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Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States

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Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and two-visit laws. Multilevel logistic regression was used to determine whether type or number of state-level restrictive abortion laws during year of birth were associated with odds of infant mortality. Results: Compared to infants living in states with no restrictive laws, infants living in states with one or two restrictive laws (adjusted odds ratio (AOR) = 1.08; 95% confidence interval [CI] = 0.99–1.18) and those living in states with 3 to 5 restrictive laws (AOR = 1.10; 95% CI = 1.01–1.20) were more likely to die. Separate analyses examining the relationship between parental involvement laws and infant mortality risk, stratified by maternal age, indicated that significant associations were observed among mothers aged ≤19 years (AOR = 1.09, 95% CI = 1.00–1.19), and 20 to 25 years (AOR = 1.10, 95% CI = 1.03–1.17). No significant association was observed among infants born to older mothers. Conclusion: Restricting access to abortion services may increase the risk for infant mortality.

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

Proponents of legal abortion believe abortion is a safe medical procedure that protects lives, while abortion bans endanger pregnant people not seeking abortions, and deny bodily autonomy, creating wide-ranging repercussions.

Opponents of legal abortion believe abortion is murder because life begins at conception, that abortion creates a culture in which life is disposable, and that increased access to birth control, health insurance, and sexual education would make abortion unnecessary. Read more background...

Pro & 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.

Pregnancy-related maternal deaths could increase 20% in US 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.

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.

Globally 45% of abortions are unsafe, 97% of which take place in developing countries. 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."
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Pro 2

Abortion bans endanger healthcare for those not seeking abortions.

Medical treatment for nonviable pregnancies is often exactly the same as an abortion.

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.

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.

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.

Further, bans are a slippery slope to contraceptive and other healthcare restrictions. For example, some already wrongly view Plan B (the morning after pill) as an abortifacient and are thinking of including it in abortion bans.
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Pro 3

Abortion bans deny bodily autonomy, creating wide-ranging repercussions.

US 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."

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.

And the consequences can be much more dire. "If a woman of childbearing age dies, it has enormous economic consequences.... It's someone who society has invested in and who has many productive economic years ahead of them," according to David Slusky, Associate Professor of Economics at the University of Kansas. Often, death also removes a wage-earner and caregiver from the household.

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.

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."
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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.

Tara Sander Lee, Senior Fellow and Director of Life Sciences at the Charlotte Lozier Institute, stated, "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.

Ending a life is murder legally and ethically, even a life that is only a few growing cells at the time of death.

Pope Francis explained, "Abortion is murder. 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."

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."
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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."

Tobin previously declared legal abortion a "brutalization of the American heart" on par with the "dehumanization of the undocumented" immigrants.

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."

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 the mentally disabled and elderly in general.

"[A]bortion is an act rife with the potential for eugenic manipulation," according to US 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."
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Con 3

Increased access to birth control, health insurance, and sexual education would make abortion unnecessary.

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.

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.

Linda Rosenstock, Public Health Professor of Health Policy and Management 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."

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).

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.
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Did You Know?

1. Throughout much of Western history, abortion was not considered a criminal act as long as it was performed before "quickening" (the first detectable movement of the fetus, which can occur between 13-25 weeks of pregnancy).

2. In 1821, Connecticut became the first US state to criminalize abortion.

3. 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.

4. 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.

5. 60% of women seeking abortions already had other children.

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Abortion - Top Arguments For and Against - ProCon.org

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The Pro Choice side says women should have control of their bodies. Pro Lifers say abortion is murder. Explore both sides of the debate.

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Health benefits of legal abortion: an analysis - PubMed

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Health benefits of legal abortion: an analysis

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Perfectly safe if legal

Abortions don't stop if made illegal, they just become unsafe

After abortions became more widely available, "The number of abortion-related deaths in the US decreased between 1972 and 1980, from 90 to 16" (Tyrer)

Legal abortions carries a lower death rate than childbearing itself

Getting a legal abortions is "7 time safer than carrying the pregnancy to term" (Tyrer)

illegal abortions "carry a risk of death...30 times that of legal abortion"(Tyrer)

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#13 Annotation: Laws Restricting Access to Abortion Services and Infant Mortality Risk in the U.S. 

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#13 Annotation: Laws Restricting Access to Abortion Services and Infant Mortality Risk in the U.S. 

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Thesis: The overall thesis of the article is to educate people on why they should consider the health impact of abortion restrictions.

"When we tested the crude relationship between each of the five types of abortion restrictive laws, each was significantly associated with an increased odds for infant mortality."

"Infants born in states with three or more restrictive laws were significantly more likely to die before their first birthday than were those born in states with no restrictions."

"The Sexual and Reproductive Framework (SRI) defines Reproductive rights as human rights and recognizes the multiple forms of oppression that impact individuals' decisions about their sexual and reproductive health."

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Abortion is currently banned in 13 states and 7 states have early gestational limits between 6 weeks and 15 weeks in effect. Nearly all of these bans include exceptions, which generally fall into four categories: to prevent the death of the pregnant person, when there is risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly. Some states have more than one abortion ban or restriction in place. The maps below illustrate the exceptions in each state's most restrictive gestational limit or total ban. For details hover over each state to read the rollover.

For more information on the status of state abortion bans, please visit our Abortion in the United States Dashboard.

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Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits | KFF

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This policy tracker documents exceptions in each state's most restrictive gestational limit or total ban.

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6 states with NO health exceptions

10 states with NO rape or incest exceptions

12 states with NO fatal fetal anomaly exception

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Long term effects: prolonged grief, anxiety, depression, post traumatic stress symptoms and suicidal ideation

Abortions are not a want in this case but a need

they can often lead to death if not handled quickly

if carried to term it is likely that either the mother or baby will die at birth

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In states with vague bans, doctors are allowed to refuse performing an abortion simply if they do not want to

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Pharmacists are refusing to fill pill bottles for miscarriages and ectopic pregnancies out of fear those pills will be used to cause an abortion

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Plan B is beginning to be viewed as an abortion pill rather than a contraceptive. People are beginning to want bans on these pills.

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restricting access to abortion is a risk factor for adverse maternal and Infant health