guttmacher Institute. doi:10.1363/2019.30760.

  • In 2017, an estimated 862,320 abortions were provided in clinical settings in the United States, representing a 7% decline since 2014 and the continuation of a long-term trend.
    *The U.S. abortion rate dropped to 13.5 abortions per 1,000 women aged 15–44 in 2017, the lowest rate recorded since abortion was legalized in 1973. Abortion rates fell in most states and in all four regions of the country.
    *A total of 339,640 medication abortions occurred in 2017—about 39% of all abortions.
    *As in previous years, clinics provided the overwhelming majority of U.S. abortions (95%), while private physicians’ offices and hospitals accounted for 5%.
  • Although the number of state abortion restrictions continued to increase in the Midwest and South between 2014 and 2017, these restrictive policies do not appear to have been the primary driver of declining abortion rates. There was also no consistent relationship between increases or decreases in clinic numbers and changes in state abortion rates.
    * Fertility rates declined in almost all states between 2014 and 2017, and it is unlikely that the decline in abortion was due to an increase in unintended births.
    *Factors that may have contributed to the decline in abortion were improvements in contraceptive use and increases in the number of individuals relying on self-managed abortions outside of a clinical setting.
  • Abortion surveillance in the United States is an important public health indicator that is needed to estimate pregnancy rates, and it can also serve as a measure of access to reproductive health care. Between 2011 and 2014, the U.S. abortion rate declined from 16.9 to 14.6 abortions per 1,000 women aged 15–44, the lowest rate ever recorded and the continuation of a decades-long trend. Still, in 2014, almost one in five pregnancies ended in abortion, and given abortion rates in that year, an estimated one in four U.S. women will have an abortion in their lifetime. These statistics demonstrate that abortion is not uncommon.
  • The Supreme Court of the United States recognized the constitutional right to abortion in 1973 in Roe v. Wade. In the decades since, the Court has continued to affirm the fundamental right to abortion, including in 1992 in Planned Parenthood v. Casey and in 2016 in Whole Women’s Health v. Hellerstedt.3,4 Despite existing precedents, states have continued to find ways to restrict or ban abortion, enacting more than 227 restrictions between January 2014 and June 2019.5 More than a dozen cases challenging some of the most extreme restrictions—such as bans on abortions after six weeks’ gestation—currently have the potential to reach the Supreme Court, and the outcomes could pose significant challenges to the legal framework protecting abortion rights. If the Court undermines or overturns Roe v. Wade, this will likely exacerbate existing disparities in abortion access and may allow individual states to explicitly or effectively ban abortion altogether. Although prior research has not found state policy to be the primary driver of the decline in the national abortion rate, abortion bans would undoubtedly prevent many individuals from obtaining abortion care in clinical settings.
    Documenting changes in the number of health care facilities that provide abortion is also an important activity, as the number of facilities can directly affect the availability and accessibility of care. In 2014, the vast majority (95%) of abortions were provided by clinic facilities, while 4% were provided by hospitals and 1% by private physicians’ offices. Between 2011 and 2014, the number of clinics providing abortions had declined by 6%. These declines were steepest in the Midwest and South (22% and 13%, respectively), regions that had also enacted the most abortion restrictions. Still, the 2014 study did not identify a clear association between changes in clinic numbers and state abortion rates between 2011 and 2014; for example, the declines in abortion rates in some states that had lost one-third or more of their clinic facilities mirrored, or were smaller than, the national decline. Updated national data suggest that the overall number of facilities providing abortion did not change much between 2014 and 2017, but state and regional patterns of clinic closures may reveal meaningful patterns in availability of and access to services over time.
  • The total number of abortions, the abortion rate and the abortion ratio in the United States all declined between 2014 and 2017. In 2017, 862,320 abortions were provided in clinical settings, a 7% decline from 2014. The 2017 abortion rate of 13.5 abortions per 1,000 women aged 15–44 represented an 8% decline from 2014. Just under one in five pregnancies (births and abortions), 18.4%, ended in abortion in 2017.
    While abortion incidence and rates declined in most states, the degree of change varied substantially. Declines in abortion rates were largest in Delaware, Arkansas, West Virginia, Alabama and Virginia; most of these states also had abortion rates substantially lower than the national rate in 2014, so even a small change in this measure can seem large. Abortion rates increased in Mississippi, New Jersey, Minnesota, Georgia, Maryland and Wisconsin. While abortion rates declined in all four regions, the drop was steepest in the West (14%). Indeed, states considered to be supportive of abortion rights in 2017—including large states such as California and New York—accounted for 43% of all U.S. abortions in that year but 55% of the decline since 2014.
    Areas with the highest abortion rates in 2017 were the District of Columbia, New Jersey, New York, Maryland and Florida. Rates were lowest in Wyoming, South Dakota, Kentucky, Idaho and Missouri. Notably, our study measures abortion by state of occurrence and does not account for individuals crossing state lines for abortion care; in the five states with the lowest rates, 28% or more of individuals go out of state to obtain abortions.
  • In 2017, 1,587 health care facilities were known to have provided abortions, a 5% decline from 2014. Changes in the overall number of facilities over time varied by facility type. The number of hospitals providing abortions declined by 19%, from 638 to 518. This decrease was largely attributable to California, where 114 hospitals that provided 633 abortions in 2014 reported zero procedures in 2017 (data not shown). California hospitals accounted for the same proportion of abortions in the state in both years (5%).
  • In 2017, 89% of U.S. counties did not have a clinic facility that provided abortion care, and 38% of women aged 15–44 lived in these counties; these figures are comparable to those found in 2014—90% and 39%, respectively. In five states, fewer than 10% of women lived in a county without a clinic facility: California, Connecticut, Hawaii, Nevada and New York. In Mississippi and Wyoming, more than 90% of women lived in a county without such a clinic.
  • In 2017, 339,640 medication abortions were provided in nonhospital facilities, a 25% increase from 2014. Medication abortion accounted for 39% of all abortions. Assuming that health care providers followed the FDA-recommended regimen that allows mifepristone to be administered up to 10 weeks’ gestation, we estimate that 60% of all eligible abortions were early medication abortions (data not shown). The majority of medication abortions were provided by specialized clinics and at high-volume facilities (those with annual caseloads of more than 1,000 abortions).
  • Between 2014 and 2017, abortions provided in clinical settings in the United States continued to decline. The 2017 rate of 13.5 abortions per 1,000 women aged 15–44 is the lowest recorded since abortion was legalized nationally in 1973 and is 54% lower than the peak rate of 29.3 per 1,000 in 1980. The decline was seen across all four regions and most states.
    One factor that can contribute to declines in abortion is a reduction in the number of facilities providing this care. While hospitals and physicians’ offices constituted a substantial share of abortion-providing facilities, the overwhelming majority of abortions, 95%, were provided by clinics
  • All 10 states that had a meaningful increase in clinic numbers also showed declines in their abortion rates. Most of the new facilities, or facilities that had not previously provided abortions in these states, were nonspecialized clinics, suggesting that the concurrent expansion of abortion care and decrease in abortion rates was taking place in the context of an increase in comprehensive health care.
    While the decline in the number of clinics providing abortion care in some states likely prevented some patients from obtaining wanted abortions, other factors also contributed to the decline in the abortion rate. Fertility rates declined in virtually all states between 2014 and 2017, suggesting that the drop in abortions was not compensated for by an increase in births. Rather, declines in reported abortions could be related to at least two other factors: self-managed abortion and a decline in pregnancy rates.
  • The majority of patients obtaining abortions are poor or low-income, many lack health insurance that will cover the procedure, and many live in states with numerous abortion restrictions.
    These factors, along with the increased accessibility of resources to help individuals safely self-manage their abortions outside of a clinical setting, likely account for some of the decline in abortions that we have documented. However, one national survey of U.S. adult women, conducted in 2017, found that only 1.4% reported ever having attempted to end a pregnancy on their own. Moreover, 24% of these instances had occurred prior to 2000, and only 28% were reported to have been successful. Abortion is underreported on surveys of this type, and the actual incidence may be higher, but it is nonetheless unlikely that even a substantial increase in self-managed abortion can account for the majority of the decline in abortion incidence nationally during the study period.
    The decline in births and abortions also means that fewer people were getting pregnant. Improved contraceptive use is one factor that could have contributed to this change. The most recent national data suggest that between 2014 and 2016, the proportion of women aged 15–44 using long-acting reversible contraceptive methods increased by 23%, from 13% to 16%; levels of sterilization were 25% and 26%, respectively. Greater reliance on highly effective methods appears to have been balanced by a drop in the use of hormonal methods such as the pill and the injectable (Depo) which, combined, declined from 29% to 25% of all contraceptive use. Still, it is possible that a decline in contraceptive failures could have reduced the incidence of unintended pregnancy. Additionally, state-level efforts to increase access to long-acting reversible contraceptive methods may have had a measurable impact, particularly in states with higher-than-average abortion rates.
  • Our study measured abortion by state of occurrence, but many patients cross state lines to obtain care. For example, CDC data for 2015 suggest that 28% of abortions reported to have occurred to residents of Idaho and 83% of those to residents of Wyoming were obtained in other states. Similarly, though the District of Columbia (DC) had the highest abortion rate in the country in 2017, the majority of abortions provided in DC in 2014 were for nonresidents, most commonly individuals from Maryland or Virginia.
  • Declines in abortion were seen in all four regions of the United States, including in states with policy landscapes that were both restrictive toward and supportive of abortion rights. However, access to abortion, when measured by the number of clinic facilities in a state, has become more polarized across regions of the country. The overall number of clinics increased in the Northeast and the West but declined in the Midwest and the South; in addition, more states (all in the Midwest or the South) have only one clinic remaining. These patterns demonstrate that the existence of more clinic facilities does not necessarily translate to an increase in abortion rates. Rather, an increase in clinic numbers likely represents greater access to health care in general, enabling patients to travel shorter distances, obtain abortion care in nonspecialized settings and perhaps obtain contraceptive care more easily.
    Medication abortion plays an integral role in abortion care, having accounted for 39% of all abortions in 2017 and more than half of abortions occurring prior to 10 weeks’ gestation. The availability of mifepristone not only allows some patients to choose between types of abortion procedure, but also lends itself to innovations in health care delivery models, such as telemedicine. For this reason, the landscape of abortion provision and access in the United States may change as these innovations spread. In addition, the increased availability of highly effective and affordable abortion pills via the internet has the potential to substantially increase access to abortion, for which future surveillance efforts will need to account. It will also be important to ensure that policies and funding promote access to all methods of abortion, so that people seeking this care are able to obtain the care that is best for them.
    As abortion service delivery and utilization continue to be restricted at the state level, documentation of abortion incidence, abortion rates and numbers of service sites is necessary to establish baselines and measure trends in a changing health care landscape.

"The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review" (April 2009)Edit

Theodore J. Joyce; Stanley K. Henshaw; Amanda Dennis; Lawrence B. Finer; Kelly Blanchard (April 2009). "The Impact of State Mandatory Counseling and Waiting Period Laws on Abortion: A Literature Review" (PDF). Guttmacher Institute. Archived from the original (PDF) on 16 March 2012. Retrieved 31 December 2010.

  • Proponents of mandatory counseling and waiting period laws argue that the state has a duty to ensure that before a woman decides to terminate a pregnancy she has been given ample time, after having been given information about her pregnancy and abortion, to weigh her options. Those opposed to these laws argue that such statutes are unneeded because physicians are required to obtain informed consent before all procedures (including abortion), that the laws impose an unnecessary burden on women who are seeking abortions and that women are able to make informed decisions about terminating a pregnancy without the imposition of a state-mandated waiting period. Opponents further argue that mandatory counseling and waiting period laws serve no medical purpose and are a ruse to decrease the accessibility of abortion.
    • p.3
  • Evaluators of mandatory counseling and waiting period laws face many of the same challenges that confront researchers of other state policies that affect access to abortion services, such as parental involvement laws and Medicaid financing of abortions.‡ For instance, national data on abortion compiled by the Centers for Disease Control and Prevention are collected by state of occurrence and not by state of residence. Using abortion data by state of occurrence to evaluate a mandatory counseling and waiting period law can lead to spurious findings if women leave their state of residence for an abortion, and if nonresidents stop coming into a state for the procedure, once the law is enforced. The problem is exacerbated by the relatively few states (seven*) that enforce the strictest form of a mandatory waiting period law—requiring in-person counseling at least 18 hours prior to the procedure—since women can travel to nearby states if they want an abortion without a required delay. In addition, mandatory counseling and waiting period laws affect women of all ages and incomes, not just minors or those eligible for Medicaid. However, older, nonpoor women have more education and are more likely to have independent income, their own means of transportation and other resources that could make accessing services in other states a more feasible option. For the results of an evaluation to be valid, therefore, researchers should demonstrate that few women left their state of residence to obtain an abortion in response to laws of this kind, or if they did, the researcher must be able to include in the analysis abortions obtained by a state’s residents in other states.
    • pp.3-4
  • Distinguishing short-term from longer-term effects of a law is another challenge. A mandatory counseling and waiting period law may cause an initial drop in abortion rate or a rise in the rate of second-trimester abortions. However, as more women become aware of the law and as more clinics improve scheduling and administration of the counseling, the “costs” associated with compliance may fall, along with the law’s impact on outcomes. In any case, it is very difficult to credibly link longer-term declines in abortion or the timing of abortion to the impact of a law, given the likelihood of confounding from other factors that influence abortion rates.
    • p.5
  • Early qualitative assessments of experiences with mandatory counseling and waiting period laws found that abortion patients and providers were burdened in multiple ways by the legislation. Women who had obtained an abortion described negative physical and mental health consequences, such as physical discomfort and mental distress. Women also reported increased burdens from having to visit clinics multiple times and having to travel out of state to a provider who was not affected by such laws. Interviews with providers suggested that many struggled to adjust to the laws immediately after implementation. These early findings make intuitive sense, as any change in this type of regulation will have some effect on providers and patients, particularly as the logistics of meeting the new requirements are being worked out. But it is important to note that these studies were conducted in a limited geographic area and included a relatively small number of women and providers. Despite the limited generalizability of these qualitative studies, they are valuable because they are the only ones to evaluate mandatory counseling and waiting period laws using such methods.
    • p.15
  • The results from Mississippi were the most convincing. Overall, the state’s mandatory counseling and waiting period statute—with its requirement that all counseling be done in person 24 hours prior to an induced termination—was associated with a decline in the abortion rate, a rise in abortions obtained out of state and an increase in the proportion of second-trimester abortions. These findings were consistent across three studies, each with a distinct research design.
    • p.15
  • The broader analyses that included data from all available states found that counseling and waiting period laws had no impact on abortion rates or birthrates. Most laws are less demanding than that of Mississippi, and it is probably safe to conclude that if they affect reproductive outcomes, the effect is not large. However, the possibility of unmeasured confounding variables and other limitations of the studies preclude ruling out small effects. A corollary finding is that mandatory counseling also has little effect on women’s abortion decisions. Since states require that specific information be provided to the woman before the waiting period, if the delay has no effect, then neither does the mandated counseling.
    • p.15
  • We conclude that mandatory counseling and waiting period laws that require an additional in-person visit before the procedure likely increase both the personal and the financial costs of obtaining an abortion, thereby preventing some women from accessing abortion services. If neighboring states have similar laws, so that access to an abortion provider who does not require this strict form of waiting period requires extensive travel, then such laws are likely to lower abortion rates, delay women who are seeking abortions and result in a higher proportion of second-trimester abortions. Laws that allow mandatory counseling to be delivered over the Internet or by mail or telephone impose lower costs on both patients and providers, and neither the waiting period requirement nor the counseling appears to have a large impact on reproductive outcomes. However, by definition such statutes do cause some delay, and the one study that addressed this issue found a 41% increase in the rate of second-trimester abortions.6 While this might not be an accurate measure of the magnitude of the effect, it is likely that some abortions are delayed to the second trimester.
    • p.15

”Abortion and the Politics of Motherhood” by Kristin Luker, University of California Press, (1984)Edit

  • At the opening of the nineteenth century, no statue laws governed abortion in America. What minimal legal regulation existed was inherited from English common law tradition that abortion undertaken before quickening was at worst a misdemeanor. ‘’Quickening’’, as that term was understood in the nineteenth century, was the period in pregnancy when a woman felt fetal movement though it varied from woman to woman (and even from pregnancy to pregnancy in the same woman), it generally occurs between the fourth and the sixth month of pregnancy. Consequently, in nineteenth-century America, as in medieval Europe, first trimester abortions and a goodly number of second trimester abortions as well, faced little legal regulation. Practically speaking, the difficulty of determining when conception had occurred, combined with the fact that the only person who could reliably tell when the pregnancy had “quickened” was the pregnant woman herself, meant that even this minimal regulation was probably infrequent. In 1809, when the Massachusetts state Supreme Court dismissed an indictment for abortion because the prosecution had not reliably proved that the woman was “quick with child,” it was simply reiterating traditional common law standards.
    In contrast, by 1900 every state in the Union has passed a law forbidding the use of drugs or instruments to procure abortion at any stage of pregnancy, “unless te same be necessary to save the woman’s life.” Not only were those who performed an abortion liable for a felony (usually manslaughter or second degree homicide), but in many states, the aborted woman herself faced the possibility of criminal prosecution, still another departure from the tolerant common law tradition in existence at the beginning of the century.
    Many cultural themes and social struggles lie behind the transition from an abortion climate that that was remarkably open and unrestricted to one that restricted abortions (at least in principle) to those necessary to save the life of the mother. The second half of the nineteenth century, when the bulk of American abortion laws were written, saw profound changes in the social order, and these provided the foundation for dramatic changes in the status of abortion Between 1850 and 1900, for example the population changed from one that was primarily rural and agricultural to one that was urban and industrial, and birth rate fell accordingly, declining from an estimated average completed fertility for whites of 7.04 births per woman in 1800 to an average of 3.56 births in 1900. The “great wave” of American immigration occurred in this period, as did the first feminist movement.
    • pp.14-15
  • The most visible interest group agitating for more restrictive abortion laws was composed of elite or “regular” physicians, who actively petitioned state legislatures to pass anti-abortion laws and undertook through popular writings a campaign to change public opinion on abortion. The efforts of these physicians were probably the single most important influence in bringing about nineteenth-century anti-abortion laws. (Ironically, a century later it would be physicians who would play a central role in overturning these same laws.)
    • p.16
  • With respect to abortion, as with respect to physicians, modern-day stereotypes about the nineteenth century can easily lead us astray. Contrary to our assumptions about “Victorian morality,” the available evidence suggests that abortions were frequent. To be sure, some of these abortions may have been disguised (or rationalized) by those who sought them. Early in the century, a dominant therapeutic model saw the human body as an “intake-outflow” system and disease as the result of some disturbance in the regular production of secretions. Prominent among medical concerns, therefore, was “blocked” or “obstructed” menstruation, and the nineteenth-century pharmacopoeia contained numerous emmenagogues designed to “bring down the courses,” that is, to reestablish menstruation. However, since the primary cause of “menstrual obstruction” in a health and sexually active woman was probably pregnancy, at least some of these emmenagogues must have been used with the intent to cause an abortion. Especially in the absence of accurate pregnancy tests, these drugs could be used in good faith by physicians and women alike, but the frequent warnings that these same drugs should not be used by “married ladies” because they would cause miscarriage made their alternative uses quite clear.
    Similarly, newspaper advertisements for patent medicines designed to bring on “suppressed menses” were common during the era; according to a number of sources, such advertisements appeared even in church newspapers. Discreet advertisements for “clinics for ladies” where menstrual irregularities “from whatever cause” could be treated (and where confidentiality and even private off-street entrances were carefully noted in the advertisement itself) were common.
    • p.19
  • As the noted medical historian Richard Shryock has observed: “One of the most striking and common forms of quack advertising in the United States was that of abortifacient drugs; a fact which seems hardy consistent with out notion of Victorian propriety. . . . The common form of the ‘ads’ was something of this sort: ‘Dr,-‘s Female Pills, one dollar a box, with full discretions. Married ladies should not use them. Sent by mail.’ “ Shryock validates a commonly heard complaint by noting: “Similar announcements and other quack appeals filled not only the daily and weekly papers, but the ‘family newspapers’ and even the religious press.”
    Aside from the use of these emmenagogues to bring on “delayed” menstruation, various attempts were made during this period to estimate the frequency of induced abortion as we not understand it. These estimates were primarily the work of physicians who wanted to convince the public that abortion was a problem of great magnitude, and so their estimates must be treated cautiously. Nonetheless, estimates from differing sources yield roughly comparable results. An Ohio medical investigation concluded that one-third of all “live births” (sic) ended in induced abortion. Dr. Horatio Storer, one of the most visible anti-abortionists of the era, estimated that there was one abortion for every four pregnancies; a survey of Michigan physicians found between 17 and 34 percent of all pregnancies ending in abortion; and an 1871 American Medical association committee concluded that 20 percent of all pregnancies were deliberately aborted.
    • p.19
  • This tolerant common-law standard was still in effect in nineteenth century America when state legislatures began to pass the very strict anti-abortion laws that the Supreme Court later overturned in Roe v. Wade. Indeed, as James Mohr writers, “American courts pointedly sustained the most lenient implication of the quickening doctrine even after the British themselves had abandoned them.”
    I shall return to this point shortly. For the moment, note as well that the Catholic position was still undergoing change. In 1591, Pope Gregory XIV restricted the penalty of excommunication to only those responsible for aborting an animated fetus. Starting in the seventeenth century, however, increasing medical knowledge about reproduction and embryology leg to growing doubts about the doctrine of delayed animation. Fetal growth appeared more and more a continuous matter, with no significant breaks between conception and birth. In 1863, Ferdinand Kember discovered that conception is produced by the male sperm entering the female ovum. Since, in Aristotelian doctrine, the male sperm carries the soul, this discovery implied that ensoulment takes place at conception. Increasingly, the Roman Catholic Church insisted that abortion is gravely wrong at any point after conception. In 1869 Pope Pius IX removed the distinction between animated and unanimated fetuses from the canon law, this providing excommunication for causing abortion at any stage of fetal development.
    • p.23
  • In the new American nation, because the lenient common-law standard prevailed, the situation at the beginning of the 19th century was quite tolerant regarding abortion. “Consequently” writers Luker, “in nineteenth-century America, as in medieval Europe, first trimester abortions, and a goodly number of second trimester abortions as well, faced little legal regulation” Numerous home medical manuals-frequently written expressly for women-contained information about how to induce abortion, often in the form of advice on how to remove blockages to normal menstrual flow. Among tese were William Buchanan’s Domestic Mediine (probably the most widely consulted one; continually reprinted from 1782 through 1850), Samuel K. Henning’s Married Lady’s Companion (which “had its second printing in 1808 and was intended for women in rural areas”), Joseph Brevitt’s Female Medical Repository (1810), and Thomas Ewell’ Letter to Ladies (1817). Ewell was “a surgeon at Navy Hospital in Washington, D.C. . . . , who wrote forthrightly about unblocking obstructed menses.” Like the other books just mentioned, Ewell’s
    urged hot sitz baths, doses of aloe, and a number of training exercises. Walking, horseback riding, and jumping, the more the better, ll helped bring on abortion, he counseled, especially at the tie menses would normally have occurred had the last period not been missed. Ewell [also[ thought electricity through the thighs might end a suppression [of menstrual flow[ and that light bleeding could be beneficial. To those rather elemental staples Ewell added some medically more advanced ideas including internal douching with trong brandy, water as hot as could be tolerated, vinegar, wine, or strong brine.
    • pp. 23-24
  • In addition to early-nineteenth-century home medical manuals, Americans seeking information about abortifaients, as well as abortion themselves could consults midwives and herbal healers (“so-called Indian doctors”). Mohr speculates that, because of the impossibility of confidently diagnosing pregnancy in its early stage and because of the common acceptance of procedures to treat for amenorrhea (blocks menses), many regular (formally trained or apprentices) physicians performed early abortions. And, says Mohr, “this practice was neither morally nor legally wrong in the eye of the vast majority of Americans, provided it was accomplished before quickening.” Leslie Reagan maintains that both the willingness of physicians (in private) to perform early abortions and the popular view that these abortions were morally acceptable continued throughout the period of legal repression that was to come.
    • pp.24-25
  • The first American statue concerning abortion was enacted by Connecticut in 1821. Prior to that date, there appears to have been no prosecution of abortion under the common law. The Connecticut statute itself did little more than restate the common-law rule as interpreted by Blackstone, inasmuch as it provided punishment only for abortions performed after quickening. Over the next two decades, seven more states passed abortion laws similar to Connecticut’s.
    Things began to change in the 1840s. According to Mohr, “Medical writers throughout the period [agreed] unanimously . . . that the incidence of abortion rose dramatically around 1840.” Moreover, abortion became more publicly visible. “During the 1840s, Americans . . . learned for the first time not only that many practitioners would provide abortion services, but that some practitioners had made the abortion business their chief livelihood. Indeed, abortion became one of the first specialties in American medical history[!] The business of selling abortifacient medicines also boomed, as evidenced by the rising number of advertisements for such products as “Madame Restell’s Female Pills,” each said to produce miscarriage, though this advice was sometimes couched as a “warning” to pregnant women not to take the pills.
    Also starting in the 1840s, there was a change in the social character of abortion, or at least in the perception of its social character. Whereas, prior to this era, abortion had been seen as the recourse of unmarried women desperate to avoid the stigma of unwed motherhood, now it seemed that more married women were resorting to abortion to limit family size. This, at least, was the opinion widely held by regular physicians. Regular physicians also believed that abortion was far more prevalent among Protestant women than among Catholics and, though numerous immigrant abortionists catered to other immigrants, more prevalent among native-born than among immigrant women. Similarly, the medical profession was sure that the practice was growing among middle- and upper-class women, and the relatively high pries of the procedure supply some support for this view. There is demographic evidence of a steep drop in the birthrate for native-born women (as distinct from immigrant women) after 1840, a drop large enough to lead to an overall decline in the birthrate throughout the nation compared to earlier in the century. However, the evidence that this was due to abortion is based largely on the opinions of regular physicians, who were, s we shall see, not disinterested observers.
    • pp.25-26
  • In 1840, Maine became the first state to clearly prohibit abortion at any stage of pregnancy. It’s statute provided: <br Every person, who shall administer to any woman pregnant with child, whether such child be quick or not, any medicine, drug or substance whatever, or shall use or employ any instrument or other means whatever, with intent to destroy such a child, and shall thereby destroy such child before its birth, unless the same shall have been done as necessary to preserve the life of the mother, shall be punished by imprisonment in the stae prison, not more than five years, or by fine, not exceeding one thousand dollars, and imprisonment in the county jail, not more than one year.
    This statute was still in force when the U.S. Supreme Court issued its decision in Roe v. Wade 113 year later. Note that, though the statute treats abortion as a crime at any time after conception, it does not treat it as equivalent to murder. The penalties are much lighter than those normally provided for murder, and an exception is allowed for abortions needed to save the life of the pregnant woman. Moreover, at least until the 1850s, successful prosecutions for pre-quick abortions under this and similar laws were extremely rare due to the difficulty of proving intent In light of the presumed legitimacy of operations to remove “unnatural obstruction of the menses,” it was necessary to prove that the alleged abortionist intended to abort the fetus rather than only to restore menstrual flow.”
    New laws, although still relatively lenient, began to be passed in other states In 1845, Massachusetts made attempted abortion a misdemeanor and, if the attempt resulted in the death of the woman, a felony. However, the law was not very effective. “Between 1849 and 1857 there were only thirty-to trials in Massachusetts for performing abortions and not a single conviction.” New York also passed new abortion legislation in 1845 Its law made no reference to quickening and took “the unprecedented step” of making women “liable for seeking and submitting to an abortion or for performing one upon [themselves].” But this provision was never enforced against women in the nineteenth century. Mohr speculates that the aim of the law was to get at commercial abortionists and that the innovation of ending the immunity that women had had under the common law was due to belief that abortion was no longer limited to desperate unmarried women who were unlikely to be deterred by legal threat.
    Michigan in 1846, Virginia in 1848, and New Hampshire in 1849, made abortion at any stage punishable, nut provided severer penalties if it occurred after quickening. Other states and even federal territories passed anti-abortion statues in the 1850s. The anti-abortion laws passed between 1840 and 1860 were, according to Mohr, “limited and cautious” responses to the increased number and visibility of abortions that characterized the period: “[O]nly three states stuck the immunities traditionally enjoyed by American women in cases of abortion. . . . [A]nd thirteen of the thirty-three states in the Union by 1860 had yet to pass any statutes on the subject of abortion.” Mohr writes, “The advent of more comprehensive and forceful anti-abortion laws throughout the United States still awaited a major campaign. . . on the part of a politically conscious organization with a vested interest in placing . . . less permissive statutes on the books.”
    • pp.26-27
  • Reformers were becoming more vocal about the problems of criminal abortion at a time when criminal abortion was probably becoming less lethal to women. Largely because of the increasing use of antibiotic drugs, overall maternal mortality had been steadily declining for many years and had begun to drop dramatically after World War II. For example between 1915, and 1919 there were 727.9 maternal deaths nationwide per 100,000 live births. In 1945, by contrast, there were only 207.2 such death, and by 1960 there were only thirty-seven maternal deaths per 100, 000 live births.
    • p.74
  • The presence of a strict law satisfied those who wanted to believe that virtually all abortions should be outlawed whereas the much broader interpretation of the law in actual medial practice satisfied those who felt that embryos were only potential persons and that embryonic rights were far less compelling than the rights of mothers. Since the fundamental ideological differences between the two views were hidden from the public ( to be weighed in individual cases by individual doctors), this form of compromise worked reasonably well for many years.
    It is therefore of great historical importance that in the early 1960s the efforts of the first reform constituency-the persons concerned with the problems of illegal abortion-came to be supported by a more actively involved interest group whose stake in the issue was more direct. This new group prefigured by the two obstetricians who testified at the 1962 hearings, was composed of physicians who saw the ideological consensus within the medical profession breaking down and sought to have explicit new ground rules on abortion spelled out.
    The consensus was being broken down by several forces. First, and probably foremost, was the improvement in obstetrical science, which by the 1950s had virtually eliminated the need to perform abortions simply in order to save the life of the mother. In California, as elsewhere, abortions were usually undertaken because of psychiatric indications. For reasons outlined in the previous chapter, once the “cover” of strictly medical conditions began to evaporate, physicians began to make abortion decisions that were perceived by their colleagues and the general public alike as less “technical” than moral.
    • pp.76-77
  • Here is how one physician, who became one of the earliest and most prominent abortion law reformers of the early 1960s, described the situation in the 1950s:
    I wasn’t really interested in reshaping the law; ‘’I considered what I was doing was acting within the law then.’’ You have to realize we lived in an entirely different legal climate then. . . . There were malpractice, illegal activity, and professional liability aspects, but [they were[ relatively rare. It should have to be that somebody died [in an abortion] under most unusual circumstances. Doctors were not being sued like they are now, but there was always the rumbling in the background- “if the district attorney hears about this, we might be faced with criminal charges.” . . . When we’d consult [our lawyers] and say, “We think this patient should be aborted, but we don’t know if this is life-threatening or not,” they’d say, “Well, you might be sued” You don’t know anything about the disease and its relation to pregnancy. What effect does the pregnancy have on the disease? What effect doe the disease have on the pregnancy? And so we would go ahead on the basis that it was a life-threatening disease or situation. But [such cases] were rare, you might have one or two in the hospital in a year, and it took a great deal of work to accumulate even six or eight cases. But there was always the implication in the background that the district attorney, if he decided to make an issue of this, it could be a legal problem because even the district attorney couldn’t interpret the law.
    As this statement suggests, the early physician-activists were primarily interested in securing legal backing for what they were already doing. They were in effect already using a “broad construction”” of the law, which they believed was accepted by their colleagues as ethical; they wanted ]their decision-making rights explicitly written into law, just to be on the safe side.
    • p.78
  • Once there came to be an obvious difference of opinion among physicians about the moral status of abortion rather than the technical grounds for it, the control of abortion was open to new claims. It is not surprising that after one group of physicians (the “broad constructionists”) asked state legislature to make some changes in the law, other interest groups were encouraged to press their demands. In other words, it is conceivable that the public movement on abortion might never have been successful had physicians not sought to amend the law that gave them the right to control abortion in the first place. Had the medical profession been able to maintain its consensus that abortion was an appropriate enterprise for physicians (and only physicians) and had it not sought legal sanction for one interpretation of the law, non professionals might have had little luck with their claim that abortion was a woman’s right.
    Perhaps the point can be made in yet another way, by comparing the success of the abortion reform activists with the relative failure of those who claim that control over the experience of childbirth is a woman’s right. Despite considerable public discussion by feminists about the need for women to seize control of labor and delivery, the fact remains that for the overwhelming majority of pregnancies, physicians have the upper hand when it comes to decision-making. Managing pregnancy, birth, and delivery continues to be almost unanimously claimed by the medical profession as a technical enterprise. However much the physician may wish to please a pregnant woman, the physician can still claim to be the possessor of technical information beyond the ken of the lay person and must therefore be the ultimate decision-maker “for the patient’s own good.”
    Thus before abortion could become a “women’s issue,” the medical profession had to give up or lose its claim to technical control over abortion. As soon as some physicians were willing to publicly criticize the practice of colleagues on grounds of principle, the legitimate control over abortion by physicians was at an end, an the field was cleared for new contenders.
    • pp.109-110
  • The rhetoric of liberal physicians in support of the Beilenson bill was a signal to interested groups that physicians were no longer in agreement about their control over abortion and that there was room for change. However much women as a group may have wanted to seek control over abortion, they were largely without influence until they took up the new tactics introduced by groups like SHA across the United States: civil disobedience, public speaking to any group that would listen, and, most important, use of the rhetoric that women had a right to abortion. These tactics transformed the debate. Now women who wanted abortions were no longer victims, a less-than-legitimate group of rule breakers who wanted the rules changed simply because they had “gotten caught.” Rather, they were women who were crusading for a basic civil right-the right of a woman to “own the flesh she stands in,” as one of them had put it.
    It was of central importance that by the time physicians began to visibly relinquish their control over abortion, SHA’s “consciousness raising” activities throughout the state had created a group of women ready to accept a new “”definition of the situation.” They were no longer interested in simply expanding the legal grounds on which doctors could perform abortions. They wanted to make women, not doctors, the ultimate decision-makers about abortion.
    • p.110

James C. Mohr, “Abortion in America The Origins and Evolution of National Policy 1800-1900”, Oxford University Press, (1978)Edit

  • In the absence of any legislation whatsoever on the subject of abortion in the United States in 1800, the legal status of the practice was governed by the traditional British common law as interpreted by the local courts of the new American states. For centuries prior to 1800 the key to the common law’s attitude toward abortion has been a phenomenon associated with normal gestation known as quickening. Quickening was the first perception of fetal movement by the pregnant woman herself. Quickening generally occurred near the midpoint of gestation, late in the fourth or early in the fifth month, though it would and still does vary a good deal from one woman to another. The common law did not formally recognize the existence of a fetus in criminal case until it had quickened. After quickening, the expulsion and destruction of a fetus without due cause was considered a crime, because the fetus itself had manifested some semblance of a separate existence: the ability to move. The crime was qualitatively different from the destruction of a human being, however, and punished less harshly. Before quickening, actions that had the effect of terminating what turned out to have been an early pregnancy were not considered criminal under the common law in effect in England and the United States in 1800.
    • pp.3-4
  • An ability to suspend one’s modern preconceptions and to accept the early nineteenth century on its own terms regarding the distinction between quick and unquick was absolutely crucial to an understanding of the evolution of abortion policy in the United States. However doubtful the notion appears to modern readers, the distinction was virtually universal in America during the early decades of the nineteenth century and accepted in good faith Perhaps the strongest evidence of the tenacity and universality of the doctrine in the United States was the fact that American courts pointedly sustained the most lenient implications of the quickening doctrine ever after the British themselves had abandoned them. In 1803 Parliament passed a law, the details of which will be discussed in the next chapter, that made abortion before quickening a criminal offense in England for the first time. But the common law in the United States, as legal scholars have pointed out, was becoming more flexible and more tolerant in the early decades of the nineteenth century, especially in sex-related areas, not more restrictive.
    • p.5
  • In 1812 the Massachusetts Supreme Court made clear the legal distance between the new British statute on abortion and American attitudes toward the practice. In October of that year the justices dismissed charges against a man named Isaiah Bangs not on the grounds that Bangs had not prepared and administered an abortifacient potion; he probably had. They freed Bangs because the indictment against him did not aver “that the woman was quick with child at the tie.” In Massachusetts, the court was asserting, an abortion early in pregnancy would remain beyond the scope of the law and not a crime. Commonwealth v. Bangs remained the ruling precedent in cases of abortion in the United States through the first half of the nineteenth century and, in most states, for some years beyond midcentury.
    Prosecutors took the precedent so much for granted that indictments for abortion prior to quickening were virtually never brought into American courts. Every time the issue arose prior to 1850, the same conclusion was sustained: the interruption of a suspected pregnancy prior to quickening was not a crime in itself.
    • pp.5-6
  • Because women believed themselves to be carrying inert non-beings prior to quickening, a potential for life rather than life itself, and because the common law permitted them to attempt to rid themselves of suspected and unwanted pregnancies up to the point when the potential for life gave a sure sign that it was developing into something actually alive, some American women did practice abortion in the early decades of the nineteenth century. One piece of evidence for this conclusion was the ready access American women had to abortifacient information form 1800 onward. A chief source of such information was the home medical literature of the era.
  • p.6
  • Home medical manuals characteristically contained abortifacient information in two different sections. One listed in explicit detail a number of procedures that might release “obstructed menses” and the other identified a number of specific things to be avoided in a suspected pregnancy because they were thought to bring on abortion. Americans probably consulted William Buchan’s Domestic Medicine more frequently than any other home medical guide during the first decades of the nineteenth century. Buchan suggested several courses of action designed to restore menstrual flow if a period was missed. These included bloodletting, bathing, iron and quinine concoctions, and if those failed, “a tea-spoonful of the tincture of black hellebore [a violent purgative]. . . twice a day in a cup of warm water.” Four pages later he listed among “the common causes” of abortion “great evacuations [and] vomiting,” exactly as would be produced by the treatment he urged for suppressed menses Later in pregnancy a venturesome, or desperate, woman could try some of the other abortion inducers he ticked off: “violent exercise; raising great weights; reaching too high; jumping, or stepping from an eminence; strokes [strong blows] on the belly; [and] falls.”
    American women of the early nineteenth century who wanted more detailed information could consult books like Samuel K. Jennings’s The Married Lady’s Companion. The Jennings volume, which billed itself in subtitle as a Poor Man’s Friend, had its second printing in 1808 and was intended for women in rural areas, where there were no physicians, and for families unable to afford a doctor’s fee. The book was remarkably straightforward about advising otherwise healthy girls afflicted with “what you call a common cold.” “Taking the cold” was a common nineteenth century euphemism for missing a menstrual period, and there can be no doubt that Jenning’s italics sufficiently alerted his readers. Jennings favored bleeding from the foot, hot baths, doses of calomel and aloes. Calomel was prescribed for almost anything in the early decades of the nineteenth century; aloes, another strong cathartic, remained a standard ingredient in abortifacient preparations for the next hundred years.
    Like most early abortion material, Buchan’s and Jenning’s advice harked back to almost primordial or instinctual methods of ending a pregnancy. Bloodletting, for example, was evidently thought to serve as a surrogate period; it was hoped that bleeding from any part of the body might have the same flushing effect upon the womb that menstrual bleeding was known to have. This primitive folk belief lingered long into the nineteenth century, well after bleeding was abandoned as medical therapy in other kinds of cases, and it was common for abortionists as late as the 1870s to pull a tooth as part of their routine. This procedure had been given learned sanction in 1808, when the first American edition of John Burns’s classic Observations on Abortion appeared. Burns, a Glasgow medical professor whose volume remained a standard for half a century, was primarily concerned with spontaneous miscarriage rather than induced abortion, but twice in different contexts stated: “The pulling of a tooth . . . sometimes suddenly produces abortion.” Aside from the pain and shock of an extraction without anesthetic, which probably could induce miscarriage in some women, the process must have been psychologically akin to pulling a plug for the patient. In later years it also offered the sophisticated abortionist a medical camouflage upon which he or she might blame possible postoperative complications. Similarly, bathing, though it may have had some abortive effect as a muscle relaxer and a source of internal infection, probably went back to primitive beliefs that the pregnancy could simply be washed away, physically expunged. Finally, Jennings, recommendations of calomel and aloes paralleled Buchan’s reliance on black hellebore. These substances were ingested on the reasonably plausible theory that a sufficiently violent disruption of the lower digestive tract might cause the uterus to empty its contents also. This belief became the basis of a booming pharmaceutical business in abortifacient preperations, which will be discussed later in another context.
    • p.6-8
  • Joseph Brevitt’s The Female Medical Repository, which was published in Baltimore in 1810, made many of the same points that Buchan and Jennings made, but added some significant details. Brevitt liked hellebore and aloes, but he considered savin especially effective. Savin, as Brevitt’s work reminded American women, had a tremendous advantage in the United States over hellebore or aloes because any woman could easily obtain some simply by extracting the oil from one of the common juniper bushes that grew wild all over North America. Both black hellebore and aloes, on the other hand, had to be imported and were, as a result, expensive. Reports of attempted abortion by ingesting savin, and of accidental death from savin overdoses, reained common throughout the nineteenth century. There can be little doubt that juniper extract was the single most commonly employed folk abortifacient in the United States during the early decades of the nineteenth century. Jalap, scammony, and bitter apple could also be tried in a pinch, according to ‘’The Female Medical Repository’’. Brevitt asserted that the French referred horehound, and he believed, wrongly, that amdder root worked directlyupon the muscles of the uterus itself. He cautioned against cantharides, or Spanish fly, because he considered it dangerous to the urinary tract, but the fact that he made such a warning suggests that at least some women were trying it for abortifacient purposes. “Electricity”, he added, “generally and sometimes locally applies, has frequently been known to restore the discharge.” This idea, too, was subsequently picked up by later nineteenth-century entrepreneurs, who developed a number of galvanic contraptions designed to aid women who were “obstructed”.
    After listing the usual “external causes” of abortions, which included riding, jumping, falls, and the like, Brevitt added an asterisk and a footnote that helped confirm further the fact that Americans from an early period were practicing abortion: “I feel constrained to note here, the horrid depravity of human weakness, in wretches lost to every sense of religion, morality, and that natural attachment from a mother to her offspring, and every tender tie in nature, seek the means to procure abortion: nor are there wanted, in the other sex, infernals wicked enough to aid their endeavors.” Considering the detailed abortifacient information that Brevitt’s own volume contained, that statement might appear singularly disingenuous. But it probably was not. In Brevitt’s terms the word “abortion” implied the termination of a pregnancy ‘’after’’ the pregnancy was certain, that is, after quickening. He was testifying that even ‘’illegal’’ abortions were being performed in the United States in 1810, abortions after quickening, and that some physicians were willing to provide abortion services for women at virtually any stage of gestation. The procedures Brevitt counseled, even though they were designed to bring on what the twentieth century would call an abortion, were not considered criminally abortifacient either in Brevitt’s terms or in the opintion of hiss readers, unless a woman persisted in them after she quickened.
    • pp.8-10
  • The Virginian Thomas Ewell, a surgeon at Navy Hospital I Washington, D.C., was another who wrote forthrightly about unblocking obstructed menses in his Letter to Ladies, published in 1817. Like many before him, he urged hot sitz baths, doses of aloes, and a number of straining exercises. Walking, horseback riding, and jumping, the more the better, all helped bring on abortion, he counseled, especially at the time menses would normally have occurred had the last period not been missed. Ewell, too, thought electricity through the thighs might end a suppression and that light bleeding could be beneficial. To those rather elemental staples, however, Ewell added some medically more advanced ideas including internal douching with strong brandy, water as hot as could be tolerated, vinegar, wine, or strong brine. Considering that the book appeared in 1817, this was reasonably sophisticated advice. Though Ewell could not have known anything about bacteria, each of the douches he recommended (assuming that the water was cooled from a boil) was fairly antiseptic. Moreover, he correctly speculated that the douches were not abortifacients themselves but provoked menstrual flow by causing cervical irritation, as in fact, they might have done. If forced into the uterus itself after cervical dilation, which was something medical practitioners knew how to do, such solutions would almost certainly have been effective abortifacients and not prohibitively unsafe.
    • pp.10-11
  • In addition to home medical guides and health manuals addressed to women, abortions and abortifacient information were also available in the United States from midwives and midwifery texts. Midwives has long enjoyed a dubious reputation as abortion procuresses both in England and in America This led to difficult problems for male physicians like valentine Seaman, who wanted to upgrade America’s midwife corps. Seaman, who was physician to the lying-in (maternity) ward of the New York city Almshouse and also associated with New York Hospital, taught midwifery. In his classes he had to instruct midwives on how to perform abortions in order that they might meet such crises as the death of a fetus in utero or an incomplete spontaneous abortion or a badly handled intentional abortion begun by someone else. But when he published his lectures in 1800, he was at considerable pains to point out that he cautioned new midwives against prescribing for obstructed menses on their own, lest they inadvertently becomes the dupes of women who already knew they were pregnant and wanted abortions. Again the caution suggests that some American women were approaching midwives for abortifacient services.
    Herbal healers, the so-called Indian doctors, and various other irregular practitioners also helped spread abortifacient information in the United States during the early decades of the nineteenth century. Their surviving pamphlets, of which Peter Smith’s 1813 brochure entitled “The Indian Doctor’s Dispensary” is an example, contained abortiacient recipes that typically combined the better-known cathartics with native North American ingredients thought to have emmenagogic properties. For “obstructed menses” Smith recommended a concoction he called “Dr Reeder’s chalybeate.” The key ingredients were myrrh and aloes, combined with liquor, sugar, vinegar, iron dust, ivy, and Virginia or Seneca snakeroot. A sweet-and-sour cocktail like that may or may not have induced abortion, but must certainly have jolted the system of any woman who tried one.
    • pp.11-12
  • The snakeroot to which Smith referred appears to have been another of the popular folk abortifacients used in the United States early in the nineteenth century. When Thomas Massie, a medical student at the Uniersity of Pennsylvania, wrote his 803 doctoral dissertation on the properties of ‘’Polygala Senega’’, he quoted a letter from an eminent medical man in Hartford Country, Maryland, to the effect that Seneca snakeroot was frequently used among the illiterate rural population of his area “intentionally to destroy the foetus in utero.”” Massie’s thesis, subsequently selected for publication in 1806, put forward the likelihood that Seneca acted directly upo the uterus itself, as he and Brevitt and others also believed madder did, and that regular physicians might ‘administer it “with great advantage… to those laboring under obstructed catamenia.” Thirty years later John B Beck, by then the nation’s leading authority on the medical jurisprudence of abortion, confirmed that Seneca “has now been known and used in this country for a number of years, for the purpose of acting on the uterine organ, with a view of restoring menstrual secretion.” Beck added along the same line that folk doctors also liked common North American black cohosh, sometimes called squawroot, for the ssame purpose. Native Indian women evidently employed an herbal brew of cohosh as an emanagogue and, according to Beck, the same brew for the same purpose was “a good deal used by our American practitioners.”
    • pp. 12, 14
  • Finally, and most importantly, America’s regular physicians, those who had formal medical training either in the United States or in Great Britain or had been apprenticed under a regular doctor, clearly possessed the physiological knowledge and the surgical techniques necessary to terminate a pregnancy by mechanical means. They knew that dilation of the cervix at virtually any stage of gestation would generally bring on uterine contractions that would in turn lead to the expulsion of the contents of the uterus. They knew that any irritation introduced into the uterus would have the same effect. They knew that rupturing the amniotic sac, especially in the middle and later months of pregnancy, would usually also induce contractions and expulsion, regardless of whether the fetus was viable. Indeed, they were taught in their lecture courses and in their textbooks various procedures much more complex than a simple abortion, such as in utero decapitation and fetal pulverization, processes they were instructed to imply in lieu of the even more horribly dangerous Caesarean section. Like the general public, they knew the drugs and herbs most commonly used as abortifacients and emmenagogues, and also like the general public, they believed such preparations to have been frequently effective.
    Moreover, there is little reason to doubt that American physicians sometimes used their knowledge to terminate unwanted pregnancies for their patients. Walter Channing, who lectured on midwifery and the diseases off women and children at the Harvard Medical School during the 1820s, taught his students that pregnancy was impossible to diagnose with complete accuracy during the early months of gestation. Textbooks repeated the same dictum. Even John Beck, an opponent of induced abortions at any stage of gestation, had to assert unequivocally that pregnancy could not be legally determined beyond all doubt prior to quickening. As a medical student reminded himself in his lecture notebook very early in the nineteenth century: “When reliance can be put on the account of ye patient, there is no fear of confounding this disease [amenorrhea or blocked menstrual flow] with any o[ther]. [W]e cannot always determine the state of the patient, the Menses should be wanting during pregnancy, and those who want to conceal pregnancy often pretend that they are subject to a variety of symptoms in on sequence of the obstructed menses.”
    This placed great pressure on physicians to provide what amounted to abortion services early in pregnancy. An unmarried girl who feared herself pregnant, for example, could approach her family doctor and ask to be treated for menstrual blockage If he hoped to retain the girl and her family as future patients, the physician would have little choice but to accept the girl’s assessment of the situation, even if he suspected otherwise. He realized that every member of his procession would testify to the fact that he had no totally reliable means of distinguishing between an early pregnancy, on the one hand, and the amenorrhea that the girl claimed, on the other. Consequently, he treated for obstruction, which involved exactly the same procedures he would have reused to induce an early abortion, and wittingly or unwittingly terminated the pregnancy. Regular physicians were also asked to bring to safe conclusion abortions that irregulars or women themselves had initiated. The Medical Recorder of Philadelphia detailed exactly such a case in 1825 and the regular who was called upon, despite some moral qualms, considered it is his duty to finish the job for the young woman involved. And through all of this the physician might bear in mind that he could never be held legally guilty of wrongdoing. No statues existed anywhere in the United States on the subject of abortion, and the common law, as reaffirmed in America in the Bangs case, considered abortion actionable only after a pregnancy had quickened. No wonder then that Heber C. Kimball, recalling his courtship with a woman he married in 1822, claimed that she had been “taught…in our young days, when she got into the family way, to send for a doctor and get rid of the child’’; a course that sh followed.
    • p.14-16
  • In summary, hen, the practice of aborting unwanted pregnancies was, if not common, almost certainly not rare in the United States during the first decades of the nineteenth century. A knowledge of various drugs, potions, and techniques was available from home medical guides, from health books for women, from midwives and irregular practitioners, and from trained physicians. Substantial evidence suggests that many American women sought abortions, tried the standard techniques of the day, and no doubt succeeded some proportion of the time in terminating unwanted pregnancies. Moreover, this practice was neither morally nor legally wrong in the eyes of the vast majority of Americans, provided it was accomplished before quickening.
    The actual number of abortions in the United States prior to the advent of any states regulating its practice simply cannot be known. But an equally significant piece of information about those abortions can be gleaned from the historical record. It concerns the women who were having them. Virtually every observer through the middle of the 1850s believed that an overwhelming percentage of the American women who sought and succeeded in having abortions did
    • p.16
  • By the early 1840s, between 30,000 and 40,000 people were said to have signed petitions opposed to the rigid regulation and regularization of medicine in New York. Under these circumstances, New York’s statutory prohibition of abortion, which could have been interpreted to cover abortions before quickening as well as after quickening, lay buried in code, unenforced. A precedent has been established for future abortion policies, but the practice of abortion itself was little affected by the legislation of 1828 in New York.
    The decade of the 1830s, generally speaking, was one of wide-open medical practices throughout the nation, not just in New York. New York’s foray into medical regulation was not widely imitated elsewhere, and those states that had passed medical practice acts similar to New York’s 1827 law repealed them during the 1830s. Consequently, it is not surprising that the period was not one of vigorous anti-abortion activity in state legislatures. One of the exceptions was Ohio. In 1834 legislators there made attempted abortion a misdemeanor without specifying any stage of gestation, and they made the death of either the mother or the fetus after quickening a felony.
    • p.39

Munson, Ziad W. (2008). “The making of pro-life activists: how social movement mobilization works”. University of Chicago Press. ISBN 978-0-226-55120-3. Retrieved 31 December 2011.Edit

  • The partisan valence of the abortion issue had not yet developed in these early years of the pro-life movement. Today pro-life political views are strongly tied to the Republican Party, while pro-choice views are tied to the Democrats. This had not always been true. The Republicans first adopted a pro-life position in their national party platform in 1980. At the same time, longtime Democrat Jesse Jackson spoke out consistently against abortion rights throughout the late 1970s and early 1980s. In a 1977 article written for the NRLC newsletter, Jackson explained that “human beings cannot give or create life by themselves, it really is a gift from God. Therefore, one does not have the right to take away (through abortion) that which he does not have the ability to give.” Prominent pro-life leaders have also been committed Democrats. Jackie Schweitz, who led MCCL for eighteen years until 2001, was active in the Democratic the Democratic Party through the 1980s.
    • pp.86-87
  • Although the contours of the conflict looked different in the first fifteen years of the movement, the political and legal story of abortion since 1973 had shown a consistent pattern of slow but steady erosion of the rights granted to women by the landmark Supreme Court decisions. At the same time, the basic finding of those decisions-that women have a legal right to abortion at least under some circumstances-has been consistently and repeatedly confirmed. State legislatures, the U.S. Congress, and the courts were the primary venues in the battle over abortion beginning in 1973. Both the legislative and judicial systems have faced an avalanche of abortion-related bills and cases since that time. Legislatures in all fifty states review hundreds of new pieces of legislation annually that affect abortion services.
    • p.87
  • Abortion is one of the most common medical procedures in the United States. More than one pregnancy in five is ended by abortion, a total of 1.29 million abortions in 2002 and more than 42 million since the procedure was legalized in 1973 (Finer et al 2005). Before the age of forty-five, fully a third of all U.S. women will have one or more abortions (Henshaw 1998). The ubiquity of abortion in American life has done little to reduce the controversy that continues to surround it. Survey evidence suggests that abortion is one of the only morally charged social issued about which American opinion has become more polarized over the last three decades (DiMaggio, Evans, and Bryson 1996; Hour 1999; Evans 2003). The battle over the issue is evident in the political realm: state legislatures considered more than 1,120 pieces of legislation related to abortion in 2006 alone (NARAL 1007). Abortion was the central focus of the debates over the confirmation of Supreme Court justices John Roberts and Samuel Alito in 2005 and 2006. The 2007 Supreme Court decision overturning the constitutional requirement for a health exception in any state abortion ban has once again put the issue squarely at the top of the national agenda.
    • p.89
  • The absolute number of abortions as well as the abortion rate grew steadily after 1973. The highest recorded number of reported abortions (1.61 million) occurred in 1990; the highest abortion rate (29.3 per one thousand women of childbearing age) occurred in 1981 (Jones et al. 2008). Since that time, both the number of abortions and the abortion rate have steadily declined. In 2005, there were an estimated 1.21 million abortions and an abortion rate of only 19.4 per one thousand women (Jones et al. 2008). The causes of this decline are hotly debated and include changes in ideas about abortion, couples’ contraceptive habits, and young women’s demographic situations. It may also be affected by the availability of abortion services in different parts of the country, a factor that has been influenced by the political and social debates over legalized abortion.
    There are in fact, substantial obstacles to obtaining a legal abortion today, in comparison to the availability of other gynecological obstetric services. The vast majority of counties in the United States-87 percent-have no abortion provider at all. Almost a quarter of women who have an abortion travel more than fifty miles to obtain one, and the costs of abortion-which start at about four hundred dollars-have risen 9 percent in recent years (Finer and Henshaw 2003). Clinics are also subject to increasing pressure by pro-life protesters. Although the incidence of violence against abortion clinics has declined in recent years as, the amount of pro-life picketing has steadily increased There were more than ten thousand cases of picketing in front of clinics in 2007 (National Abortion Federation 2008).
    Despite these changes, public opinion about abortion has remained remarkably stable.. Since 1972, the number of Americans who believe abortion should be legal in cases where there is a high chance of fetal defects has remained between 78.5 percent and 85.5 percent (see figure 4.1). Since 1977, the number of Americans who support legalized abortion for any reason has stayed consistently between 33.3 percent and 43.5 percent. Results are similar for other variations on poling questions. Despite all their efforts over the last three decades, neither the pro-choice movement nor the pro-life movement has succeeded in shifting the weight of public opinion on abortion even as the social, political, legal, economic, and medical contexts of legalized abortion in the United States have all changed over the same period.
    • p.90
  • The legal status of abortion following Roe v. Wade and Doe v. Bolton was the most permissive since the first statues outlawing abortion were passed in the early 1800s. Since that time, new federal and state laws, along with a whole series of Supreme Court rulings that support them, have generally imposed new limits on the availability of legal abortions. This pro-life movement that has mobilized and pushed for these restrictions is today a well-institutionalized and heterogeneous phenomenon. It includes a whole range of organizations both nationally and in cities and towns across the country.
    • p.95

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

National Academies of Sciences, Engineering; Division, Health Medicine; Board on Health Care Services; Board on Population Health Public Health Practice; Committee on Reproductive Health Services: Assessing the Safety Quality of Abortion Care in the U.S (2018). "The Safety and Quality of Abortion Care in the United States”, at NAP.edu. doi:10.17226/24950. ISBN 978-0-309-46818-3. PMID 29897702

  • Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed.
    • ch.2, p.45
  • In the more than 40 years since national legalization of abortion, investigators have conducted randomized controlled trials (RCTs), large retrospective cohort studies, patient and provider surveys, systematic reviews, and other types of research on abortion care and its health effects on women, resulting in an extensive literature.
    • ch.2, p.45
  • The committee’s review emphasizes contemporary approaches to abortion care because abortion methods have been refined in response to new evidence. Some research conducted before 2000 is unlikely to reflect the outcomes of how abortions are typically performed in the United States today. As discussed below, for example, the U.S. Food and Drug Administration (FDA)-approved protocol for medication abortion was updated in 2016 based on extensive research showing improved outcomes with a revised regimen. Techniques used in aspiration procedures are also safer and more effective than in the past. Sharp metal curettes, once commonly used, are considered obsolete by many professional groups, and their use is no longer recommended for abortion because of the increased (albeit rare) risk of injury. New approaches to cervical preparation and the use of ultrasound guidance have also improved abortion safety.
    • ch.2, p.46
  • Induction abortions are rarely performed in the United States; in 2013, they accounted for approximately 2 percent of all abortions at 14 weeks’ gestation or later. For many women in the United States, D&E is often the preferred alternative because induction is more painful, its timing is less predictable and slower (sometimes taking more than 24 hours), and it is more expensive (see below). In some clinical settings, however, D&E is not an option because the available clinicians lack the necessary experience and/or training in D&E procedures.1 In addition, D&E abortions are illegal in Mississippi and West Virginia.
    • p.66
  • Death associated with a legal abortion in the United States is an exceedingly rare event. As Table 2-4 shows, the risk of death subsequent to a legal abortion (0.7 per 100,000) is a small fraction of that for childbirth (8.8 per 100,000). Abortion-related mortality is also lower than that for colonoscopies (2.9 per 100,000), plastic surgery (0.8 to 1.7 per 100,000), dental procedures (0.0 to 1.7 per 100,000), and adult tonsillectomies (2.9 to 6.3 per 100,000). Comparable data for other common medical procedures are difficult to find.
    • pp.74-75
  • Unlike other health care procedures provided in office-based settings, abortions are subject to a wide array of regulations that vary by state. Except for abortion, states typically regulate individual, office-based health services only when the service involves using sedation or general anesthesia (and depending on the level of sedation). Twenty-five states regulate office-based procedures (other than abortion). In 23 of these states, the regulation is triggered by the level of sedation, and in most cases, it requires that the facility be either accredited or licensed by the state in order to offer patients moderate or deep sedation.
    • p.76
  • The clinical evidence presented in this chapter on the provision of safe and high-quality abortion care stands in contrast to the extensive regulatory requirements that state laws impose on the provision of abortion services. These requirements may influence the efficiency of abortion care by requiring medically unnecessary services and multiple visits to the abortion facility, in addition to requiring that care take place in costlier and more sophisticated settings than are clinically necessary. These requirements go beyond the accepted standards of care in the absence of evidence that they improve safety. Some requirements, such as multiple visits and waiting periods, delay abortion services, and by doing so may increase the clinical risks and cost of care. They may also limit women’s options for care and impact providers’ ability to provide patient-centered care. Furthermore, many of these laws have been documented to reduce the availability of care by imposing unneeded regulations on abortion providers and the settings in which abortion services are delivered. The implications of abortion-specific regulations for the safety and quality of abortion care are described below.
    • p.77
  • The clinical evidence makes clear that legal abortions in the United States—whether by medication, aspiration, D&E, or induction—are safe and effective. Serious complications are rare; in the vast majority of studies, they occur in fewer than 1 percent of abortions, and they do not exceed 5 percent in any of the studies the committee identified. However, the risk of a serious complication increases with weeks’ gestation. As the number of weeks increases, the invasiveness of the required procedure and the need for deeper levels of sedation also increase. Thus, delaying the abortion increases the risk of harm to the woman.
    State regulations that require women to make multiple in-person visits and wait multiple days delay the abortion. If the waiting period is required after an in-person counseling appointment, the delay is exacerbated. Restrictions on the types of providers and on the settings in which abortion services can be provided also delay care by reducing the availability of care.
    Financial burdens and difficulty obtaining insurance are frequently cited by women as reasons for delay in obtaining an abortion. As noted in Chapter 1, 33 states prohibit public payers from paying for abortions, and other states have laws that either prohibit health insurance exchange plans (25 states) or private insurance plans (11 states) sold in the state from covering or paying for abortions, with few exceptions.
    • pp.77-78
  • Long-established ethical and legal standards for informed consent in health care appear to have been compromised in the delivery of abortion care in many areas of the country. Thirty-five states have abortion-specific regulations requiring women to receive counseling before an abortion is performed, and abortion patients in many of these states are offered or given inaccurate or misleading information (verbally or in writing) on reversing medication abortions, risks to future fertility, possible breast cancer risk, and/or long-term mental health consequences of abortion. As noted earlier in this chapter, the principal objective of the informed consent process is that patients understand the nature and risks of the procedure they are considering. However, legally requiring providers to inform women about risks that are not supported and are even invalidated by scientific research violates the accepted standards of informed consent. For example, some states require that providers inform women that abortion puts them at greater risk for breast cancer; mental health disorders; and difficulties in having a healthy, successful pregnancy. Three states require providers to inform women that a medication abortion can be reversed after the woman takes mifepristone. This information is not supported by research that meets scientific standards.
    • pp.78-79

O'Brien, George Dennis (30 September 2010). “The Church and abortion: a Catholic dissent”. Rowman & Littlefield. ISBN 978-1-4422-0577-2. Retrieved 5 January 2012.Edit

  • It might have been less divisive politically if abortion had moved toward legal permission through legislative debate in the states. One should not be deluded, however, into thinking that if abortion were once again before state legislatures, we would be in the same situation legally or socially as in 1973 when Roe was handed down. The fact that history cannot be simply reversed has been made by various justices in their opinions resisting the overturn of Roe. For more than thirty-five years women have assumed that legalized abortion was possible in the United States. Whether their decisions to have an abortion during that time were moral or wise, the deed was done legally. What would be the social dynamic if abortion were again prohibited?
    • p.23
  • I do not believe that the question of criminal law can be evaded; specific laws raise further moral issues beyond the immorality of abortion itself. If, after reversing Roe, abortion were to be banned by any means nationally, or, more plausibly, locally in the states, legal penalties would have to be enacted against those who violated the law. What would be an appropriate and effective law? The ultimate “realism” of anti-abortion legislation hinges on the plausibility of solving the lord high executioner’s “object all sublime”: to make the punishment fit the crime. Failure to match crime and punishment undermines law: too harsh a penalty and juries will not convict, too lenient and the crime disappears from public perception and the docket.
    • pp.24-25
  • Simple realism suggests that even modest anti-abortion laws are unlikely to be enacted in the United States. If two conservative states like South Dakota and Colorado could not muster majorities for anti-abortion statutes, what are the chances in other states? There may be a few states, probably in the so-called Bible belt, that would pass anti-abortion laws in the absence of Roe, but even there it is unlikely that the laws would match the foundational rhetoric of the Catholic oral crusaders. The reason that even conservatives and prudent Catholic bishops pull back from highly punitive law stems from quite appropriate moral assessment that seldom strays into the anti-abortion rhetoric. I will examine these moral assessments in the next chapter, but before I do I want to point out one more reason why abortion should not be the trump card in politics.
    • p.32

Claire E. Ramussen, “Abortion”; in Chapman, Roger (2010). “Culture wars: an encyclopedia of issues, viewpoints, and voices, M.E. Sharpe. Inc, (2010)Edit

  • In the United States in the late 1800s, a coalition of women’s rights activists and doctors campaigned to outlaw abortions most of which were being performed by practitioners without medical training or being attempted by the pregnant woman herself. These “back alley abortions” resulted in many deaths and injuries. By 1900 abortion was banned throughout the United States. By the mid-1900 abortion was banned throughout the United States. By the mid-1900s, however, the medical profession has changed its position on abortion. By that time, private physicians were able to perform safe abortions, and they did so in certain situations, particularly if a pregnancy was caused by rape or incest or if the life of the mother was at risk. Physicians joined with the growing feminist movement to decriminalize abortion.
    • pp. 1
  • The American Medical Association endorsed legalized abortion in 1967. Medical professionals reported that each year they were treating thousands of women who had obtained illegal abortions and had been injured as a consequence. Believing that abortions were inevitable in American society, they argued that legalizing the practice would allow trained medical staffs to perform safe procedures in medical facilities. Religious leaders in more liberal Christian denominations also became advocates. These included the United Church of Christ, the United Methodist Church, the Episcopalian Church, and the United Presbyterian Church.
    The anti-abortion movement also began to grow in the 1960s and became a leading opponent of the Roe v. Wade ruling. The Roman Catholic Church became a powerful voice in opposition to abortion in the 1960s, when the National Conference of Catholic Bishops organized the Family Life Division (FLD). After 1973, leaders of the FLD formed the National Right to Life Committee, which became the largest-antiabortion organization. Led by John Wilke, the group fought for changes to abortion laws at the legislative level through lobbying and sponsored publication of anti-abortion materials for distribution to voters.
    • pp. 1-2
  • Anti-abortion violence rose dramatically in the 1980s and 1990s. In a series of related incidents, several abortion clinics in Florida were bombed on Christmas Day 1984. In 1993, Dr. David Gunn was shot and killed in front of his clinic by Michael F. Griffin, an anti-abortion activist, who surrendered to police at the scene and was sentenced to life in prison. In 1998, Dr. Bernard Slepian, a doctor known to provide abortion services, was shot and killed at his home in Amherst, New York, near Buggalo, by a sniper. In 2001, James Kopp, a member of a radical anti-abortion group, was arrested in France for the Slepian murder. Kopp was eventually extradited to New York and convicted of second degree murder. Incidents of violence against clinics declined after 2000, but abortion clinics still report more than a thousand incidents per year, affecting approximately a third of all such sites.
    • p. 2.
  • The anti-abortion movement has largely succeeded in restricting the ability of women to obtain abortion services. As of 2008, even though early-term abortion was largely unregulated by law, 88 percent of counties in the United States had no abortion services. In practice, this means that women seeking abortion must travel to large urban areas, where abortion procedures are more readily available. The movement’s success in restricting practical access proves that determined resistance can go far toward nullifying legal rulings that a large, devoted group finds unjust. The pro-life movement has been less successful in affecting public opinion on abortion. Recent polls by a variety of polling organizations show that a majority of adults continue to believe that abortion should be available to women “all the time” or “most of the time.” A substantial minority believes it should be available only in special cases, but fewer than 10 percent believe it should be outlawed in all cases.
    • pp. 2-3.

"The Comparative Safety of Legal Induced Abortion and Childbirth in the United States" (February 2012)Edit

Raymond, Elizabeth G.; Grimes, David A. (February 2012). "The Comparative Safety of Legal Induced Abortion and Childbirth in the United States". Obstetrics & Gynecology. 119 (2, Part 1): 215–219. doi:10.1097/AOG.0b013e31823fe923. ISSN 0029-7844. PMID 22270271. S2CID 25534071.

  • RESULTS:
    The pregnancy-associated mortality rate among women who delivered live neonates was 8.8 deaths per 100,000 live births. The mortality rate related to induced abortion was 0.6 deaths per 100,000 abortions. In the one recent comparative study of pregnancy morbidity in the United States, pregnancy-related complications were more common with childbirth than with abortion.
    CONCLUSION:
    Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.
  • Decades of research have demonstrated that legal induced abortion is safe. Mortality and serious acute complications are extremely rare. Recently, allegations of later sequelae—breast cancer and mental illness—were refuted. However, laws in 22 states in the United States now require that before an abortion is performed, the patient must be given detailed, specific verbal or written information about potential risks. In some cases, this material is misleading or patently wrong.
    Health policy and medical practice should be based on the best available evidence. In the past 10 years, the introduction of new abortion methods may have affected the overall safety of the procedure. Notably, mifepristone was approved by the U.S. Food and Drug Administration for medical abortion in 2000; by 2008, approximately 17% of all nonhospital abortions were performed medically rather than surgically. In addition, changes in the risk profile of pregnant women—for example, as a result of growing obesity and an upward shift in the maternal age distribution—as well as the rising cesarean delivery rate may have enhanced the risks of the alternative to abortion, childbirth. The objective of this review is to provide an updated assessment2 of the safety of abortion relative to delivery.
  • Between 1998 and 2005, the pregnancy-associated mortality rate among women known to have delivered live neonates in the United States was 8.8 deaths per 100,000 live births. Of all pregnancy-associated deaths of women with known pregnancy outcome, 71% occurred after live births; if 71% of women with unknown pregnancy outcome who died of pregnancy-associated causes are also assumed to have had live births, the mortality estimate increases to 10.4 deaths per 100,000 live births. The mortality rate related to legal induced abortion during that same interval was 0.6 deaths per 100,000 abortions. Thus, according to federal statistics, the risk of death associated with childbirth was approximately 14 times higher than that with abortion.
  • Only one recent study provided comparative data on morbidity associated with various pregnancy outcomes in the United States. Epidemiologists at the CDC examined all International Classification of Diseases, 9th Revision, Clinical Modification diagnoses reported during or within 8 weeks after all 24,481 pregnancies among members of the Kaiser Permanente Northwest Health Maintenance Organization between 1998 and 2001. Of these pregnancies, 16,824 ended in live birth, 4,192 in induced abortion, and the rest in spontaneous abortions, stillbirths, or other outcomes. Common maternal morbidities were defined as conditions either unique to pregnancy or potentially exacerbated by pregnancy that occurred in at least 5% of all pregnancies.
    Every complication was more common among women having live births than among those having abortions. The relative risks of morbidity with live birth compared with abortion were 1.3 for mental health conditions, 1.8 for urinary tract infection, 4.4 for postpartum hemorrhage, 5.2 for obstetric infections, 24 for hypertensive disorders of pregnancy, 25 for antepartum hemorrhage, and 26 for anemia.
  • Legal abortion in the United States remains much safer than childbirth. The difference in risk of death is approximately 14-fold. Abortion also is associated with substantially less pregnancy-related morbidity. These results are consistent with prior analyses of national data.2 Indeed, the relative safety of abortion has increased substantially since the first decade after nationwide legalization, when child birth-related mortality was approximately seven times the mortality related to abortion.15 Although we could not find data that allowed comparable calculations of mortality or morbidity associated with surgical and medical abortion, Danco Laboratories, the distributor of mifepristone in the United States, has identified only 11 pregnancy-related deaths among the estimated 1.6 million women who have used the drug in the United States since 2000, which is a mortality rate of 0.7 per 100,000 users (Abigail Long, Danco Laboratories, LLC, personal communication). Clearly, the growing use of medical regimens has not increased relative abortion risk overall.
    The disparity between abortion and childbirth safety is not surprising. Pregnancies ending in abortion are substantially shorter than those ending in childbirth and thus entail less time for pregnancy-related problems to occur. Many dangerous pregnancy-related complications such as pregnancy-induced hypertension and placental abnormalities manifest themselves in late pregnancy; early abortion avoids these hazards. Moreover, in the United States in 2008, one third of births occurred by cesarean delivery, an abdominal operation with substantial morbidity.
  • [P]atients undergoing abortion appear to be at higher underlying risk than women who opt for delivery. Women who had abortions were more likely to be African American or unmarried, demographic characteristics strongly associated with increased mortality. In addition, because comorbidities are sometimes the motivation for abortion, the underlying medical risk of patients undergoing abortion may be higher than that of other pregnant women. Women in good health may be more likely to choose to continue their pregnancies than those who are ill (selection bias termed the “healthy mother” effect). Thus, mortality among patients undergoing abortion may overestimate the mortality risk of the procedure itself.
  • Pregnant women considering their options deserve accurate information about comparative risks. Currently, some state laws and policies violate this standard. In Texas, for example, the mandatory 23-page pamphlet, “A Woman's Right-to-Know,” lists 12 potential complications of medical abortion with mifepristone and misoprostol, 12 of suction curettage, and 11 of dilation and evacuation. In contrast, the pamphlet names only six potential complications of vaginal delivery and eight of cesarean delivery. To laypersons who have little understanding of medical risk but can count complications, these tallies may imply that abortion has more complications than does childbirth. Similarly, the mortality statistics are presented as fractions with one in the numerator and with large denominators (eg, 8,475). Empiric evidence has demonstrated that women with less formal education than a college degree have trouble comparing risks expressed in this manner. Mortality risk should be expressed as number of deaths per 100,000, which is an easier format to understand.
    Laws that compel exposure of women to such biased material thwart informed choice and contravene the ethical principle of autonomy.24 Moreover, they put clinicians in the untenable position of having to be complicit in misleading their patients. Since the early 1970s, the public health evidence has been clear and incontrovertible: induced abortion is safer than childbirth.

Leslie J. Reagan, “When abortion was a crime: women, medicine, and law in the United States, 1867-1973”, “Introduction”, (December 31, 1996)Edit

  • Sympathy for their female patients drew physicians into the world of abortion in spite of legal and professional prohibitions. Indeed, it was physicians and lawyers who initiated the earliest efforts to rewrite the abortion laws. Ultimately, women’s pressing need for abortion fueled a mass movement that succeeded in reversing public policy toward abortion in the 1960s and 1970s.
    • “Introduction”, p.1
  • This is the first study of the entire era of illegal abortion in the United States. Most scholarship on abortion was criminalized in the mid-nineteenth century, and when it was decriminalized a hundred years later in the mid-1960s and early 1970s. The century of illegal abortion is typically treated as obscure and unchanging. I find, however, that the history of illegal abortion was dynamic, not static.
    • p.2
  • Abortion serves as a case study for rethinking the nature of the state in the United States. Much of the regulation of abortion was carried out not by government agents, but by voluntary agencies and individuals. The state expected the medical profession to assist in enforcing the law. It may be more accurate to think of the state apparatus not as the government, but as consisting of official agencies that work in conjunction with other semiofficial agencies. State officials, this history and others show, have often relied on “private” agents to act as part of the state.
    Feminist scholars in the 1970s tended to see the medical profession as the source of the regulation of female sexuality and reproduction, but the medical profession’s role was more complex. This book shifts the attention to the state’s interest in controlling abortion and the alliance between medicine and the state. It would have been virtually impossible for the state to enforce the criminal abortion laws without the cooperation of physicians. State officials won medical cooperation in suppressing abortion by threatening doctors and medical institutions with prosecution or scandal. Physicians learned to protect themselves from legal trouble by reporting to official women injured or dying as a result of illegal abortions. By the 1940s and 1950s, physicians and hospitals had become so accustomed to this regulatory stance toward women and abortion that they instituted new regulations to observe and curb the practice of abortion in the hospital. The medical profession and its institutions acted as an arm of the state.
    • p.3
  • This book is the first to chart the nation’s enforcement of the criminal abortion laws. To understand the power of law in the lives of the masses of Americans requires that one take seriously the experiences of ordinary people caught in criminal investigations. Thus it is necessary to analyze the processes and routine procedures of the legal system that shape those experiences. Most historians of crime and punishment have focused on police and prisons, while historians of women and the law have focused mainly on marriage and property rights, not crime. Surprisingly little historical work has examined the relationship between medicine and law. Few have studied law in practice. Analysis of the day-to-day workings of the legal system, rather than statutory changes, judicial rulings, or the volume of cases, reveals how the law intervened in the lives of ordinary citizens to regulate reproductive and sexual behavior.
    • pp.4-5
  • Law is not fixed but fluid. The criminal abortion laws passed in every state by 1880 made exceptions for therapeutic abortions performed in order to save a woman’s life. Because the laws governing abortion did not precisely define what was criminal and what was not, this had to be worked out in practice, in policing, and in the courts. The complexity of defining “legal” and “illegal” abortions for medical practitioners and legal authorities alike, the gray and evershifting nature of “criminality,” is an important theme in this book. Nor was medical understanding of therapeutic abortion stable. Medicine too is interpretive and changing. Throughout the period of illegal abortion, physicians disagreed on the conditions that mandated a therapeutic abortion and on the methods: there was no consensus. Changes in medicine influenced legal definitions of crime; at the same time, the law shaped medical thinking and practice. The medical profession and the legal profession each looked to the other the define the legality of abortion practices. Therapeutic abortion became increasingly important in the 1930s; by the 1960s the practice (and nonpractice) of therapeutic abortion was at the very heart of the campaign to reform and repeal the criminal abortion laws.
    • p.5
  • The illegality of abortion had hidden the existence of an unarticulated, alternative, popular morality, which supported women who had abortions. This popular ethic contradicted the law, the official attitude of the medical profession, and the teachings of some religions. Private discussions among family and friends, conversations between women and doctors, and the behavior of women (and the people who aided them) suggest that traditional ideas that accepted early abortions endured into the twentieth century. Furthermore, through the 1920s at least, working-class women did not make a distinction between contraception and abortion. What I call a popular morality that accepted abortion was almost never publicly expressed but was rooted in people’s daily lives. Americans have a long history of accepting abortion in certain situations as a necessity and as a decision that, implicitly, belongs to women to make. This popular attitude made itself felt in the courts and in doctors’ offices: prosecutors found it difficult to convict abortionists because juries regularly nullified the law by acquitting abortionists, and few physicians escaped the pressure from women for abortions. Throughout the period of illegal abortion, women asserted their need for abortion and, in doing so, implicitly asserted their sense of having a right to control their own reproduction.
    • p.6
  • Abortion was not always a crime. During the eighteenth and early nineteenth centuries, abortion of early pregnancy was legal under common law. Abortions were illegal only after “quickening,” the point at which a pregnant woman could feel the movements of the fetus (approximately the fourth month of pregnancy).
    • p.8
  • Colonial and early-nineteenth-century women, historians have learned, perceived conception as the “blocking” or “obstructing” of menstruation, which required attention. The cessation of the menses indicated a worrisome imbalance in the body and the need to bring the body back into balance by restoring the flow.
    • p.8
  • Both of these concepts, blocked menses and quickening, must be taken seriously by late-twentieth century observers. Blocked menses cannot be dismissed as an excuse made by women who knew they were pregnant. Quickening was a moment recognized by women and by law as a defining moment in human development. Once quickening occurred, women recognized a moral obligation to carry the fetus to term. This age-old idea underpinned the practice of abortion in America. The legal acceptance of induced miscarriages before quickening tacitly assumed that women had a basic right to bodily integrity.
    • p.9
  • By the mid-eighteenth century, the most common means of inducing abortion-by taking drugs-was commercialized. The availability of abortifacients was so well-known that a common euphemism described their use. When Sarah Grosvenor, a Connecticut farm girl, confided to her sister in 1742 that she was “taking the trade,” her sister understood. That Grosvenor successfully conveyed her meaning to her sister in three metaphoric words tells us a great deal about the world of mid-eighteenth century New England. Many New Englanders, including these sisters, knew of the possibility of inducing an abortion by purchasing and ingesting drugs. The need for a euphemism tells of the difficulty of speaking only about sex and reproductive control and of the need for secrecy. Yet it reveals an awareness that women could and did regulate their own fertility through abortion. Furthermore, abortifacient had become a profitable product sold by doctors, apothecaries, and other healers.
    • pp.9-10
  • The first statutes governing abortion in the United States, James Mohr had found, were poison control measures designed to protect pregnant women like Grosvenor by controlling the sale of abortifacient drugs which often killed the women who took them. The proliferation of entrepreneurs who openly sold and advertised abortifacients may have inspired this early legislation, passed in the 1820s and 1830s. The 1827 Illinois law, which prohibited the provision of abortifacients, was listed under “poisoning”.
    It is crucial to recognize what these early-nineteenth-century laws did not cover: they did not punish women for inducing abortions, and they did not eliminate the concept of quickening. Even as poison control measures, they said nothing about growing the plants needed in one’s own garden or mixing together one’s own home remedy in order to induce an abortion. The legal silence on domestic practices suggests that the new laws were aimed at the commercialization of this practice and, implicitly, retained to women the right to make their own decisions about their pregnancies before quickening.
    By the 1840s, the abortion business boomed. Despite the laws forbidding the sale of abortifacients, they were advertised in the popular press and could be purchased from physicians or pharmacists or through the mail. If dugs filed, women could go to a practitioner who specialized in performing instrumental abortions. Advertisements and newspaper exposes made it appear that what had been an occasional domestic practice had become a daily occurrence performed for profit in northern cities. Madame Restell, for example, openly advertised and provided abortion services for thirty-five years. Restell began her abortion business in New York City in the late 1830s; by the mid 1840s, she had offices in Boston and Philadelphia and traveling agents who sold her “Female Monthly Pills.” Restell became the most infamous abortionist in the country, but she was not the only abortionist. The clientele of these busy clinics were primarily married, white, native-born Protestant women of the upper and middle classes.
    • p.10
  • In 1857, the newly organized AMA initiated a crusade to make abortion at every stage of pregnancy illegal. The antiabortion campaign grew in part, James Mohr has shown, out of regular physicians’ desire to win professional power, control medical practice, and restrict their competitors, particularly Homeopaths and midwives. “Regular,” or “orthodox,” physicians, practitioners of “heroic” medicine, had come under attack in the 1820s and 1830s as elitist. They faced competition from a variety of practitioners from other medical sets, collectively known as “Irregulars.” Through the 1870s, regular physicians across the country worked for the passage of new criminal abortion laws. In securing criminal abortion laws, the Regulars won recognition of their particular views as well as some state control over the practice of medicine.
    Though professional issues underlay the medical campaign, gender, racial, and class anxieties pushed the criminalization of abortion forward The visible use of abortion by middle-class married women, in conjunction with other challenges to gender norms and changes in the social makeup of the nation, generated anxieties among American men of the same class. Birth rates among Yankee classes had declines by midcentury while immigrants poured into the country. Antiabortion activists pointed out that immigrant families, many of them Catholic, were larger and would soon out populate native-born white Yankees and threaten their political power. Dr. Horatio R. Storer, the leader of the medical campaign against abortion, envisioned the spread of “civilization” west and south by native-born white Americans, not Mexicans, Chinese, Blacks, Indians, or Catholics. “”Shall” these regions, he asked, “be filled by our own children or by those of aliens? This is a question our women must answer; upon their loins depends the future destiny of the nation.” Hostility to immigrants, Catholics, and people of color fueled this campaign to criminalize abortion. White male patriotism demanded that maternity be enforced among white Protestant women.
    • pp.10-11
  • Regular medical men had entered the debate about sexual politics by attacking the female practice of abortion as immoral, unwomanly, and unpatriotic. In giving abortion new meaning, the Regulars provided a weapon that white, native-born, male legislators could use against the women of their own class who had been agitating for personal and political reform. Regular physicians won passage of new criminal abortion laws because their campaign appealed to a set of fears of white, native born, male elites about losing political power to Catholic immigrants and to women. Class privilege did not protect middle-class white women from public policy designed to control them. Although the criminalization of abortion was aimed at middle-class white women, it affected women of every class and race. The new laws passed across the country between 1860 and 1880 regarded abortion in an entirely different light from common law and the statutes regulating abortifacients. In general, the laws included two innovations: they eliminated the common-law idea of quickening and prohibited abortion ay ay point in pregnancy. Some included punishment for the women who had abortions. The “Comstock Law” passed in 1873 included abortion and birth control in federal antiobscenity legislation, states and municipalities passed similar ordinances.
    • p.13
  • The antiabortion laws made one exception: physicians could perform therapeutic abortions if pregnancy and childbirth threatened the woman’s life. A bill criminalizing abortion unless done for “’bona fide’’ medical or surgical purposes” passed the Illinois state legislature unanimously and was signed into law in 1867. A few years later, Illinois passed another law prohibiting the sale of abortifacients but made an exception for “the written prescription of some well non and respectable practicing physician.” Physicians had won the criminalization of abortion and retained to themselves alone the right to induce abortions when they determined it necessary.
    Through the antiabortion campaign, doctors claimed scientific authority to define life and death. In doing, they claimed the authority of religious leaders. In leading this moral crusade and thoroughly criticizing the ministry’s lack of interest in abortion, regular doctors set themselves above religious leaders as well as above the general populace. The medical profession’s claim to moral purity and the authority of the clergy was a stepping-stone to greater social authority. Regular physicians won an important victory when they persuaded the nation’s states to criminalize abortion. Physicians entered a new partnership with the state and won the power to set reproductive policy. In the process, women’s perceptions of pregnancy were delegitimated and women lost what had been a common-law right.
    • pp.13-14
  • During the more than one hundred years that abortion was illegal in the United States, the patterns, practice, policing, and politics of abortion all changed over time, though not always simultaneously.
    • p.14
  • The epoch of illegal abortion may be broken down into four periods. The first covers the time from the criminalization of abortion state-by-state, accomplished nationwide by 1880, to 1930. This period, covering fifty years, is heavily marked by continuity. As other historians have also found, the reproductive lives of most women and the day-to-day practice of most physicians changed slowly. In this period, abortion was widely accepted and was practiced in women’s homes and in the offices of physicians and midwives. The diversity of practitioners, the privacy of medical practice, and the autonomy of physicians in the late nineteenth and early twentieth centuries made the widespread medical practice of abortion possible. A crackdown on abortion occurred between 1890 and 1920 as specialists in obstetrics renewed the earlier campaign against abortion, and the medical profession was drawn into the state’s enforcement system.
    • pp.14-15
  • The structural transformation that occurred during the 1930s, the second period, was crucial for the history of abortion. Abortion became more available and changed location. As the practice moved from private offices and homes to hospitals and clinics, abortion was consolidated in medical hand and became more visible. The changes wrought by The Depression accelerated the pace of change in the coming decades, particularly in the methods of enforcing the criminal abortion laws.
    The third period was marked by increasing restrictions on abortion by state and medical authorities and intensifying demand for abortion from women of all groups. This period begins in 1940, when the new methods of controlling abortion were first instituted, and continues through 1973, when they were dismantled. In reaction to the growing practice of abortion as well as apparent changes in female gender and reproductive patterns, a backlash against abortion developed. 1940 marks a dividing line as hospitals instituted new policies, and police and prosecutors changed their tactics. The repression of abortion was part of the repression of political and personal deviance that took place in the 1940s and 1950s. Yet even in this period, the practice of abortion expanded in new directions in response to relentless demand. The new repression of abortion, however, was devastating for women. A dual system of abortion, divided by race and class, developed. During the post-war period, the criminalization of abortion produced its harshest results.
    • p.15
  • A new stage in the history of abortion, the movement to legalize it, overlaps with the third period. The movement to decriminalize abortion began in the mid-1950s and arose out of the difficult experiences resulting from the repression of abortion in the 1940s and 1950s. In the 1950s, a handful of physicians began to challenge the very abortion laws their profession had advocated a century earlier. The progress of that challenge attests to the continuing power of the medical profession to make public policy regarding reproduction. As legal reform moved forward, a new feminist movement arose, which radically transformed the movement for legal change. When the women’s movement described abortion as an aspect of sexual freedom, they articulated a new feminist meaning for abortion; when they demanded abortion as a right they echoed generations of women.
    • pp.15-16
  • Despite the criminalization of abortion nationwide, abortion continued, and despite the efforts of Dr. Horatio Storer and his antiabortion allies, the thinking of ordinary Americans about early pregnancy had not been transformed. Abortion was widely tolerated. Many ordinary Americans at the turn of the century had not adopted the idea that there was a rigid dividing line between menstruation and conception, but continued to think of menstruation and early pregnancy as related. Abortion continued to be an important method of birth control, particularly for working-class, married women like Collins. Early twentieth-century women’s use of abortion was part of a long tradition among women to control and limit their childbearing.
    In the past twenty-five years feminists have often used the metaphor of “silence to describe the subordination of women. Describing women as silent and silenced brought attention to the dominance of the masculine voice in politics, law, medicine, and the media and the near absence of women’s words and perspectives in these public political forums. The powerful metaphor’s provocative image of the silenced woman-unable to speak, ignored and unheard-reverberated with women’s experiences and encouraged women to be bold and to speak of their lives. In the late 1960s, an important tactic of the movement to legalize abortion was getting women to tell of their abortions at “speakouts” and thus discover their shared experiences and shared oppression. However, the metaphor of silence has limitations, for it has at times obscured women’s historical experiences by portraying women as more isolated, helpless, and victimized than they felt.
    • Ch.1 “An Open Secret”, p.20
  • The evidence shows that many American women and their friends and family accepted abortions. The widespread acceptance of abortion, expressed in word and deed during the era of its illegality, suggests the persistence of a popular ethic that differed from that of the law and the official views of medicine and religion. This popular acceptance of abortion took into account women’s sense of their own bodies, the particular situations in which women found themselves, and the material reality that made women and men need reproductive control. This finding suggests the need to refine our thinking about morality. Neither legal statutes nor the words of priests, ministers, or rabbis can be assumed to represent the moral thinking of the citizenry or congregations. Instead of assuming universal agreement on the immorality of abortion as expressed in the law and insisted upon by regular medical leaders, we might think of gradations in moral thinking or the existence of multiple moralities. The behavior and beliefs of ordinary people in daily life deserve serious attention. Abortion was part of life.
    • pp.21-22
  • Analysis of inquests into women’s deaths resulting from illegal abortions are crucial for my analysis of abortion from the late nineteenth century through the 1930s. Many of the details of early twentieth-century abortion practices and the most intimate stories of women and their relationships are drawn from these public records. These stories can be painful to read because the women died as a result of their illegal abortions, but their deaths allow us to learn about the lives of women, particularly immigrant and working women, who were most likely to appear in legal records. In studying these texts closely, this book honor the lives of these women who died trying to control their reproduction. Their deaths, however, were unusual. Most women survived their abortions and never had to tell anyone unless they chose to do so.
    • p.22
  • Mrs. Collins was one of hundreds of thousands of women who had abortions every year. Some late-nineteenth-century doctors believed there were two million abortions a year. In 1904, Dr C. S. Bacon estimated that “six to ten thousand abortions are induced in Chicago every year.” As one physician remarked in 1911, “Those who apply for abortions are from every walk of life, from the factory girl to the millionaire’s daughter; from the laborer’s wife to that of the banker, no class, no sect seems to be above . . . the destruction of the fetus.” As early twentieth-century reformers investigate abortion, produced and preserved knowledge of the business. Their reports, themselves evidence of the growing scrutiny of female sexual and reproductive behavior, show that a significant segment of the female population had abortions. A study of ten thousand working-class clients of Margaret Sanger’s birth control clinics in the late 1920s found that 20 percent of all pregnancies had been intentionally aborted. Surveys of educated, middle-class women in the 1920s showed that 10 to 23 percent had had abortions. Anedotal information, patient histories collected at maternity and birth control clinics, and mortality data show that women of every racial and religious group had abortions. A more comprehensive survey conducted by Regine K. Stix of almost one thousand women who went to the birth control clinic in the Bronx in 1931 and 1932 found that 35 percent of Catholic, Protestant, and Jewish clients alike had had at least one illegal abortion. By the 1930s, Dr. Frederick J. Taussig, a St. Louis obstetrician and nationally recognized authority on abortion, estimated that there were at least 681,000 abortions per year in the United States.
    Most of the women who had abortions at the turn of the century were married. Tracking changes in the demographic characteristics of those who had illegal abortions is difficult, but evidence shows that abortion continued to be a practice of mostly married women until after World War II. Yet the image of the seduced and abandoned unmarried woman dominated turn-of-the-century newspapers and popular thinking. The image of the victimized single woman spoke to fears of the city and the changing roles of women in the same way that visions of married women aborting had expressed mid-nineteenth century anxieties. Newspapers, physicians, and prosecutors highlighted the abortion-related deaths of unwed women.
    • p.23
  • To the dismay of medical leaders, the public still believed that quickening marked the beginning of life. The practice of abortion persisted nationwide “Many otherwise good and exemplary women,” Dr. Joseph Taber Johnson reported in 195, thought “that prior to quickening it is no more harm to cause the evacuation of the contents of their wombs than it is that of their bladders or their bowels.”
    Women’ critics found it provoking that women did not appear to be ashamed about their illegal abortions, but freely discussed them, advised each other in the methods for inducing abortions, and referred their friends to abortionists. One physician observed in 1891 that leading ladies of the community “not only . . . commit this crime, but talk about it very unconcernedly, or engage in disseminating a knowledge of the work among friends as earnestly as they would work for a supper for the benefit of a hospital, kindergarten, or the far-distant heathen.” The scene sketched by this doctor implicated well-to-do, respected women active in voluntary and charitable activities in the crime of abortion and criticized them for treating the subject lightly. It may be fruitful to read the doctor’s comparison literally: control over their own reproduction was as important to women as building a hospital or caring for the needy. Indeed, women’s involvement in charitable and reform activities made the ability to control childbearing necessary, and that control made voluntary activities possible.
    • pp.25-26
  • Women shared with one another very specific knowledge about how to induce abortions. Female sharing of abortion techniques was both part of the routine exchange of knowledge about how to treat illnesses of all kinds and a continuation of earlier tradition when women traded recipes for abortifacients. “The older ladies of the community are prolific in advice,” one Chicago physician remarked in 1900. “Hot drinks, hot douches, and hot baths are recommended. Violent exercise is suggested and humping off a chair or rolling down stairs is a favorite procedure. Certain teas are given . . . and the different emmenagogue pills are too easily procurable.”
    “Older ladies” shared the traditional techniques known to them; younger women shared more modern and scientific information. The information women gave each other changed over time along with changes in medicine When a turn-of-the-century physician warned a young married woman of septic infection, the woman answered, “’My friend told me to boil my catheter before using it.’” Medical precautions against sepsis, this report suggests, had entered popular knowledge. Armed with medical wisdom and personal experience, these patients dismissed warnings and vexed their doctors. Barbara Brookes has found that early-twentieth-century English women “helped” each other induce abortions. American women did the same. In 1920 a nurse reported the story of a married, working-class woman, “Annie .,” who had induced three abortions already and, if pregnant, planned to do so again. When warned of the dangers of abortion, “Annie laughed and said: ‘Oh! It’s easy.’ And . . . added: ‘I have told lots of women how to do it.’”
    • pp.26-27
  • Parents, especially mothers, often played a crucial role in the effort to obtain an abortion when their daughter was unwed. Reflecting the sympathies and training of gender, daughters generally turned to mothers for help when faced with a pregnancy out of wedlock. In the late nineteenth century, Joan Jacob Brumberg has argued, illegitimacy became a “traumatic event” for middle-class families, which threatened the reputations of both the unmarried women themselves and their families. Many parents had a strong interest in protecting their daughters and themselves from the shame associated with single motherhood. In late-nineteenth-century New York, one woman approached a female doctor about an abortion for her daughter, whose fiancé had fled “Death before dishonor” the mother reportedly declared “my daughter is not going to be disgraced all her days, and the man to go scot-free.” The mother’s words succinctly summarized the sexual double standard: she knew that bearing an illegitimate child would stigmatize her daughter for life while the boyfriend could experience sexual pleasures without hurting his honor. If fathers were apt to overreact to their obvious inability to control the sexuality of their daughters, daughters and their mothers might collude to keep the man of the house ignorant.
    • p.28
  • To avoid the social disaster of single motherhood, turn-of-the century physicians and women’s charity groups urged unwed women to bear their children in maternity homes. Some homes arranged for adoption of illegitimate infants; others insisted that the new mothers keep them. ‘’The Journal of the American Medical Association’’ viewed these homes as a way “to combat the crime of induced abortion.” Yet many homes refused African American women. One African American physician established a hospital in Louisville, Kentucky, in order to provide a place where unmarried African American women could deliver their babies and give them up for adoption instead of having abortions. The policies of unwed mother’s homes could be oppressive. Maternity homes expected mothers to repent and required them to stay long periods of time, perform domestic tasks and participate in religious services. State agencies and private charities required the women, whether keeping or giving up their newborns, to breast-feed for several months. Some women surely concluded that an abortion, though illegal, could be a simpler solution to a pregnancy out of wedlock. Regina Kunzel has found that many women in maternity homes had tried but failed to abort their pregnancies. One maternity home inmate gave her new friends at the home valuable information for the future; she described how to do their own abortions.
    • pp.28-29
  • The economic difficulty of rearing children as a single woman helped push the pregnant and unmarried to have abortions. Working women earned waged half those of men and inadequate for a woman by herself, let alone with dependent children. A 1908 study of Chicago’s store and factory workers found that more than half of the women living alone earned less than a subsistence wage. Although real wages increased in the 1920s, the average female worker in manufacturing still earned below subsistence. African American women, who were segregate into domestic service jobs, were paid less than white coworkers. Furthermore, single working mothers risked losing their children as a result of being charged with child neglect by reformers and officials.
    • p.29

Jeffrey H. Reiman, “Abortion and the Ways We Value Human Life”, (Rowman & Littlefield 1998 ISBN 978-0-8476-9208-8)Edit

  • Ironically, as Mohr points out, most feminist leaders shared the physicians’ opposition to abortion, though they did not share the physicians’ explanation of its prevalence. Elizabeth Cady Stanton, for example, viewed the increase in the incidence of abortion as a result of “the degradation of women in the nineteenth century. Feminists generally thought that women had abortions because they lacked the ability to control their sex lives in the face of pressure from tyrannical husbands or because husbands, who wanted sex but didn’t want the financial burdens of additional mouths to feed, directly pressured them to have abortions.
    • p.30
  • In view of how many abortionists were female midwives, it is plausible that male physicians opposed abortion out of a wish to put control of women’s reproduction in men’s hands. In any event, regular doctors had a financial interest in eliminating competition from these and other irregulars; licensing laws regulating who could practice medicine would not appear until the final decades of the nineteenth century. “The specific cases of abortion cited in the medical journal almost invariably stressed that the performer was a ‘quack,’ a ‘doctress,’ an ‘irregular,’ or the like, and regular physicians remained openly jealous of the handsome fees abortionists collected for their services.”
    • pp.30-31
  • Until 1967, when the first stirrings of legal liberalization began, abortion was a felony in forty-nine states and the District of Columbia (in New Jersey it was a “high misdemeanor”). In forty-two of these states, an exception allowed abortion if necessary to save the life of the pregnant woman. New Mexico and Colorado permitted it if necessary to save her from “serious and permanent bodily injury”; Alabama and the District of Columbia, to protect her life or health; and Maryland, for her “safety.” Louisiana and Pennsylvania allowed no exceptions at all. The result of these laws was not so much to eliminate abortion as to drive it underground. In 1936, an estimated 500,000 abortions-one for every five live births-were performed in America; in 1960, an estimated 1.2 million-one for every three live births Of these 1.2 million, only a tiny fraction, about 8,000, were legally permitted therapeutic abortions. Though the secrecy attending illegal abortions makes it appropriate to treat estimates of their number with skepticism, it does seem that a very large number of illegal abortions occurred during tis period.
    • p.31
  • Movements toward liberalization began slowly. A small number of radicals pressed for legalization of abortion during the 1930s but the association of this goal with the Left (the Soviet Union had made abortion legal in 1920) largely doomed the movement and led American birth control advocate to dissociate themselves from the call for legalization. Major family planning organization focused on making contraceptive devices and information readily available, first to married women and later to single women. Their leaders often expressly condemned abortion and promoted contraception as a way of reducing its incidence. Advocates of liberalization directed their efforts primarily at expanding the allowable legal exceptions rather than repealing the laws against abortion. And doctors increasingly interpreted the existing exceptions liberally.
    According to Reagan, in response to growing female independence, a new wave of repression of abortion started in the 1940s and coincided with the “domestic revival” of the 1950s. Abortion was likewise a target of McCarthyism during that period. With greater legal repression, abortions became harder to obtain and more dangerous. Maternal mortality resulting from abortions increased dramatically, especially for black and poor women. “Public-health statistics revealed an appalling picture of death and discrimination. . . . The illegality of abortion had produced a public-health disaster-especially for low-income and minority women. . . . Public health activists interested in reducing maternal mortality now had to turn their attention to one of the most important causes: illegal abortion.” Interestingly, Luker maintain that maternal deaths from illegal abortions decline throughout the twentieth century but agrees that they occurred disproportionately among the poor and that the helped to mobilize some of the first groups to enter the abortion reform movement.
    In 1952, symposium of psychiatrists recommended a legal exception to permit abortions needed to preserve the pregnant woman’s
    • p.32

“Science, Technology, and Society: An Encyclopedia” (2005)Edit

Restivo, Sal P., ed. (2005). “Science, Technology, and Society: An Encyclopedia”. Oxford University Press. ISBN 978-0-19-514193-1. Archived from the original on 15 March 2015.

  • Legal abortion preserves women’s lives from unsafe pregnancies and nonmedical abortions. For feminists, the “right to choose” abortion also symbolized women’s liberation from patriarchal control. Although “pro-choice” rhetoric is consistent with American values of self-determination, “choice” may be a misguided symbol for reproductive rights; many women experience abortion not as desirable but as an unfortunate necessity following failed contraception, forced intercourse, or “positive” diagnosis of fetal abnormality. Further, women’s ability to “choose” an abortion in the United States remains subject to some federal and state-level legislative restrictions. The 1976 Hyde Amendment restricts Medicaid-funded elective abortions, and in 2000, 87 percent of U.S. counties lacked abortion providers. Reproductive rights groups have run into conflict with disability rights activists over the possible eugenic use of elective abortion following prenatal screening, such as for Down syndrome, to limit the range of acceptable human life.
    • p.1
  • ”Roe” ultimately gives physicians, not pregnant women, the ability to determine whether and when abortion is warranted. In the nineteenth century, women of all social classes could legally procure abortion, often using herbal abortifacients. As “regular” physicians distinguished themselves from midwives and homeopaths, many lobbied state legislatures to criminalize induced abortion. Shortly after its formation in 1847, the American Medical Association (AMA) declared human life to begin at conception and not, as women apparently believed, at “quickening,” midway through gestation, when a woman first feels fetal movement in the womb. In taking an anti-abortion stance, physicians not only professionalized but moralized their practice through association with saving lives. By end of century, abortion was criminalized throughout the United States and recognized to be a medical issue. It is an historic irony that abortion was medicalized to restrict its practice, only to be legalized a century later precisely based on its status as medical procedure, a private matter between patient and doctor.
    • p.1
  • Since “Roe”, “pro-life” activists redefined the question of “life” in the abortion controversy as fetal, rather than maternal, right to life. Legalization galvanized opposition from pro-life activists, for whom abortion eroded traditional gender roles and women’s moral standing as childbearers. Right-to-life activists return to early AMA formulations of distinct life beginning at conception. Appropriating prenatal medical imaging technologies, they produce propagandistic displays. Photographic and ultrasound images of free-floating fetuses are used to portray fetal life as not only viable but autonomous, suggestive of personhood and rights. Pro-life campaigns project images of intact, well-developed fetuses despite the fact that 90 percent of abortion sin the United States occur during the first trimester. Radical pro-lifers view abortion as a holocaust and a symbol of America’s moral degeneracy. Activists commit property crimes including arson at abortion facilities, and during the late 1980s and 1990s several abortion providers were murdered by extremists who championed a Christian nation at millennium’s end where God’s law would prevail over human law.
    • pp.1-2

“Management of unintended and abnormal pregnancy: comprehensive abortion care” (April 27, 2009)Edit

Allan Rosenfield, “Introduction” in Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds) “Management of unintended and abnormal pregnancy: comprehensive abortion care”. (April 27, 2009) Oxford: Wiley-Blackwell. ISBN 978-1-4051-7696-5.

  • No topic engenders more heated controversy in the USA and elsewhere in the world than induced abortion, and this conflict is not likely to be resolved in the forseeable future. Those who feel that life begins at fertilization or implantation, and that abortion at any stage of development is the equivalent of murder, will not compromise their strong views. Similarly, those who defend a woman’s right to control her body and to decide whether to continue or terminate a pregnancy will not moderate their strong views. Other than supporting better programs to prevent unwanted pregnancies (and even here, a subset of those opposed to abortion also objects to all modern forms of contraception),no real common ground exists between these opposing points of view, despite many attempts to search for some means of communication between the two.
    Notwithstanding prevailing religious, moral, or cultural attitudes toward abortion, women who do not wish to be pregnant for whatever reason will attempt to terminate the pregnancy, regardless of the risks involved. Worldwide, approximately 42 million abortions occur annually, and 20 million or more are performed under unsafe, usually illegal, circumstances. Furthermore, the World health Organization estimates that between 65,000 and 70,000 women die each year from unsafe abortion and 5 million more suffer from complications of hazardous or botched abortions, most taking place in the developing world and primarily in those countries in which abortion is illegal.
    In the USA in the late 1980s, data from the National Survey of Family Growth (NSFG) showed that nearly 60% of all pregnancies were unintended at the time of fertilization. Thus, over 3 million pregnancies per year were unintended and 45% of these pregnancies, or 1.4 million, ended in abortion. Approximately half of all unintended pregnancies in the USA still end in abortion, resulting in approximately 1.2 million induced abortions each year. Moreover, the most recent NSFG data from 2002 demonstrated a notable increase in the proportion of births to women who wanted no more children (approximately 14% as compared to 9% in the 1995 data). According to Finer and Henshaw, “between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates, and the wealthiest women, but increased among poor and less educated women. Thus, women with the least resources bear a disproportionate burden of unintended pregnancy and its consequences. Although many assume that teenagers have the majority of abortions in the USA, they actually account for less than one-fifth of all abortions, the remainder taking place among women over age 20.
    In close to half of those women experiencing an unintended pregnancy, the woman or her partner regularly used a contraceptive method, but for a variety of reasons, it was not used on that occasion or it failed. Similarly, approximately 54% of US women who had an abortion in 2000-2001 had been using a contraceptive method during the month they conceived. Despite the relatively large number of highly effective reversible contraceptive methods on the market, none meets the needs of all couples. The most effective ones (intrauterine devices, injectables, and implants, which have failure rates essentially equal to a sterilization procedure) all have drawbacks or are associated with misperceptions that limit their use. Oral contraceptives, the most widely used reversible method of contraception, carry failure rates of 6 to 8% in actual practice. The advent of emergency contraception is an important advance, providing an option for those women who have unexpected mid-cycle intercourse.
    • p.34-35
  • Due to myriad factors, including the shortage of abortion providers and state and federal restrictions on abortion, many areas of the USA lack abortion services. As a result, many women travel considerable distances in order to obtain abortions. In some states, services are severely limited, and a few dedicated clinicians travel by plane to different clinic settings on a regular, repeating schedule. This situation is extraordinary in a country in which abortion is legal and in which over 40,000 obstetrician-gynecologists practice.
    • p.35

“The Abortionist: A Woman Against the Law” (1994)Edit

Rickie Solinger, “The Abortionist: A Woman Against the Law”, The Free Press, 1994, pp. xi, 5, 16–17, 157–75.

  • For the past one hundred and fifty years in the United States, when abortion has been discussed in public, the context has almost always been legal: we need laws to stamp out abortion. We need to liberalize the laws. We need to give women a legal right to choice. We need to restrict or recriminalize the practice. While these discussions have proceeded across the decades of the nineteenth and twentieth centuries-when abortion was a crime, and when it was not-girls and women have found abortion practitioners to terminate pregnancies they were unable to manage. Our history shows us that neither criminal statues nor censorious public attitudes were ever sufficient to stop women determined to decide for themselves whether and when to become a mother.
    Nobody knows for sure how many illegal abortions were performed each year in the decades before “Roe v. Wade”, the 1973 Supreme Court decision that legalized abortion. Law enforcement officials and public health experts often estimated the annual number of abortions at one million, with only ten thousand of those conducted in hospitals as medically sanctioned therapeutic abortions. In 1953, when abortion was most empathetically a crime, Alfred Kisey’s pathbreaking study, “Sexual Behavior and the Human Female” reported that more than one out of every five women in the United States who had sexual relations-whether inside or outside of marriage-ad had an abortion. The experts generally agreed that most illegal abortions were performed on married women, not surprisingly, since more married than single women engaged in sexual relations. But an enormous number of girls and women in both groups found abortionists to take care of them in the illegal era.
    • pp.ix-x
  • We have no reliable numbers to attach to illegal abortions, nor do we have a thorough profile of abortion practitioners. Many were able to conduct their business without exposure. Like many people who operate outside of the law, a number left no evidence of their illegal activities. We do know that in a great many cities and town, medical doctors in the illegal era did sneak in an abortion case every now and then, often as a favor to a long-time patient who made her desperation and her determination frighteningly plain.
    • p.x
  • Some practitioners were not physicians, but were nevertheless highly skilled and experienced. Some were midwives, others nurses, chiropractors, naturopaths. The vast majority of illegal abortions were performed by individuals-doctors and others-who knew what they were doing because they provided their services day in and day out, year after year, for decades at a time with the tactic consent of law enforcement.
    Others who performed abortions in the illegal era were not trained or skilled. These were the notorious back-alley butchers, the car mechanics, the hairdressers, the proprietors of hardware stores, the housewives who saw that the law together with women’s need to control their fertility, created lucrative opportunities for a person with the stomach to try his or her luck at scraping wombs. These types performed a relatively small share of the abortion carried out in the illegal era. Their careers generally did not last long. They made mistakes, and they were arrested at once. The terrible consequences of their work, and the highly public fate of these abortionists-their arrests and trials and incarcerations-guaranteed them an enduring place in our historical memory of the illegal era, despite their brief and limited practices.
    • pp.x-xi
  • People who saw the results of anti-abortion laws firsthand in the illegal era-the physicians and public health officials who kept tabs on emergency room traffic-were well aware that it was not the physician-abortionist, nor the midwife or chiropractor or even the car mechanic, who caused abortion-seeking girls and women the most physical damage before “Roe v. Wade”. By far, the lion’s share of the damage was at the hands of the unwillingly pregnant woman herself, so desperate and resourceless, so shamed and determined, that she’d take up a hideous array of herbs and implements, despite the spectre of damage and death from self-styled abortions that haunted every woman in those days. Dr. Kinsey and his colleagues in the 1950s estimated that seventy-five to eighty-five percent of septic abortions were self-induced. An obstetrician in Washington, D.C., observed in 1958 that attempts to suppress abortion simply raised the self-induced abortion rate and consequently the death rate.
    • p.xi
  • Today, anti-choice legislators and a minority of our citizenry are determined to use the law again to mandate “counselling” and waiting periods, to require parental and spousal notification to deny insurance coverage for abortion, to prohibit certain kinds of procedures, and ultimately to outlaw altogether the right of women to control their own fertility. The effect of these efforts, where they prevail, will be to mandate the degradation of unwillingly pregnant girls and women and to further entrench a tiered system of access to abortion services that will hurt poor women first.
    The history of our recent past teaches that anti-abortion statues have had and would again have an additional malign effort-degrading the law itself Although the law never did and never will stop millions of women from determining their own reproductive lives, it has in the past, as Ruth Barnett’s story shows, provided a wealth of opportunities for police corruption, politically corrupt selective enforcement, and politically timed sensational and salacious exposes, all of which endangered and damaged women.
    • p.xii
  • Anti-abortion statues have never stopped abortion in part because these laws have always been at odds with public opinion. That fact may be difficult to remember in the midst of today’s noisy, sometimes violent anti-choice rhetoric and legislative grandstanding. But in the depths of the illegal era, legal experts and law enforcement officials regularly pointed out that the majority of Americans were not opposed to abortion because, then as now, to many of our wives, mothers, sisters, aunts, girlfriends-too many of us-have been caught by unmanageable pregnancies. Yet, in the absence of a feminist movement that linked abortion rights and women’s rights, public tolerance of abortion in the illegal era meant that most Americans passively accepted laws against abortion and quietly sanctioned massive, secretive, individual resistance. But today the public cannot afford to be passive about the right to abortion because a desperate segment of the opposition has turned violent and murderous. This opposition and its far-right supporters are determined to have the state control women’s bodies and fertility once again.
    • p.xii
  • Whether the anti-abortion statues were rarely enforced, as in the Depression-era 1930s, or often enforced, as in the 1950s, the fact that these laws were on the books created opportunities for individuals-sleazy entrepreneurs and ambitious politicians-who did not perform abortions but positioned themselves to benefit from women’s desperation, at women’s expense. And the laws on the books provided a foundation for a kind of vulnerability that started with heterosexual intercourse and rippled out over all the facets of a woman’s life. The story of the illegal era shows how when an activity is simultaneously illegal, culturally taboo, and perceived by women as one of life’s necessities, opportunities about for the degradation of women and the enhancement of the power of men.
    • p.xv
  • Most females who had heterosexual intercourse could become pregnant at any time. Educators, employers, cultural authorities, and many other social arbiters constructed their ideas about girls and women on this reality. Unexpected pregnancy and motherhood justified excluding females from many fields of study and many jobs, justified paying them lower wages than men, and otherwise stunted the claims of women to full membership in society. Plus, as long as females were subjected to laws that denied them sexual and reproductive autonomy, all women were affected, whether or not any one of them climbed up on the abortionist’s table.
    This insight about the danger to all women has frightening relevance today. “Roe v. Wade” hangs by a thread. Opponents of “Roe” continue to raise religious beliefs about secular law, in violation of the Constitution but with breathtaking conviction and persistence-and success. They proceed with their efforts to recriminalize abortion as if it were possible to cancel this one reproductive right without changing “everything” about the status of fertile, potentially pregnant persons in the United States. Living under a regime of coerced pregnancy, coerced childbearing and coerced parenthood changed everything.
    • ”Preface to 2019 Edition”, pp.xviii-xix
  • The notion of quickening was a venerable, woman-centered concept long embedded in the common law. It allowed that a pregnancy could not be confirmed until the woman felt the fetus move within her body. In the days before drugstore pregnancy kits, sonograms and rabbit tests, and all the other modern methods of verifying pregnancy, the woman herself was the definitive expert. Doctors and midwives agreed that menstrual irregularity-in fact, all the symptoms of pregnancy-“could” be associated with conditions other than pregnancy. So traditionally, it was not until the woman reported the sensation of fetal movement that she could be declared pregnant. Consequently, an abortion in the early months of pregnancy-often treated as an operation to restore the woman’s menstrual flow by removing a “blockage”-was not considered a crime. During all of the eighteenth century and the first half of the nineteenth century, the quickening doctrine governed abortion law in the North American English colonies, and then in the United States.
    Even after doctors had prevailed on legislators to make abortion crime, many states retained the quickening doctrine by criminalizing abortion only after the woman reported movement. Oregon’s first anti-abortion statute was based on this premise. The concept of quickening was so enduring that as late as the 1930s, seven states still incorporated it into the statutory language by specifically outlawing procedures on a woman “pregnant with a quick child”.
    • Ch.1 “Danger”, p.11-12
  • It was always the case that a woman lying in the city hospital, suffering the effects of a botched abortion, caught the attention of law enforcement officials. If the policemen called to her bedside by the hospital staff had reason to believe that the criminal abortion was the work of a lay practitioner, their eagerness to make an arrest might be quite keen. Some observers of the behavior of law enforcement in these years pointed out that police were especially eager to arrest a female abortionist, whether or not she had a death on her hands.
    A medical man who performed abortions-on the side or for a living-was not so endangered. Certainly he was less likely to be arrested for being a known abortionist. After all, a doctor had the skills that came with medical training, so a district attorney, not eager for abortion prosecutions any-way, could reason that a doctor’s abortion work didn’t really hurt the community or put women’s lives in danger. A seasoned D.A. knew for sure that any abortion conviction was hard enough to win, and a doctor-defendant only made matters worse. For one thing, just about any doctor in town had respectable, pillar-of-the-community colleagues to stand up for him in court and claim the abortion was a medical necessity, no doubt about it.
    • p.14
  • As one observed in Ruth Barnett’s day put it, “It was to be expected that the abortionists could not ply their trade in security without insuring that law enforcement agencies would keep their eyes fixed in the opposite direction.” Many abortionists dutifully paid the insurance premium directly to the cops. Throughout the illegal decades and across the country, law enforcement officials who did not want to get involved in abortion busts understood that extortion was remunerative alternative to arrest. In most towns it was common knowledge that wherever there were abortionists, there were cops being paid off. One reported, snooping around among abortionists in California, came away convinced of this. He wrote, “In big cities an abortionist who operated openly in a downtown office building must be assumed to have purchased immunity, for the constant stream of women to his office would quickly attract attention.” It was not unusual that a high-level investigator looking into the goings-on in these down-town buildings would end up with more extortion-than abortion-related indictments. In the real world, the anti-abortion laws created more problems than they solved.
    • p.15

“Abortion Wars: A Half Century of Struggle, 1950–2000” (1998)Edit

Solinger, Rickie (1998), "Introduction", in Solinger, Rickie (ed.), “Abortion Wars: A Half Century of Struggle, 1950–2000”, University of California Press, ISBN 978-0-520-20952-7

  • Fifty years ago, politicians in this country did not speak in public about abortion. Nor did priests or rabbis. Large groups of people did not collect in Washington, D.C., to demonstrate their support for or abhorrence of abortion rights. Fifty years ago almost no one in the United States imagined coupling the shadowy world of abortion with the concept of the civil rights of women. Abortion practitioners-and there were hundreds of them working in our cities and towns then-did not don bulletproof vests when they went to work in the morning. And fifty years ago, hundreds of thousands of women sought and obtained abortions, furtively keeping appointments with criminalized practitioners in venues on the wrong side of the law.
    At the end of the twentieth century, the subject of abortion occupies the dedicated space in public discourse for expressions of fear, outrage, and hatred; for struggle over ideology and justice. This is the space that forty to fifty years ago was filled by the subjects of civil rights and communism. Clearly, a great deal has changed in the past half century regarding abortion…
    • p.1
  • There are pressing reasons to look at the abortion controversy in the United States over time. But before discussing some of the reasons that seem particularly pressing, I want to make the simple point that when a subject is given its history-when the abortion controversy and abortion practice are examined within ahistorical framework-it becomes unsettilingly impossible tot hink about the subject ina fixed, static wat or to claim universalized, decontextualized meanings for abortion and its satellite issues.
    • pp.1-2
  • What would a contemporary reader make, for instance, of a 1966 letter in my files form a Portland, Oregon, parish priest in good standing who wrote in the Portland city Council imploring this body to quit harassing the city’s most active, most successful, and most demonized abortion practitioner? In this letter the priest insisted that the council grant a permanent license for the motel the abortionist owned on the same block occupied by St. Michael’s Catholic Church. The priest defined his defense of the abortionist clearly: “I sincerely trust that we are still living in an age when a person’s property is respected.” This letter directs the attention of today’s readers to the very interesting fact that in 1966 a catholic clergyman not only argued publicly that property rights trumped abortion wrongs but even portrayed the abortion provider as a hardworking, generous grandmother of four whose place of business was a respectable hostelry.
    Keeping the priest from St. Michael’s in mind, let’s return to the important reasons for considering the subject of abortion in its historical context. Tobegin with, a historical framework makes clear that the meanings of the most fundamental terms associated with abortion- such as “life, choice, mother, fetal viability”-have shifted, contracting or expanding over the past half century. For both scholarly and strategic reasons, it is important to cultivate a heightened awareness of this process.
    • p.2
  • The fact is, when foundational terms-particularly those associated with politically charges matters-have fluid and mutable meanings over time, their usage is easily manipulated or distorted and politicized. An advocate can emphasize vestigial meaning in a way that subtly but powerfully eclipses contemporary usage. In the abortion arena, opponents of abortion rights often invoke terms such as “life” and “mother’s destiny” as if they had fixed enduring transcultural and transhistorical meanings. At other times, these same people imbue old terms with apparently modern significations. A demonstration that the meaning of many abortion-related terms has changed over time calls into question the claim of universal, unchanging truth advanced by the anti-rights forces.
    • p.2
  • Fifty years ago, embryologists and neonatologists were in general agreement that viability-the capacity of the fetus to live outside the womb-was reached after approximately thirty-four weeks of gestation. Scientists and physicians also agreed that “fetal viability” was a technical term relevant mostly to obstetric emergencies. Over the decades, scientific advances have pushed the date of veral viability back, so that today, in some cases, a fetus of twenty-seven or twenty-eight week’s gestation can be rendered viable. New science has thus fractured old meanings and common usage. Today, anti-rights legislators all over the country and in Congress have appropriated the term from the medical domain and refashioned it as a legal status anda political rallying cry. For abortion rights opponents, the term now demarcates the beginning f a stage of pregnancy in which abortion is deemed “late”, and therefore notoriously and irredeemably wicked. “Fetal viability” has become an anti-rights strategy for demonizing women and disqualifying doctors.
    • pp.2-3
  • More than 25 years have elapsed since Dr. Bourne, an eminent London obstetrician, was found not guilty after having performed an abortion on a 14-year-old girl who had become pregnant after a particularly brutal rape. In this country no state has specifically legalized an abortion for pregnancy resulting from rape or incest. It is extremely likely, however, that many victims of such crimes have been aborted upon the medical, or more accurately psychiatric, opinion that the operation is necessary to preserve the patient's life. Our society tends to express vigorous condemnation of criminal abortion until confronted with a personally or socially unacceptable pregnancy.
    In contrast, for abortion rights proponents, the term largely retains its original reference to the fetus “qua” fetus. People who support abortion rights are aware that the very small number of abortion performed after fetal viability are bund up with unavoidable tragedy. Many rights advocates have come to believe that, in practice, fetal viability is a socially constructed and not simply a scientifically predictable status; a woman’s access to prenatal care, adequate diet, high-tech obstetric and neonatal services, and other resources has a decisive impact on when any given fetus achieves viability. Taking into account older meanings and usages of terms central to public discussion of abortion, and the ways these have changes over time, it is not only an interesting intellectual pursuit. It is an aspect of building an effective political strategy.
    • pp.2-3
  • Looking at abortion politics in a historical framework creates one more important opportunity: the historical evidence challenges and can even demolish the myths that have frozen much of the public discussion of abortion in a dangerous rhetoric outside of time and social context, obscuring and distorting what is at issue.
    • p.4
  • Terry, Buchanan, and others broadcast the untruth that before “Roe v. Wade”, the United States was a virtually abortion-free country and thus, they say, a country with stronger family values, closer to God. The historical evidence makes clear, however, that before legalization, hundreds of thousands of women obtained abortions each year. The historical evidence forces us to recognize that the laws against abortion did not come anywhere near ending or even effectively containing the procedure, though the laws did, f course, making being a woman more dangerous in this country.
    • p.4
  • A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers. In one recently released pro-rights documentary about the illegal era, women forced into the back alley by the law and determination to control their own fertility are portrayed as taking their lives into their hands because practitioners were all filthy mercenaries, sexual predators, or both. Again, the historical evidence does not support such claims. Rather, trial records and public health studies-two of the best historical sources for tracking a secret, criminal activity such as abortion-show astonishingly high rates of technical proficiency among criminalized abortion practitioners and surprisingly low rates o septic abortion caused by these persons. The widespread practice of self-induced abortion, on the other hand, did leave a horrible trail of morbidity and mortality. The enduring myth of the back-alley butcher has profound contemporary relevance. The anecdotal, unsubstantiated taint attached to old-time practitioners has a way of bleeding across time to infect the public and professional standing of contemporary practitioners, who, with the myth intact, are “justifiably” targeted by violent “pro-lifers,” marginalized by the medical profession, and shunned by their own communities.
    • p.4
  • In some ways, at the end of the twentieth century, abortion politics exists on paradoxical terrain. On the one hand, the status of abortion in the United States is more volatile than ever, dependent on a host of variables including presidential elections, the political complexion of the Supreme Court and the fifty state legislatures, and even on the political culture of thousands of municipal police departments. On the other hand, abortion has achieved a dailiness in consciousness of Americans. Regular news reports o legislative hearings, protests, violence, legal challenges to restrictions, and other abortion-related events have kept the issue before the public in ways that were simply unimaginable a half century ago and that today push millions of Americans to consider their personal relation to the issue and take a stand.
    • p.4
  • It is worth noting here that my own use of the term “abortion rights”, instead of the more commonly used term “choice”, reflects a grow in recognition among advocates that “choice” is the ultimate marketplace concept. When wee construct the abortion arena on the marketplace model, we justify the fact that millions of women in the United States cannot afford to purchase adequate or necessary reproductive health services. When we talk about “rights”-about reproductive rights, including abortion rights of all women-then we are constrained to reevaluate the kings of efforts in which venues we must pursue thee rights, as Kathryn Kolbert and Andrea Miller put it, in order to secure a “new positive rights articulation of Roe” as well as to protect the abortion rights women currently have and win back the ones already lost.
    • p.9
  • Finally, a theme or undercurrent that runs through all the essays in “Abortion Wars” is that the rights advocates included here, and te organizations, constituencies, caused they represent, have not lost their taste for the struggle. Despite the work and the pain involved in facing and facing down the violent opposition, despite the tragedies that has entailed, despite the harsh tasks of responding to hostile legislators while devising innovative strategies, despite the arduous efforts associated with applying the lessons of history to the process of redefining the issues that constitute the heart of the abortion rights struggle today, the voices in this volume are surprisingly energetic. At the end of the twentieth century, abortion rights-reproductive rights-remain a deeply worthy cause because achieving these rights will bolster the claim of all women to lives imbued with justice, safety, and dignity.
    • p.9
  • In recent years historians and activists have begun to write the history of abortion politics in the era before 1973. They have been motivated to reclaim this history in part to remind women and men in the United States how dangerous it was to be a fertile female in this country when the judiciary, the legislatures, and social agencies-but not vulnerable pregnant women had the legal right to determine who was a mother and when. Historians of this era are also determined to analyze the factors that made legalization possible in 1973, including, prominently, a massive, organized pro-rights feminist movement. The writers of the three historical essays in this section believe that understanding the waning decades of criminal abortion is important for understanding contemporary abortion politics and the opportunities before us today.
    • "Coercion, Resistance, and Liberation Before Roe. v. Wade", p.13
  • In the late 1980s, when the legal right to abortion seemed desperately threatened, I decided to find out as much as I could about the experience of single mothers and unwillingly pregnant girls and women in the decades immediately preceding “Roe v Wade”. I imagined that in uncovering these experiences, I would find patterns reflecting literally millions of instances of danger, coercion, humiliation, and basic degradation of females in the United States. And indeed I did. I believed that writing about these patterns-laying out the proof of degradation-would help dissipate legislative and judicial efforts to reenslave girls and women to their fertility.
    Today, with the threat to reproductive freedom still a virulent strain in out political culture, I am painfully aware of the romanticism of my original intention, based as it was on the simple conviction that history is transformative. Having had such high hopes for the evidence I found in archives and trial transcripts, I neglected to consider how difficult it is to communicate history, perhaps especially this recent, decidedly unglamorous history of the politics of female fertility.
    But even now that my perspective on the power of history is more clear-sighted, in the sense that I know more about how hard it is to bring history into the political and policy arenas, I remain just as certain that knowledge of the history of reproductive politics in the United States is crucial, for a number of reasons. One o the most important reasons is that history does teach that most transformative lesson: progressive social change is possible and occurs most surely and swiftly in eras of progressive activism. And, when we know the history of reproductive politics, we can better understand the roots of current conflicts in this arena. Then we who believe in women’s reproductive rigts can use this understanding to define out goals and shape our strategies.
    • “Pregnancy And Power Before Roe v. Wade, 1950-1970”, p.15
  • The truth is that even when blocked by laws, institutions, and authorities, up to one million women a year sought and obtained abortions in the illegal era-though not without a struggle.
    • p.16
  • The contemporary history of reproductive politics in the United States begins immediately after World War II, after a period when women had joined the paid workforce in unprecedented numbers, and at a point when the issue of race was emerging as a central concern of the polity and its citizens. In the late 1940s and into the 1950s, cultural arbiters and authorities-psychiatrists, lawyers and judges, educators and employers, journalists and politicians, advertisers, the clergy, fashion designers, social service providers, and others-used the media as never before to address what had become a set of burning questions: Who is the American woman? What is a woman? Who is a mother? Most prominently published responses to these questions claimed not just that motherhood was defining attribute of womanhood, but that for motherhood to be an authentic expression of femininity (a postwar synonym for womanhood), it must occur within marriage. A woman, they claimed, must passively receive and submit to the “gifts” of marriage, especially pregnancy. Sensationalized public censure of females who got pregnant without being married or were otherwise unwillingly pregnant, combined with greatly increased prosecutions of illegal abortion practitioners, gave bite to prevailing definitions of womanhood and warned all women about the wages of transgression. It was in this context that various power centers mobilized to clamp down on women seeking to control their fertility and on those willing to help them do so.
    • p.17
  • Today, abortion practitioner in the United States are targeted and reviled by the radical right and isolated by their communities. Many wear bulletproof vests in public, and almost all have unlisted home telephone numbers. The need for such precautions is relatively recent. During the illegal era (from the mid-nineteenth century until 1973), abortion practitioners operated with varying degrees of secrecy, but they did not fear for their lives. In fact, a number of abortionists I the illegal era provided their services for years-twenty, thirty, forty years, and more-completely unimpeded by the law. In many communities, the local abortion practitioner’s name and address were well known, not only to women who might require the service but also to police and politicians, who generally regarded the presence of a good abortionist a public health asset. For decades after the American medical Association worked with state legislatures in the nineteenth century to outlaw abortion, abortion prosecutions were rare relative to the number of abortions performed. In most communities an unwritten agreement prevailed between law enforcement and practitioners: no death, no prosecution.
    But after World War II the old agreement was rather suddenly canceled, and practitioners-chiefly the female ones (presumed by law enforcement to be unskilled, untrained, and unprotected in comparison to their male counterparts, and therefore more likely to be convicted)-were arrested, convicted, and sent to jail in unprecedented numbers, even when there was no evidence of a botched abortion. Many of these practitioners were highly skilled and experienced, having performed twenty some abortions a day, year after year.
    • pp.17-18
  • If we look at when and how these arrests were carried out and at how abortion trials were conducted, we can get a sense of what was at issue and begin to understand the agendas of the district attorneys, judges, and politicians who managed the postwar crackdowns. In many cities what stands out is that everything about these prosecutions-the sensationalized media coerage of police raids, arrests, and trials-transformed abortion from an everyday, if semi-secret, occurrence into a crime. Often sccandal0tainted mayors and police forces were looking for opportunities to demonstrate that municipal governance and law enforcement were not ineffectual or corrupt, as charged. Many police chiefs, in concert with a district attorney’s office, an eager-crime busting reporter, or a clutch of city fathers concerned with civil probity, scouted for fodder for municipal exposes. Theirs was a peculiarly postwar-cold war project: to root out the “hidden” enemy within and “cleanse” the city in the process. I Los Angeles, San Francisco, Cincinnati, St. Louis, Trenton, Portland, Oregon, and other cities, even though there was no expressed anti-abortion agenda (nobody raised the specter or even the subject of unborn babies), women abortionists and their clients became attractive targets. These women represented a political opportunity because they were vulnerable, with almost no resource to credible defense. Moreover, given the associations of sex and secrecy, the arrests were eciting; the lurid headlines sold newspapers and made law enforcement appear well deployed.
    What one finds in the abortion courtroom is that in the postwar decades such trials became first-rate occasions for men0doctors, lawyers, judges, police, jury members-to gather in apublic place and affirm their right to govern women’s bodies, to define women’s rights, and to enforce women’s vulnerability. In addition, these trials were titillating dramas that pitted one woman against another-the alleged abortionist (case most often as a perverse and mercenary harridan) against her putative client (the slut). The whole event was drenched in sex. Whatever it occurred, the trial emerged day by day as a species of pornography, a cryptoporn show in which, in the name of the law and public morality men invoked women’s naked bodies, their sexuality, and their vulnerability in a style that was both contemptuous and erotic.
    • pp.18-19
  • Anyone could see that enforcing anti-abortion laws involved the degradation of women. Every woman, whether she ever had or ever would climb up on the abortionist’s table, was endangered by the statutes that criminalized abortion.
    The prosecutions (and our memories of them) also carried the message that abortion practitioners were vulnerable vermin-an attitude that lives on in the anti-abortionists’ hit list, as well as in the pro-choice claim that the chief function of “Roe v. Wade” has been to protect women from the back-alley butchers of the past, despite the historical reality that most illegal abortions were performed by highly skilled and experienced practitioners, who compiled an astonishing record of successful procedures under extremely difficult conditions. In actuality, the power of “Roe, v. Wade” has been, since 1973, to diminish the danger and the degradation of women mandated by the anti-abortion statues of the criminal era.
    • pp.19-20
  • At the same time that police and politicians were busy burnishing their reputations by cracking down on illegal abortionists, medical doctors were experimenting with opportunistic and oppressive supervisory structures of their own. In the late 1940 doctors designed these structures-hospital abortion boards-to govern the meaning and the course of the pregnancies of millions of women. The boards ensured that experts, not women themselves, had final control over the abortion decision.
    • p.20
  • In the postwar era, after several generations of performing abortions themselves, looking th other way, or facilitating, through referrals, illegal abortions, a great many doctors adopted an aggressive position against abortion. Before the war many women had found cooperative doctors, as evidenced by the vast number of approved medical indications for “therapeutic abortion” (a list that kept expanding through the 1930s). Even a woman who did not have a medical problem had little trouble finding one of the hundreds of illegal practitioners who practiced undisturbed, in the shadows of cities and towns across the country. One way or another, thousands and thousands of women each year who wanted to end their pregnancies found a way. But after the war things changed. Many doctors said abortion was no longer necessary.
    For one thing, the list of illnesses that doctors had defined as incompatible with pregnancy began to shrink year by year with the advent of new therapies and technologies. By the early 1950, influential physicians were standing up to make the claim that almost no medical contraindications to pregnancy remained. Even a woman with breast cancer or cardiovascular disease, who could have gotten a routine hospital abortion in the 1930s, was not told not to worry about having a baby.
    • pp.20-21
  • In these postwar years, pregnancy became fundamentally a moral issue. As new imaging technology allowed doctors to construct the fetus as a “little person,” they tended to describe pregnancy “fist” as a process of fulfillment and realization for the fetus, and to refer to the pregnany woman’s bdy in terms that suggested a safe reproductive container. Now the pregnany woman,, along with her physician, had the moral duty to keep the container fit. As one obstetrician put it: “Woman is a uterus surrounded by a supporting mechanism and a directing personality." completely effaced, the woman-as-uterus simply housed the child.
    As doctors adopted and promoted these ideas, the number and the rate of therapeutic abortions performed in U.S. hospitals plummeted.
    • pp.20-21
  • In some ways the situation was paradoxical. On the one hand, many people believed that doctors were scientific and humanitarian heroes for subduing the dangers of pregnancy and for developing methods to conquer diseases that threatened pregnancy and the pregnant female. On the other hand, state laws still required that a pregnant woman’s life had to be endangered for her to get an abortion. Medical advances had seemingly wiped out any legal grounds for demanding abortion-but they had not changed women’s determination to get abortions, the law and their doctors’ proscriptions notwithstanding.
    • p.22
  • There is no question that doctors were feeling the squeeze from all sides and from within their own ranks as well. Any two doctors might disagree about which woman should be given permission for an abortion, under which conditions. Nevertheless, doctors still had a legal responsibility to make the decision. And they were still interested in holding on to their medical authority to do so. The result was that many physicians struggled to find new grounds for making medical decisions about abortions. To a significant extent, psychiatrists helped out in the crisis, providing myriad esoteric ways of selecting who should and who should not be permitted an abortion. It must be added that most of these ways were based on providing a clinical answer to the question, “Is this woman psychologically fit to be a mother?” Answers in the negative-those that gave women permission to abort-defined the petitioner as unfit, unwomanly, to some degree depraved. The means and the ends here were both degrading to women seeking to control their fertility.
    Beyond this help from psychiatrists, though, physicians felt a need to create institutional structures to strengthen their position as abortion decision makers. In the late 1940s an early 1950s, they began to assemble hospital-based abortion committees. From these official groups, professional, expert diagnoses an decisions regarding individual women could be issued in one voice. The abortion committees gave doctors legal protection and ensured that the “right” ratio of births to abortions was maintained in the hospital. The ratio varied from hospital to hospital, but doctors everywhere believed that a high ratio of births to abortions would protect the reputation of their hospital.
    • p.22
  • Briefly, after World War II tens of thousands of white girls and women who became pregnant outside of marriage each year were unable to determine either the course of their pregnancies or the conditions of their maternity. They were, in astonishing numbers, deeply shamed by their families removed from school, diagnosed as psychologically disturbed, and defined as not-mothers without husbands. They were pressed, even coerced, into giving up their “valuable” white babies for adoption to infertile, white, married couples prescreened and judged by social workers to be eager and proper parents.
    In contrast, black girls and women who were unmarried and pregnant kept their “illegitimate” children, often with the help of their families and community-based institutions. But politicians in every region of the country began to blame unwed blac mothers for producing “excessive” numbers of “unwanted” black babies. Politicians and journalists said these babies created burdens for white taxpayers. Worse, many politicians, policy makers, and ordinary citizens began claiming at mid-century that the wombs of poor black women, excessively and wantonly fertile, were the course of all problems in the black community (including poverty, juvenile delinquency, and urban disorders) and, bu extension, in America as a whole.
    Consequently, beginning in the late 1940s and continuing with increasing determination throughout the postwar decades, politicians threatened unwed mothers of color with incarceration, sterilization, and removal from welfare rolls. Social scientists and social commentators of diverse political persuasions began-at a time when the whole country was a battleground in the war of integrationists versus segregationists-to use the out-of-wedlock pregnancies of some women of color to bolster policies of white supremacy. Many used these “illegitimate” pregnancies to justify stands against school integration and for restrictive public housing policies. Numerous politicians associated welfare with oversexed black women who had too many children, thus giving focus to white opposition to government aid to poor mothers and their children, especially African Americans.
    • p.27
  • We can find additional roots (and lessons) in this history. To begin with, it seems to me that the poisonous attacks and deathly threats against abortion providers today depend heavily on a continuing cultural hostility to women who take the right to separate sex and maternity. The attacks also depend, just as heavily, on a misreading of the past, a misreading that says that cravenly greedy back-alley butchers were the chief source of danger to helpless women in the criminal era. Given the salacious and sensational prosecutions of illegal abortionists in the’. postwar decades it is easy to understand why so many people on all sides of the abortion issue find it reasonable to marginalize or target practitioners. They forget that it was “the law”, not illegal abortionists, that created, even mandated, danger for all women before “Roe v, Wade
    • p.28
  • The lessons of midcentury reproductive politics are not, however, all cautionary and grim. For example, it is instructive to know that in the late 1950s, among broadly middle-class white girls and women who got pregnant while unmarried, over 95 percent gave their babies up for adoption. Today the rate for all such girls and women is 3 percent. This is a startling change and suggests that with “Roe v. Wade”, women won more than the right to decide whether to stay pregnant. They also won the overlapping but distinct right to decide whether to become a mother. With the dramatic decline of coerced adoptions and the advent of legal abortion, many women in the United States have rights and choices that were virtually unimaginable in the recent past and certainly unobtainable. Social change is possible and, in the case of reproductive politics, was realized largely during the resurgence of the feminist movement from 1965 to 1980.
    At the end of the twentieth century, racism, misogyny, and prejudice against poor people are factors that deeply stain our national culture and consequently stain the politics of female fertility.
    • pp.28-29

"Abortion surveillance – United States, 2003" (2006)Edit

Strauss, L.T.; Gamble, S.B.; Parker, W.Y.; Cook, D.A.; Zane, S.B.; Hamdan, S.; Centers for Disease Control Prevention (2006). "Abortion surveillance – United States, 2003". Morbidity and Mortality Weekly Report Surveillance Summaries. 55 (SS11): 1–32. PMID 17119534. Archived from the original on 2 June 2017.

  • Results: A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002. The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002. The abortion rate was 16 per 1,000 women aged 15--44 years for 2003, the same as for 2002. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998--2003. During 2001--2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion.
    The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged <25 years (51%). Of all abortions for which gestational age was reported, 61% were performed at <8 weeks' gestation and 88% at <13 weeks. From 1992 (when detailed data regarding early abortions were first collected) through 2002, steady increases have occurred in the percentage of abortions performed at <6 weeks' gestation, with a slight decline in 2003. A limited number of abortions were obtained at >15 weeks' gestation, including 4.2% at 16--20 weeks and 1.4% at >21 weeks. A total of 36 reporting areas submitted data documenting that they performed and enumerated medical (nonsurgical) procedures, making up 8.0% of all known reported procedures from the 45 areas with adequate reporting on type of procedure.
  • Public Health Action: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.
  • Overall, the annual number of legal induced abortions in the United States increased gradually from 1973 to 1990 (peak point) and then generally declined thereafter. In 2003, a total of 848,163 legal induced abortions were reported to CDC by 49 reporting areas. This change represents a 0.7% decline from 2002, for which 49 areas reported 854,122 legal induced abortions.
    The national legal induced abortion ratio increased from 196 per 1,000 live births in 1973 (the first year that 52 areas reported) to 358 per 1,000 in 1979 and remained nearly stable through 1981. The ratio peaked at 364 per 1,000 in 1984 and since then has demonstrated a generally steady decline. In 2003, the abortion ratio was 241 per 1,000 in 49 reporting areas and 243 for the same 47 reporting areas for which data were available since 1998.
    The national legal induced abortion rate increased from 14 per 1,000 women aged 15--44 years in 1973 to 25 per 1,000 in 1980. The rate remained stable at 23--24 per 1,000 during the 1980s and early 1990s and at 20--21 per 1,000 during 1994--1997. The abortion rate remained unchanged at 17 per 1,000 during 1998--1999 and at 16 per 1,000 during 2000--2002, both overall and in the same 47 reporting areas. In 2003, the abortion rate remained unchanged overall at 16 per 1,000 and decreased to 15 per 1,000 in the 47 reporting areas.
  • Women aged 20--24 years obtained 33% of all abortions for which age was adequately reported. Adolescents aged <15 years obtained <1.0% of all abortions in the 48 areas that reported age. Among the 48 reporting areas, age was not reported for 0.6% of patients; however, this percentage ranged from 0 (in 19 areas) to 4.6% (Nevada). Abortion ratios were highest for adolescents aged <15 years (830 per 1,000 live births) and lowest for women aged 30--34 years (144 per 1,000). In contrast to abortion ratios, among females for whom age was reported, abortion rates were highest for women aged 20--24 years (31 per 1,000 women) and lowest for females at the extremes of reproductive age (1 per 1,000 adolescents aged 13--14 years and 3 per 1,000 women aged 40--44 years). Among women aged <20 years (46 reporting areas), the percentage of abortions obtained increased with age; the abortion ratio, however, was highest for adolescents aged <15 years§ (828 per 1,000 live births) and lowest for women aged 19 years (328 per 1,000). Conversely, the rates of abortions were lowest (1 per 1,000) for adolescents aged <15 years and highest (27 per 1,000) for women aged 19 years.
  • A total of 848,163 legal induced abortions were reported in the United States for 2003 from 47 states, DC, and NYC, which reflects a decline of 0.7% from the number of legal induced abortions reported for 2002. After five previous annual decreases, a slight increase of 0.1% in the number of abortions occurred in 2002, with another decline of 0.7% in 2003, also apparent when the same 47 reporting areas that reported for all years, 1998--2003, are compared with those that reported for 2001--2003. Before 1998, a substantial number of legal induced abortions were estimated to have been performed in California (e.g., >23% of the U.S. total in 1997). Beginning in 1998, data were no longer estimated for nonreporting states. The lack of data for California for 2003 largely explains the majority of the 28% decrease from the annual number of abortions reported for 1997 and part of the decrease in the total ratio and rate.
    Overall, abortion ratios and abortion rates have declined over time until 2002. The abortion ratio for 2003 (241 per 1,000 live births for 49 reporting areas) decreased from the previous year's ratio of 246. For the same reporting areas as 2000--2002, the abortion rate for women aged 15--44 years (16 per 1,000 women) remained identical to the rate reported since 2000 and then was 15 per 1,000 women for 2003. The overall declines in the reported abortion ratio and rate over time might reflect multiple factors, including a decrease in the number of unintended pregnancies; a shift in the age distribution of women toward the older and less fertile ages; reduced or limited access to abortion services, including the passage of abortion laws that affect adolescents (e.g., parental consent or notification laws and mandatory waiting periods); and changes in contraceptive practices, including increased use of contraceptives (e.g., condoms and, among young women, increased use of long-acting hormonal contraceptive methods that were introduced in the early 1990s).
    The findings in this report indicated that the abortion rate for the United States was higher than recent rates reported for Canada and Western European countries. Lower rates were reported for China, Cuba, the majority of Eastern European countries, and certain Newly Independent States of the former Soviet Union.
  • The percentage distribution of abortions by known weeks of gestation has shifted slightly since the late 1970s. From 1992 (when detailed data on early abortions were first available) through 2002, data have indicated steady increases in procedures performed at <6 weeks' gestation, with a minimal increase in 2003. Data have also indicated decreases in the percentage of abortions performed at 8 and 9--10 weeks' and for 11--12 weeks' gestation from 1992 through 2002, with a slight increase in 2003. The increase in the percentage of abortions known to have been performed at <6 weeks' gestation might be related to an increase in the availability of early abortion services since 1992 and an increase in medical and surgical procedures that can be performed early in gestation. Abortions performed early in pregnancy are associated with lower risks of mortality and morbidity. The proportions of abortions performed later in pregnancy (>13 weeks) have varied minimally since 1992. The gestational age at which an abortion is obtained can be influenced by multiple factors in addition to those for which surveillance data are available (i.e., age, race, and ethnicity). These additional factors include level of education, availability and accessibility of abortion services, timing of confirmation of pregnancy, timing of personal decision-making, timing of prenatal diagnosis, level of fear of discovery of pregnancy, and denial of pregnancy.
  • The percentage of abortions known to be performed by curettage increased from 88% in 1973 to >96% from 1980--2001 and then decreased to 90% in 2003, whereas the percentage of abortions performed by intrauterine instillation declined sharply, from 10% to <1% since 1989. The increase in use of curettage at >13 weeks' gestation is likely attributable to the lower risk for complications associated with the procedure. The percentage of abortions performed by curettage at >13 weeks' gestation (D&E) increased from 31% in 1974 (the first year for which these data were available) to 97% in 2003, and the percentage of abortions performed by intrauterine instillation at >13 weeks' gestation decreased from 57% to 0.6%; the percentage of medical abortions increased from 1.0% in 2000 to 7.7% in 2003.
  • Compared with the early 1970s, the annual number of deaths associated with known legal induced abortion in the early 2000s has decreased by approximately two thirds. In 1972, a total of 24 women died from causes known to be associated with legal abortions, and 39 died as a result of known illegal abortions. No more than two deaths have occurred as a result of known illegal abortion in any year since 1979. In 2002, nine women died as a result of legal induced abortion, and none died as a result of illegal induced abortion. National case-fatality rates for 1998--2002 cannot be calculated because a substantial number of the abortions occurred in nonreporting states (four states in 1998 and 1999 and three states in 2000, 2001, and 2002), and, therefore, the total number of abortions (the denominator) is unknown.
  • [F]indings from ongoing national surveillance of legal induced abortion are useful for at least six purposes. First, public health agencies use data from abortion surveillance to identify characteristics of women who are at high risk for unintended pregnancy. Second, ongoing annual surveillance is used to monitor trends in the number, ratio, and rate of abortions in the United States. Third, statistics regarding the number of pregnancies ending in abortion are used in conjunction with birth data and fetal death computations to estimate pregnancy rates (e.g., pregnancy rates among adolescents). Fourth, abortion and pregnancy rates can be used to evaluate the effectiveness of family planning programs and programs for preventing unintended pregnancy. Fifth, ongoing surveillance provides data for assessing changes in clinical practice patterns related to abortion (e.g., longitudinal changes in the types of procedures and trends in weeks of gestation at the time of abortion). Finally, numbers of abortions are used as the denominator in calculating abortion mortality rates (35).
  • More than one in five U.S. pregnancies have ended in abortion, according to a national sample survey conducted by AGI during 2001--2002 among all known U.S. abortion providers. Inconsistent method use of the pill (75.9%) or condoms (49.3%) were the most common reason for unintended pregnancy reported by women obtained abortions. Unintended pregnancy is a pervasive public health problem for all population subgroups and women of reproductive age.

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