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]
Medication abortion regulations and court cases
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]
In Dec. 2024, Texas Attorney General Ken Paxton sued a New York doctor for mailing abortion pills to a 20-year-old woman in Texas. New York law shields doctors who provide abortion services, but Texas has a near ban on all abortions with a $100,000 fine for providing abortion medication. [330]
On Feb. 1, 2025, a New York doctor was indicted in Louisiana for providing abortion pills via an online appointment. Louisiana has a near total abortion ban, and doctors performing abortions face up to 15 years in prison, a $200,000 fine, and the loss of their medical license. District Attorney Tony Clayton likened shipping the pills to shipping fentanyl. New York Governor Kathy Hochul said she would not turn the doctor over to Louisiana authorities, while Attorney General Letitia James indicated the New York shield law would protect the doctor and be enforced. Two days later Hochul signed legislation that removes physicians’ names from prescriptions.[331][332]
Abortion and related 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 percent of pregnancies (excluding miscarriages) ended in abortion, and 1.5 percent 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 percent of women who had an abortion were teenagers, while most women who had abortions were in their 20s: 32 percent aged 20–24 and 27 percent aged 25–29. [176][189][190]
The U.S. abortion rate fell 29 percent 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 percent to its lowest point since 1973: 17 abortions for every 1,000 women; in 2014 the rate dropped another 14 percent 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 percent. [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 percent of U.S. counties did not provide abortion services, with 39 percent 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 percent 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 percent 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 percent of the abortions were performed at or before 13 weeks or gestation, 6.2 percent at 14–20 weeks, and less than 1.0 percent at or after 21 weeks’ gestation. 42.3 percent 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 percent 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]
From the June 2022 Supreme Court ruling to December 2022, tubal sterilizations (in which fallopian tubes are tied or removed to prevent pregnancy) rose 39 percent in states with abortion bans, marking a departure from the common use of non-surgical birth control methods. [333]
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]
A study released in Oct. 2024 found that in the 13 states with near-total abortion bans, abortion rates among resident women rose in all but three (Idaho, Oklahoma, and Texas), with abortion pills obtained online and travel to a state with legal abortion driving most of the increases. [334]
The infant mortality rate also rose 7 percent in the 18 months following the Supreme Court decision. Prior to 2022, infant mortality rates were trending downward. A study published in JAMA Pediatrics found that 80 percent of those deaths were due to congenital abnormalities that caused the death of the babies shortly after their birth; prior to the Dobbs decision, many women in these situations terminated their pregnancies, and their abortions were not counted as infant deaths. A majority of the 20 states with near-total abortion bans do not have exceptions for fetal abnormalities. [335]
A Jan. 2025 working paper found that states with near-total abortion bans lost about 36,000 residents per quarter since the Supreme Court ruling that overturned Roe v. Wade. One of the authors extrapolated that over a 5-year stretch, these losses could add up to a loss of almost 1 percent of a state’s population. [336][337]
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 percent 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 percent 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 percent of abortions are unsafe, 97 percent 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 percent 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 percent 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 percent of adults and 41 percent of women aged 18 to 49 were “unsure” whether medical abortion (the most common abortion method) is legal where they live. Plus, 13 percent 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 percent (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.