Contemporary abortion procedures
A surgical abortion, also called a procedural abortion, is performed in the first trimester of a pregnancy and involves dilating (enlarging) the cervix (the narrow opening of the uterus) and then removing the contents of the uterus with suction and a scraping tool called a curette; this procedure is often called D&C (for dilation and curettage); it is also commonly performed after miscarriages. Surgical abortions performed later in pregnancy (typically during the second trimester, between weeks 13-26) are called D&E (dilation and evacuation), and they take slightly longer to perform, utilize additional instruments, and can incur more risks than a D&C. Late-term (also called “partial-birth” outside of the medical profession) abortions, banned in the U.S. except when necessary to save the life of the mother. are called D&X (for dilation and extraction). [81][82]
A medical abortion (the “abortion pill”) involves taking medications, usually mifepristone and misoprostol, within the first seven to nine weeks of pregnancy to induce an abortion. [39]
“Plan B” is an emergency contraceptive, not an abortion drug: the pill “will not work if you’re already pregnant, and will not affect an existing pregnancy,” explains the FDA; it prevents pregnancy before it starts by temporarily delaying ovulation.[290]
A U.S. district judge ruled on July 13, 2020, that requiring in-person visits for abortions was unconstitutional during the COVID-19 pandemic. The ruling allowed healthcare providers nationwide to mail mifepristone for the duration of the pandemic. The drug, when used in combination with misoprotosol, induces an abortion, and was the only drug the FDA required to be administered in a medical setting, according to the ACLU. [220]
On Dec. 16, 2021, the FDA permanently lifted the in-person requirements for mifepristone, which are available via telemedicine appointments and the mail. However, telemedicine appointments for abortions were banned in 19 states and six states had bans on mailing the pills in place at the time of the decision. [226]
On Jan. 3, 2023, the FDA announced that certified pharmacies will be allowed to dispense the abortion medication mifepristone to people with a prescription, removing the requirement that only a healthcare provider may dispense the medication. In Mar. 2024, CVS and Walgreens announced their stores would begin dispensing mifepristone in legal states on a rolling basis. [289][301]
On Apr. 7, 2023, two federal district court judges issued conflicting preliminary injunctions (rulings issued before the case is heard) on medication abortion: one in Texas ordered the FDA to take mifepristone off the market, while the other in Washington ordered the FDA to maintain the status quo (which would mean keeping mifepristone on the market). The first injunction (Texas) was stayed by the judge pending appeal. On Apr. 12, 2023, 5th U.S. Circuit Court of Appeals issued a ruling on the Texas case allowing mifepristone to remain on the market while the case is heard, but restricting access: the drug may only be dispensed up to seven weeks of pregnancy instead of 10 and may not be dispensed through the mail. On Apr. 14, 2023, the U.S. Justice Department asked the U.S. Supreme Court to stay the Texas ruling, and Associate Justice Samuel Alito placed a hold on the ruling until Wednesday, Apr. 19, 2023, and the full court stayed the injunction on Friday, Apr. 21, 2023. In the meantime, some Democratic-led states were stockpiling the drug in case new restrictions are put on mifepristone. [293][294][295][296][297][298]
Abortion statistics
From the Roe v. Wade ruling (January 22, 1973) through 2017, over 60 million legal abortions were estimated to have been performed in the United States—an average of about 1.4 million abortions per year. In 2014, 19% of pregnancies (excluding miscarriages) ended in abortion, and 1.5% of women aged 15–44 had an abortion. At 2014 abortion rates, one in twenty U.S. women would have an abortion before age 20, one in five by 30, and about one in four by 45. 11% of women who had an abortion were teenagers, while most women who had abortions were in their 20s: 32% aged 20–24 and 27% aged 25–29. [176][189][190]
The U.S. abortion rate fell 29% between 1990 and 2005, from 27.4 to 19.4 abortions per 1,000 women of childbearing age, before leveling out from 2005–2008. Between 2008 and 2011, the abortion rate dropped again by 13% to its lowest point since 1973: 17 abortions for every 1,000 women; in 2014 the rate dropped another 14% to 15 abortions per 1,000 women. Pro-choice supporters credited an increased use of new birth control methods such as Mirena (an intra-uterine device that can last for several years) as one of the reasons for the decline. Pro-life groups credited an increase in anti-abortion laws at the state level amongst other factors, although abortion rates dropped faster than the national average in some states that had not enacted abortion restrictions, such as Illinois, where the rate dropped by 18%. [13][65][85][121][190]
The number of abortion providers has been declining since 1984, after it reached a peak of 2,908 providers in 1982. There were 1,671 abortion providers in the United States in 2014, including 272 abortion clinics, 516 non-specialized clinics, 638 hospitals, and 245 physicians’ offices. 90% of U.S. counties did not provide abortion services, with 39% of women living in those counties. Between 2011 and 2017, at least 126 clinics providing abortion services closed. Seven states (KY, MO, MS, ND, SD, WV, WY) had only one clinic left. [124][191][192][193][194][196]
Pro-choice advocates believe increased violence at clinics contributed to this downward trend in abortion providers. In 2016, 6% of abortion clinics reported losing staff members as a result of anti-abortion violence or harassment. According to the National Abortion Federation, a professional association of abortion practitioners, at least 229 arson attacks or bombings were committed against abortion providers between 1977 and 2017, with at least another 99 attempted arson attacks or bombings. Additionally, at least 11 abortion providers were murdered during that time, and there were at least 26 attempted murders of clinic staff and physicians. Mainstream pro-life leaders and organizations have publicly denounced violence committed against abortion providers and clinics. [98][99][195][197]
In 2017, abortion rates declined to an estimated 862,320 in the United States, or 13.5 abortions per 1,000 women between the ages of 15 and 44. Those rates represent a 7% drop since 2014, according to a Sep. 2019 Guttmacher Institute survey, and the lowest recorded rate since abortion was legalized in 1973. [216]
The Centers for Disease Control and Prevention (CDC) reported 629,898 legal abortions in 2019 (the most recent data as of May 3, 2022). 92.7% of the abortions were performed at or before 13 weeks or gestation, 6.2% at 14–20 weeks, and less than 1.0% at or after 21 weeks’ gestation. 42.3% of all abortions were early medical abortions (at or before 9 weeks). The abortion ratio was 195 abortions per 1,000 live births. [234]
In a 2022 report, the World Health Organization and the Guttmacher Institute found that between 36 to 47 abortions were performed per 1,000 women (ages 15–49) yearly in countries where abortion is broadly legal. In countries where abortion is banned, between 31 and 51 abortions were performed per 1,000 women (ages 15–49) yearly. [288]
In the year after the U.S. Supreme Court ruled abortion was not a constitutionally guaranteed right in Dobbs v. Jackson Women’s Health Organization, abortion access dropped dramatically with 14 states outlawing the procedure entirely and another seven states imposing stricter laws. However, abortion procedures rose about 0.2% instead of decreasing as expected. In the two months before the Supreme Court ruling, there were 82,115 abortions per month. In the 12 months after the ruling, 82,298 abortions were performed on average per month. According to New York Times reporters Claire Cain Miller and Margot Sanger-Katz, the increase can be attributed to the “expansion of telemedicine for mail-order abortion pills, increased options and assistance for women who traveled, and a surge of publicity about ways to get abortions.” Additionally, 20 states increased abortion protections for both people seeking abortions and the health care providers who perform or assist abortions. [299]
The Guttmacher Institute reported an estimated 1,026,700 abortions in 2023. Isaac Maddow-Zimet, a data scientist with Guttmacher, says, “That’s the highest number in over a decade, [and] the first time there have been over a million abortions provided in the U.S. formal health care system since 2012.” Some experts believe the estimate to be an undercount due to the uncountable number of self-managed abortions in which medication is obtained from a friend or a pregnant person travels to Mexico and other countries for medication. [302]
Pros and Cons at a Glance
| PROS | CONS |
|---|---|
| Pro 1: Abortion is a safe medical procedure that protects lives. Read More. | Con 1: Life begins at conception, making abortion murder. Read More. |
| Pro 2: Abortion bans endanger healthcare for those not seeking abortions. Read More. | Con 2: Legal abortion promotes a culture in which life is disposable. Read More. |
| Pro 3: Abortion bans deny bodily autonomy and have wide-ranging repercussions. Read More. | Con 3: Better access to birth control, health insurance, and sexual education would make abortion unnecessary. Read More. |
| Pro 4: Abortion is a fundamental human right warranting national legalization; its legality should not be left to the discretion of U.S. states. Read More. | Con 4: Abortion should not be legal where it is not desired; it’s too contentious an issue to be nationally legalized. Read More. |
Pro Arguments
(Go to Con Arguments)Pro 1: Abortion is a safe medical procedure that protects lives.
The death rate for legal abortions is 0.7 deaths for every 100,000 abortions. By contrast, there are one to two deaths per 100,000 plastic surgery procedures, three deaths for every 100,000 colonoscopies, and three to six deaths per 100,000 tonsillectomies. Childbirth has nine deaths per 100,000 deliveries. [236]
The “abortion pill” (Mifeprex) has a better safety record than common over-the-counter drugs including Tylenol, as well as prescriptions like penicillin and Viagra. Medication abortion (a combination of Mifeprex and misoprostol) has a mortality rate of 6.5 deaths per one million patients. [237][238]
Pregnancy-related maternal deaths could increase 20% in U.S. states with abortion bans. Amanda Stevenson, sociology professor at the University of Colorado, Boulder, explained, “People with resources are more likely to make it out of state or find out about medication abortions. People who can’t are more likely to have health issues, to live in poverty and have less access to resources.” People of color are especially likely to be in the latter category and, thus, negatively impacted by abortion bans. [239]
The predicted 20% maternal death rate does not include those who will die from “back alley” or illegal abortions because legal options were not available. [239]
Globally 45% of abortions are unsafe, 97% of which take place in developing countries with strict abortion laws. According to the World Health Organization (WHO), “Evidence shows that restricting access to abortions does not reduce the number of abortions; however, it does affect whether the abortions that women and girls attain are safe and dignified. The proportion of unsafe abortions are significantly higher in countries with highly restrictive abortion laws than in countries with less restrictive laws.” [240]
Pro 2: Abortion bans endanger healthcare for those not seeking abortions.
Medical treatment for nonviable pregnancies is often exactly the same as an abortion. [241][242][243]
Ectopic pregnancies occur when a fertilized egg implants somewhere other than the uterine cavity. About one in 50 pregnancies are ectopic, and they are nonviable. Bleeding from ectopic pregnancies caused 10% of all pregnancy-related deaths, and ectopic pregnancies were the leading cause of maternal death in the first trimester. [241][244][245][246]
Other pregnancies can be nonviable, including when there is little or no chance of the baby’s survival once it is born or if the baby has died in utero. The treatment for ectopic and other nonviable pregnancies is often the same as that for an abortion. [243][247]
One out of every ten pregnancies ends in miscarriage. The drugs used for medication abortions are the only treatment recommended for early miscarriages. For later or complicated miscarriages, the same surgical procedure used for abortions is recommended. [242]
While some abortion bans include specific exceptions for nonviable pregnancies and miscarriages, other bans are too vague to be practicable. Healthcare providers may refuse to perform a procedure that could be interpreted as an “on-demand” abortion for fear of liability or prosecution. [248]
Arguing that doctors and others use them as loopholes for “on demand” abortions, lobbyists are working to eliminate exceptions altogether, which would further endanger and traumatize people seeking care for dangerous medical conditions. [246][248]
Some pharmacists have refused to fill prescriptions for miscarriages and ectopic pregnancies, because the drugs can also be used for abortion. In Texas, pharmacists can be sued for “aiding and abetting” an abortion. [242][245]
Further, bans are a slippery slope to contraceptive and other healthcare restrictions. For example, some already incorrectly view Plan B (the morning after pill) as an abortifacient and are thinking of including it in abortion bans. [249]
Pro 3: Abortion bans deny bodily autonomy and have wide-ranging repercussions.
U.S. Treasury Secretary Janet Yellen stated, “eliminating the rights of women to make decisions about when and whether to have children would have very damaging effects on the economy and would set women back decades.... In many cases, abortions are of teenage women, particularly low-income and often Black, who aren’t in a position to be able to care for children, have unexpected pregnancies, and it deprives them of the ability often to continue their education to later participate in the workforce.” [250]
After being denied an abortion, household poverty increased and lasted four or more years, resulting in an inability to cover basic expenses including food, housing, and transportation. A denied abortion was associated with a lowered credit score, increased debt, and an increase in negative public records including evictions and bankruptcies. The households were also more reliant on government assistance. Transgender and nonbinary people denied abortions may face even worse outcomes. [251][252][253]
Some 60% of women seeking abortions already had other children. Being denied an abortion worsened the well-being of their older children, including not meeting childhood development markers. [251]
Women denied an abortion were also more likely to have serious health complications, have poor physical and mental health for years afterward, and stay with abusive partners. They were more likely to be raising their children alone five years later. [251][254]
The Turnaway Study concluded, “Abortion does not harm women,” and “Women who receive a wanted abortion are more financially stable, set more ambitious goals, raise children under more stable conditions, and are more likely to have a wanted child later.” [251][254][255]
Pro 4: Abortion is a fundamental human right warranting national legalization; its legality should not be left to the discretion of U.S. states.
Leaving an issue like abortion to the discretion of U.S. states is not only an insult to women but a sure way of creating laws that are confusing, discriminatory, and ineffective. Amnesty International stated, “Laws and policies that affect the lives of all persons who can become pregnant must ensure access to abortion and full bodily autonomy. Laws restricting access to safe abortion violate the human rights of women and people who can get pregnant.” [325]
In fact, many Americans do not know the abortion laws in their state. According to a KFF (formerly Kaiser Family Foundation) poll, approximately 50% of adults and 41% of women aged 18 to 49 were “unsure” whether medical abortion (the most common abortion method) is legal where they live. Plus, 13% of adults wrongly believed medical abortion is legal where they live. [317]
Ashley Kirzinger of KFF explained, “The majority of Americans aren’t paying that close attention to [abortion laws]. They’re hearing murmurs and rumors based on media coverage. Until they need to access it, it’s not something they’re thinking about.” The state-by-state approach to abortion laws leaves Americans confused.[318]
Allowing each state to establish abortion laws, as is the case in the United States now, “create[s] a patchwork in which some states provide reproductive freedom and equal citizenship for people who can become pregnant while others don’t,” according to the League of Women Voters. That patchwork is discriminatory, denying equal access to medical care to about 40% (approximately 25 million) of American women of reproductive age who lived in states with abortion bans as of June 2023. Either everyone should have access to abortion, or no one should.[316][319]
The laws are also ineffective. As of January 7, 2024, abortion laws in the United States range from full legality with no gestational limits to full bans in which no abortion is legal—abortions are even criminalized in some states. This patchwork of laws means that a pregnant person who lives in New Mexico is legally allowed to have an abortion. However, a person living in Texas on the border with New Mexico may be able to simply cross the border to obtain an abortion in New Mexico, even though Texas has a near total ban. Others may travel hours to get an abortion in a legal state. However, state-hopping leaves clinics in legal states so overwhelmed that they may not be able to serve their resident patients.
Pro Quotes
Ylonda Gault, director of editorial strategy and services at Planned Parenthood and author of Child, Please, stated:
“If our constitutional right to safe, legal abortion is not upheld, more than 25 million Americans of reproductive age could lose the freedom to decide when and if to have a child…
This is not complicated or political. When you have bodily autonomy and the freedom to get the health care you want, need and deserve, your whole world changes and you are able to thrive…
My abortion is a part of me, my story. And I have no shame that I made the best decision for myself, my family and our future.”
—Ylonda Gault, “I’ll Never Be Ashamed of My Abortion,” nytimes.com, Jan. 22, 2020
Richard A.S. Hall, professor of philosophy at Fayetteville State University, stated:
“Let me say outright: A woman has an inalienable moral and legal right to abortion at any stage of her pregnancy. No politician, judge, nor cleric, and certainly no man, ought to tell a woman what she ought or ought not to do with her body.
It is sufficient justification for a woman to abort her fetus if she desires to do so, even if her desire is nothing more than a whim. Abortion is strictly a matter between her and her gynecologist with even her husband or whoever impregnated her having no say in the matter.
Abortion is a moral issue and should not be a legal or political one. More fundamentally, it is a metaphysical issue over whether a fetus is a bona fide person with rights, among them, preeminently, the right to life. But resolving this issue depends on what constitutes a person—what it is to be a person, and at what stage, if any, does the fetus become a person.
Now there is no scientific resolution to this issue only a metaphysical or philosophical one. What, then, constitutes personhood? I think most would agree that the minimal qualifications for being a person are consciousness, and the capacities for communication through language or other means and for introspection.
A fetus at any stage of its development obviously lacks these and other personal attributes and so does not qualify as a person in any sense; consequently, it lacks any moral or legal rights since such belong exclusively to persons.”
—Richard A.S. Hall, “Richard A.S. Hall: Abortion Should Remain Legal and Maximally Available,” fayobserver.com, Oct. 26, 2021
Con Arguments
(Go to Pro Arguments)Con 1: Life begins at conception, making abortion murder.
Conception is the moment a sperm cell fertilizes an egg cell, which begins the process of cell division that creates a human. [256]
As Tara Sander Lee, senior fellow and director of life sciences at the Charlotte Lozier Institute, states, “life begins from the moment of conception when the sperm fertilizes the egg, because there is the creation of a new, totally distinct, integrated organism or a human being, which is going to be biologically distinct from all other life forms on this planet.” The first cell is biologically distinct because it has its own DNA that is different from either biological parent and all other humans. [257]
Ending a life is murder, legally and ethically, even a life that is only a few growing cells at the time of death.
“Abortion is murder,” explained Pope Francis. “Those who carry out abortions kill….At the third week after conception, often even before the mother is aware (of being pregnant), all the organs are already (starting to develop). It is a human life. Period. And this human life has to be respected. It is very clear.… Scientifically, it is a human life.” [258]
That people may face difficulties without abortion as an option does not excuse or justify murder. A reader of The Atlantic, who gave only the initial K., clarified the moral dilemma: “I wish that I could be pro-choice because the awful circumstances so many women face—that I can’t even imagine facing—seem so much more real to me than the rights of a fetus who doesn’t even always look human. But abortion is the intentional killing of a human being and we look back with horror at anyone in history who decided a group of people did not actually count as people. We cannot solve the problem of injustice against women with more injustice. We need solutions that support women without killing fetuses.” [295]
Con 2: Legal abortion promotes a culture in which life is disposable.
Echoing a 2014 remark by Pope Francis that connected abortion to “throwaway culture,” Cardinal Joseph Tobin of Newark, New Jersey, stated, “abortion represents a failure to recognize the sanctity of human life and promotes a culture in which human life in its most vulnerable moment is perceived as disposable. Such a proposal targets poor women as needing an expedient solution to a complex problem.”[260]
Tobin previously declared legal abortion a “brutalization of the American heart” on par with the “dehumanization of the undocumented” immigrants. [261]
Alveda King, former Georgia state representative and niece of Martin Luther King, Jr., also connected abortion to other societal ills: “Abortion and racism are both symptoms of a fundamental human error. The error is thinking that when someone stands in the way of our wants, we can justify getting that person out of our lives. Abortion and racism stem from the same poisonous root, selfishness. We create the deceptions that the other person is less important, less worthy, less human. We are all fully human. When we face this truth, there is no justification for treating those who look different than us as lesser beings. If we simply treat other people the way we’d like to be treated, racism, abortion, and other forms of inhumanity will be things of the past.” [262]
As King notes, some fetuses are treated as less than human. This ideology combined with legal abortion could create a slippery slope to designer babies, gender selection, termination of disabled but healthy fetuses, and other trait-selection-based abortions. The slippery slope can then extend to people with mental disabilities and the elderly in general. [262]
“[A]bortion is an act rife with the potential for eugenic manipulation,” according to U.S. Supreme Court Justice Clarence Thomas. “Technological advances have only heightened the eugenic potential for abortion, as abortion can now be used to eliminate children with unwanted characteristics, such as a particular sex or disability.” [263]
Instead of disposing of a life, Adoption Choice explained, “If you’re …. not prepared to raise a child, adoption is the right choice for you …. One of biggest advantages of choosing adoption is the ability to still be a part of your child’s life. Many birth mothers are able to stay in contact with the adoptive family and their child through open adoption .… Birthmothers can be reassured that their child is loved and well-cared for and can be reassured that their decision to make an adoption plan was the right one. [326]
Con 3: Better access to birth control, health insurance, and sexual education would make abortion unnecessary.
Abortion rates in the United States have fallen at what the CDC called a “slow yet steady pace” since a peak in 1981. That year there were 29.3 abortions per 1,000 women aged 15–44. The rate fell to 11.4 abortions per 1,000 women in 2019. [264][265]
Experts largely contribute the decline in abortions in the United States and elsewhere to the improved safety and availability of LARC (long-acting reversible contraception) including IUDs and contraceptive implants that can last up to 10 years. [264][266][267]
Access to health insurance to pay for contraceptives also contributed to a drop in abortions. With the passage of Obamacare (Patient Protection and Affordable Care Act), more people were insured with access to free or low-cost contraceptives and reproductive care. [264]
Linda Rosenstock, public health professor at UCLA, summarized the simplicity of the connection: “In the United States each year, about half of pregnancies are unintended and about 40% of those lead to abortion. Access to birth control leads to fewer abortions.” [264]
Further, teens are having sex later in life than their parents. 38.4% of American high schoolers reported they have had sex (down from 54% in 1991) and only 27.4% reported they were currently sexually active (37.5% in 1991). [268]
Because teen birth control use has not increased significantly, experts attribute the decline in part to better sex education. A 2021 study found that students who received comprehensive sexual education initiated sex later than students who did not participate in sex ed. The later teens have sex, the less chance there is for them to become pregnant unintentionally, which leads to fewer abortions. [264][268][269]
Historically, abortion was a popular means of birth control and family planning due to a lack of reliable contraception, education, and other resources, and the fact that childbirth was incredibly dangerous. Better options are now available, including more effective birth control, better healthcare and health insurance, and sex education to ensure an unwanted pregnancy does not happen in the first place. [264][270]
Con 4: Abortion should not be legal where it is not desired; it’s too contentious an issue to be nationally legalized.
Americans forget that the United States is huge. Texas would be the 39th largest country in the world in terms of land mass. California has the world’s 5th largest economy; it even exceeds the population of Canada. And Florida has a population that only slightly trails Taiwan. Within each of these states is a multitude of cultures, making up the famed “melting pot” that is the United States. [320][321][322]
On issues like abortion where there is enormous, polarizing disagreement between cultural and religious groups, age ranges, genders, political parties, and other groups, the legality of the action should be left to the states, where populations are often more homogenous and residents have more control over their legislatures. President Donald Trump explained, “My view is now that we have abortion where everyone wanted it from a legal standpoint, the states will determine by vote or legislation, or perhaps both. And whatever they decide must be the law of the land. In this case, the law of the state.” He continued, “Many states will be different. Many will have a different number of weeks, or some will have more conservative than others, and that’s what they will be. At the end of the day, this is all about the will of the people.” [323]
Pro-life and pro-choice advocates may scoff at this assertion, but the numbers support it. Seven states—Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, and West Virginia—where 55 percent or more residents say abortion should not be legal have restrictive abortion laws, including some or all of the following: an in-person or telephone counseling session, a waiting period, a mandated ultrasound, admitting privileges, and a ban on abortion extending to all or parts of the first trimester. [324]
Meanwhile, 21 states where support for legal abortion is 55 percent or higher have almost no restrictions in place, and in the 22 states where there is no clear majority opinion, there is also no clear pattern in abortion laws—their laws instead vary based on previous regulations and the officials elected to office. [324]
Furthermore, when abortion laws are left to the states, the laws can change based on the will of the voters. If a state’s population shifts majority opinion one way or the other, the elected officials and laws can more easily change in tandem, over time, to reflect the shift in public opinion. Decentralizing contentious issues like abortion is the most democratic way of handling them.