Overview
Access to abortion care is essential for the health and well-being of all individuals. While there is a substantial body of scientific research supporting both the importance and safety of abortion, many individuals face myriad obstacles to obtain abortion-related healthcare or are denied access to it. Restrictive abortion laws and policies laid down in the name of health and safety do not serve the stated purpose, but cause severe hardship and stress both to those seeking to end a pregnancy and to their families. As a result, black and other people of color, indigenous people, low socioeconomic and impoverished individuals, rural-based, teens, and LBGTQ+ individuals among others are disproportionately impacted to accessing abortion care.
State Laws
Guttmacher Institute, “An Overview of State Abortion Laws”, State Laws and Policies, 1 January, 2023, https://www.guttmacher.org/state-policy/explore/overview-abortion-laws
Guttmacher Institute, “State Legislation Tracker”, Major Developments in Sexual and Reproductive Health, 31 December 2022, https://www.guttmacher.org/state-policy#
Guttmacher Institute, “State Legislation Tracker”, Major Developments in Sexual and Reproductive Health, Targeted Regulation, 1 January 2023 https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers
In re Whole Woman’s Health, et al. On Petition for Writ of Mandamus No. 21-962, January 20, 2022
https://www.supremecourt.gov/opinions/21pdf/21-962_n6io.pdf
Supreme Court of Texas, No. 22-0033 ( March 11, 2022)
Whole Woman’s Health, et al., Plaintiffs-Appellees, v. Judge Austin Reeve Jackson; Penny Clarkston; Mark Lee Dickson; Stephen Brint Carlton; Katherine A. Thomas; Cecile Erwin Young; Allison Vordenbaumen Benz; Ken Paxton, Defendants-Appellants
On Certified Question from the United States Court of Appeals for the Fifth Circuit
Guttmacher Institute. “State Bans on Abortion Throughout Pregnancy.” State Laws and Policies, 1 January 2023, https://www.guttmacher.org/state-policy/explore/state-policies-later-abortions.
Thompson, Alexandra et al., Guttmacher Institute. “The disproportionate burdens of the mifepristone REMS.” Contraception, July 2021, https://www.guttmacher.org/article/2021/07/disproportionate-burdens-mifepristone-rems.
Nash, Elizabeth, Naide, Sophia, Guttmacher Institute. “State Policy Trends at Midyear 2021: Already the Worst Legislative Year Ever for U.S. Abortion Rights.” Policy Analysis, 1 July 2021, https://www.guttmacher.org/article/2021/07/state-policy-trends-midyear-2021-already-worst-legislative-year-ever-us-abortion.
Institute for Women’s Policy Research. An Economic Case for Ending Harmful State Policies. The Costs of Reproductive Health Restrictions, https://iwpr.org/costs-of-reproductive-health-restrictions/.
The American College of Obstetricians and Gynecologists (ACOG), Guide to Language and Abortion
The Guide provides medically accurate terminology to discuss abortion Available at: https://www.acog.org/-/media/project/acog/acogorg/files/pdfs/publications/abortion-language-guide.pdf?la=en&hash=EDDEB0D9B24B7427A8F52378FA72E092
Safe abortion: technical and policy guidance for health systems, second edition, World Health Organization, Department of Reproductive Health and Research, 2012, available at: https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/.
The Safety and Quality of Abortion Care in the United States, The National Academies of Sciences, Engineering and Medicine, 2018. Download a no-cost copy of the report at: https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states
See also, Public Report Webinar: The Safety and Quality of Abortion Care in the United States, Committee on Reproductive Health Services, Assessing the Safety and Quality of Abortion Care, March 23, 2018, at: https://www.youtube.com/watch?v=RsTWN947ahE
Introduction to the Turnaway Study, Research on Abortion Care, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco Medical Center, Bixby Center for Global Reproductive Health, March 2020, available at: https://www.ansirh.org/research/ongoing/turnaway-study
Effects of Carrying an Unwanted Pregnancy to Term on Women’s Existing Children.” The Journal of Pediatrics, vol. 205, 2019, pp. 183-189. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S0022347618312976.
Abortion and Mental Health, American Psychological Association, June 2018, available at: https://www.apa.org/pi/women/programs/abortion
Induced Abortion and Breast Cancer Risk, The American College of Obstetricians and Gynecologists, ACOG Committee Opinion, Number 434, June 2009 at: https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2009/06/induced-abortion-and-breast-cancer-risk.pdf
Statistics
According to the Kaiser Family Foundation, 92% of abortions occur in the first trimester of pregnancy. Furthermore, 43% of abortions occur by six weeks gestation, 36% occur between seven and nine weeks, and 13% occur at 10 to 13 weeks. Ranji, Usha, Diep, Karen, Salganicoff, Alina. “Key Facts on Abortion in the United States.” Kaiser Family Foundation, 12 July 2022, https://www.kff.org/womens-health-policy/report/key-facts-on-abortion-in-the-united-states/#At-what-point-in-pregnancy-do-abortions-occur
According to the Centers for Disease Control and Prevention’s (CDC) 2018 Surveillance Reporting for Abortions in the U.S, 619,591 abortions were reported to the agency from 49 reporting areas. According to the report, 77.7% of individuals had abortions at or before 9 weeks gestation, and 92.2 % had abortions at or before 13 weeks gestation. Kortsmit K, Jatlaoui TC, Mandel MG, et al. Abortion Surveillance — United States, 2018. MMWR Surveill Summ 2020;69(No. SS-7):1–29. DOI: http://dx.doi.org/10.15585/mmwr.ss6907a1
NYT: Kate Zernike, Sept. 10, Medical Impact of Roe Reversal Goes Well Beyond Abortion Clinics, Doctors Say
State abortion bans carry narrow but sometimes vague exceptions, and years of prison time. That’s forcing doctors to think like lawyers, and hospitals to create new protocols
Article discusses abortion ban exceptions to save the life of the pregnant person forces doctors to compromise their medical judgement concerning the best interests of the patients health and well-being and shift to legal considerations and potential criminalization for patient care.
Available at: https://www.nytimes.com/2022/09/10/us/abortion-bans-medical-care-women.html
Salon.com: Charlotte Huff, New Abortion Laws Jeopardize Cancer Treatment for Pregnant Patients In states with abortion bans, doctors have questions about how they can treat pregnant patients with cancer
Article discusses the difficulties physicians and their pregnant patients face to obtain cancer treatment in states that ban abortion but allow an exceptions for a medical emergency.
Nambiar, Anjali et al., Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion, American Journal of Obstetrics & Gynecology, Research Letter, 2022, available at: https://www.ajog.org/article/S0002-9378(22)00536-1/pdf
Anderson, Elizabeth M., et al., “Willing but unable: Physicians’ referral knowledge as barriers to abortion care.” SSM – Population Health, Volume 17, March 2022, https://doi.org/10.1016/j.ssmph.2021.101002
Fulcher, Isabel R., et al., “The impact of the COVID-19 pandemic on abortion care utilization and disparities by age.” American Journal of Obstetrics and Gynecology, Volume 226, Issue 6, June 2022, https://doi.org/10.1016/j.ajog.2022.01.025
Arey, Whitney, Lerma, Klaira, Beasly, Anitra, et al., “A Preview of the Dangerous Future of Abortion Bans — Texas Senate Bill 8.” The New England Journal of Medicine, 22 June 2022, DOI: 10.1056/NEJMp2207423
Dovile Vilda, Maeve E. Wallace, Clare Daniel, Melissa Goldin Evans, Charles Stoecker, Katherine P. Theall, “State Abortion Policies and Maternal Death in the United States, 2015‒2018”, American Journal of Public Health 111, no. 9 (September 1, 2021): pp. 1696-1704. https://doi.org/10.2105/AJPH.2021.306396
American Psychological Association. “Restricting access to abortion likely to lead to mental health harms, APA asserts.” 3 May 2022, https://www.apa.org/news/press/releases/2022/05/restricting-abortion-mental-health-harms
World Health Organization, Department of Reproductive Health and Research. Safe abortion: technical and policy guidance for health systems. 2nd ed., World Health Organization, 2nd edition, 132 p., 2012, Sexual and reproductive health, https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/
National Academies of Sciences, Engineering, and Medicine. 2018. The Safety and Quality of Abortion Care in the United States. Washington, DC: The National Academies Press. Download a no-cost copy of the report at: https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states
Committee on Reproductive Health Services. Public Report Webinar: The Safety and Quality of Abortion Care in the United States. 23 March 2019. Assessing the Safety and Quality of Abortion Care, https://www.youtube.com/watch?v=RsTWN947ahE.
Advancing New Standards in Reproductive Health (ANSIRH). “The Turnaway Study,.” University of San Francisco, (UCSF), https://www.ansirh.org/research/ongoing/turnaway-study.
Bai, Nina. “As More States Restrict Abortions, Research Points to Negative Health Outcomes for Women, Families.” University of California at San Francisco (UCSF), 22 May 2019, https://www.ucsf.edu/news/2019/05/414551/more-states-restrict-abortions-research-points-negative-health-outcomes-women.
Rocca, Corinne H., et al., Social Science & Medicine, Emotions and Decision Rightness over Five Years: An Examination of Decision Difficulty and Abortion Stigma, Social Science & Medicine, Volume 248, March 2020, https://doi.org/10.1016/j.socscimed.2019.112704.
American Psychological Association, Abortion and Mental Health, June 2018, https://www.apa.org/pi/women/programs/abortion.
American College of Obstetricians and Gynecologists (ACOG), Induced Abortion and Breast Cancer Risk, Committee Opinion, No. 434, June 2009, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2009/06/induced-abortion-and-breast-cancer-risk.
Cartwright, Alice F., et al. “Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search.” J Med Internet Res, vol. 20(5): e186., 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972217/.
Wolfe, Taida, and Yana van der Meulen Rodgers. “Abortion During the COVID-19 Pandemic: Racial Disparities and Barriers to Care in the USA.” Sex Res Social Policy., 2021, pp. 1-8.
Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion, American Journal of Obstetrics & Gynecology, Research Letter, 2022
Study of pregnancy outcomes and morbidities for women at less than 22 weeks gestation and needing obstetrical management at 2 Texas Hospitals after Texas Bills SB 8 and SB 4 went into effect. The study involved 28 pregnant patients (less than 22 weeks gestation) presenting with obstetrical complications. Prior to the passage of Texas laws SB 4 and SB 8, these individuals would have been “,,,counseled and offered expectant management (closely monitored) or induction of labor.” After Sept. 2021, these patients were “expectantly managed with medical intervention when there was an immediate threat to maternal life.” State-mandated expectant management of obstetrical complications corresponded with significant maternal morbidity. In fact, while most of these patients presented with medical indications for delivery they endured “serious morbidity and fetal outcomes were poor.”
Available at: https://www.ajog.org/action/showPdf?pii=S0002-9378%2822%2900536-1
Nambiar, Anjali et al., Maternal morbidity and fetal outcomes among pregnant women at 22 weeks’ gestation or less with complications in 2 Texas hospitals after legislation on abortion, American Journal of Obstetrics & Gynecology, Research Letter, 2022, available at: https://www.ajog.org/article/S0002-9378(22)00536-1/pdf
Severe Maternal Morbidity in the United States, Reproductive Health, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), 2021, at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
Severe maternal morbidity (SMM) refers to labor and delivery outcomes resulting in short or long-term consequences to the person’s health. “SMM has been steadily increasing in recent years….” In 2014 (most recent available data) it has affected more than 50,000 women in the U.S.”
CDC: Maternal Mortality Rates in the United States, 2021, Donna L. Hoyert, Ph.D., Division of Vital Statistics. Available at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#:~:text=In%202021%2C%201%2C205%20women%20died,20.1%20in%202019%20(Table)
dc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.pdf
The Maternal Mortality Consequences of Losing Abortion Access, Amanda Jean Stevenson, Leslie Root, and Jane Menken, University of Colorado Boulder. Available at https://osf.io/preprints/socarxiv/7g29
Approximately 700 women die from pregnancy-related complications each year in the United States and “significant racial/ethnic disparities in pregnancy related mortality exist”. “During 2007-2016, Black and American Indian and Alaska Native women had significantly more pregnancy-related deaths per 100,000 births than did White, Hispanic, and Asian/Pacific Islander women.” Peterson, Emily et al, Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention (CDC), September 2019
https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm; About Maternal Morbidity and Mortality, National Institutes of Health, February, 2022
https://www.nih.gov/research-training/medical-research-initiatives/improve-initiative/about-maternal-morbidity-mortality
In the U.S., Black women and American Indian and Alaskan Native (AIAN) women have higher rates of maternal mortality and morbidity than white women Artiga, Samantha, et al, Racial Disparities in Maternal and Infant Health: An Overview, KFF, November 2020
https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/
“In 2020, the maternal mortality rate for non-Hispanic Black women 2.9 times the rate for non-Hispanic White women” Hoyert, Donna L., Maternal Mortality Rates in the United States, 2020, National Center for Statistics, Centers for Diseases Control and Prevention (CDC) https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#anchor_1559670130302
Estimates are that there will be an increase in pregnancy-related deaths if “wanted legal abortions” are prevented, even if those individuals denied an abortion do not utilize unsafe abortion methods. Additional deaths and increase in lifetime risk will be greatest among non-Hispanic Black women. A projected 33% increase in subsequent years.
Stevenson, AJ, The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant, Demography, December 2021 https://pubmed.ncbi.nlm.nih.gov/34693444/
Four in 5 Pregnancy-related deaths in the U.S. are preventable, Press Release, Centers for Disease Control and Prevention (CDC), September 19. 2022
“More than 80% of pregnancy-related deaths were preventable, according to 2017-2019 data from Maternal Mortality Review Committees (MMRCs)…” Available at: https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html
Dovile Vilda, Maeve E. Wallace, Clare Daniel, Melissa Goldin Evans, Charles Stoecker, Katherine P. Theall, “State Abortion Policies and Maternal Death in the United States, 2015‒2018”, American Journal of Public Health 111, no. 9 (September 1, 2021): pp. 1696-1704. https://doi.org/10.2105/AJPH.2021.306396
Maternal Mortality rates in the United States, 2020, Donna Hoyert, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), 2022. at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm
“In 2020, maternal mortality rates for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women.” “The increases from 2019 to 2020 for non-Hispanic Black women and Hispanic women was significant.”