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A New York Times article reports that an estimated “7 percent of U.S. women will attempt self-managed abortion at some point in their lives”. With abortion laws become even more strict in states like Texas, the probability of self-managed abortions could increase.

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Even as abortion is restricted, telemedicine allows some women to end unwanted pregnancies using legal medications.

Credit... Gracia Lam

Abortion is once again a prominent source of controversy, restrictive legislation and, for many, great distress. A little background may help put this in perspective.

Fifty years ago last fall, after New York State adopted the most lenient abortion law in the country, many out-of-state women with unwanted pregnancies sought help from New York doctors.

On assignment from The Times, I accompanied two such women from Minnesota through their newly legal New York abortion experience. One was a Catholic woman on birth control pills, the mother of three children all with serious birth defects whose husband threatened to abandon the family if she had another child. The other was a 17-year-old who didn't know that she got pregnant after her high school prom, not weeks later at her graduation party. Both women had abortions safely performed by reputable New York gynecologists.

It was an emotionally fraught experience, but not nearly as harrowing as one I'd endured five years earlier when an unmarried friend with neither money nor access to a safe medical abortion tried in vain to terminate her pregnancy by drinking turpentine.

It is a different world today, with many more and better contraceptives and a 1973 Supreme Court ruling, Roe v. Wade, that protects a woman's right to choose abortion, now becoming increasingly curtailed by state-imposed restrictions and subject to the possibility of being overturned by the court. At the same time, according to a recent report, more women with unwanted pregnancies are finding a safe way to end them on their own using medications licensed by the Food and Drug Administration.

Though dangerous methods - the proverbial coat-hanger abortions - are now relatively uncommon, they are by no means gone. Despite current availability of highly effective contraception covered for most women by the Affordable Care Act, the problem of unwanted or ill-timed pregnancies is still very much with us and likely always will be.

According to the Guttmacher Institute, a champion of reproductive rights that gathers solid data on abortion and related issues, nearly a quarter of women in the United States will have an abortion by age 45. The institute states that three-fourths of women seeking abortions are poor or low-income, and more than half are already mothers who for various reasons - monetary, medical, emotional, societal or professional - cannot now afford to have another child.

In the report, published in December in JAMA Network Open, a research team headed by Lauren Ralph, epidemiologist in reproductive medicine at the University of California, San Francisco, found in a nationally representative survey of 7,022 women aged 18 to 45 that 1.4 percent admitted to having tried to terminate a pregnancy without medical assistance. Such self-managed abortion attempts were more than three times as common among Black and Hispanic women than non-Hispanic white women, with finances playing an important role; 15 percent of respondents in the survey were living below the federal poverty level.

Adjusting for the known level of underreporting of abortion, the research team "estimated that 7 percent of U.S. women will attempt self-managed abortion at some point in their lives," often using ineffective and sometimes dangerous methods. Dr. Ralph said that data from abortion clinics on how many women had first attempted to induce abortion on their own greatly underestimates the true number of self-managed abortions because more than one in four attempts were likely to have been successful.

Among women in the study, nearly half reported using the licensed abortion drug misoprostol or another medication in their most recent attempt to self-terminate a pregnancy, while 38 percent used herbs they heard could induce abortion, and nearly 20 percent used a physical method, such as being hit in the abdomen. Nearly 28 percent said they had succeeded in ending the pregnancy. Among those who had failed, 33.6 percent subsequently had abortions at a clinic (often 100 miles or more from home), and 13.4 percent continued the pregnancy. Eleven percent said they had suffered a complication following their self-attempt at abortion.

The most common reasons they gave for having tried to end a pregnancy on their own, without involving the health care system, were that it seemed easier or faster, that the procedure at a facility was too expensive and that the nearest clinic was too far away. Although this survey did not include adolescents, pregnant teens are often reluctant or unable to seek parental consent that many states require for a medically supervised abortion, which prompts some teens to attempt a self-induced abortion.

According to Dr. Ralph and co-authors, "abortion clinics and practitioners report caring for an increasing number of individuals who have attempted self-managed abortions." The researchers predicted that efforts by women to induce abortions on their own will become increasingly common as access to facility-based abortion care continues to decline.

For instance, the last clinic in Missouri that provides abortions, operated by Planned Parenthood, could be forced to stop the practice in a dispute with state regulators. It won a reprieve to continue operating through next May. Missouri and Mississippi are among a number of states in which lawmakers have banned abortions in early pregnancy, and most recently Texas banned all abortions after six weeks of pregnancy, a point at which the vast majority of women don't yet know they are pregnant.Last month, the Supreme Court accepted a case that could result in overturning Roe v. Wade.

"As more abortion clinics close and restrictions increase, the convenience of self-managed abortions will likely make them more prevalent," Dr. Ralph said in an interview. "Just because states make abortion more difficult to access doesn't mean the need for abortion will go away. We should make sure that women have the safest and most effective methods available."

She noted that pandemic-induced limitations on in-person medical visits may have made it easier for women in many states to access self-managed abortion in their homes. More doctors are now willing to provide abortion counseling over the phone and may even "distribute abortion medication by mail or hand it to women in the parking lot," she said.

Used correctly within 70 days of the start of a woman's last menstrual period (10 weeks gestation), medical abortion is effective in ending pregnancy more than 95 percent of the time, the Guttmacher Institute has reported. There are two prescription drugs, best used in combination, that can induce abortion early in pregnancy. One, an oral drug called mifepristone, is taken first to block the hormone progesterone needed for pregnancy to continue; the other, misoprostol, is dissolved in the mouth or inserted vaginally one or two days later to induce contractions and expel the contents of the uterus, ending the pregnancy.

Mifepristone access is rigidly controlled and can be difficult for doctors to prescribe, but misoprostol, which was licensed as an ulcer drug, is readily available in pharmacies with a doctor's prescription and is usually effective in ending an early pregnancy even without mifepristone. Some women have ordered misoprostol online or obtained it from Mexico or elsewhere.

Still, even with such drugs, if clinic access continues to decline or Roe is overturned, most women past 10 weeks of pregnancy might have no safe, legal access to abortion.

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Even as abortion is restricted, telemedicine allows some women to end unwanted pregnancies using legal medications. Abortion is once again a prominent source of controversy, restrictive legislation and, for many, great distress. A little background may help put this in perspective.

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Women have to turn to unsafe “procedures” when abortion is illegal.

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Make Abortion Safe. Make Abortion Legal.

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“What abortion advocates consider "restrictions on women," pro-lifers see as protections for preborn children.”
Putting something that hasn’t even taken a breathe above an actual living life doesn’t seem reasonable.

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In Tamara Thompson‘s article, she states “Governments should respect a woman's human right to make decisions regarding her reproductive life.”  Having the right to do what you want with your body is a human right. The government should be protecting women’s rights, instead of there being laws that prevent women from having safely done procedures like abortions.

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In 2008, an estimated 86 million women had unintended pregnancies. The impact of unintended pregnancies vary immensely depending on such factors as a woman's health, family relationships, economic resources, and the availability of medical care. These and other factors influence her decision to either carry a pregnancy to term or to seek an abortion. Given the complexity of this decision, the only person equipped to make it is the pregnant woman herself.

Governments should respect a woman's human right to make decisions regarding her reproductive life. A woman who decides to have an abortion-as 46 million women do annually-must have access to the facilities and care that will enable her to terminate her pregnancy safely. Governments that prosecute and punish women who have had abortions penalize women for exercising their basic rights. These rights are no less compromised when a woman who decides to terminate a pregnancy can do so only by undertaking a serious risk to her life or health.

International legal support for a woman's right to safe and legal abortion are found in numerous international treaties and other instruments.... The right to choose abortion has support in guarantees of life, health, freedom from discrimination, autonomy in reproductive decision-making, freedom from cruel, inhuman, or degrading treatment and the right to enjoy the benefits of scientific progress.

Multiple human rights instruments protect the right to life. In 2000, in elaborating States' obligations in reporting on their compliance with the right to life enshrined in the International Covenant on Civil and Political Rights (ICCPR), the Human Rights Committee called upon States to inform it of "any measures taken by the State to help women prevent unwanted pregnancies, and to ensure that they do not have to undergo life-threatening clandestine abortions."

It is widely acknowledged that in countries in which abortion is restricted by law, women seek abortions clandestinely, often under conditions that are medically unsafe and therefore life-threatening. According to the World Health Organization (WHO), about 21.6 million women had unsafe abortions in 2008. These unsafe abortions were responsible for the deaths of nearly 47,000 women. The incidence of unsafe abortion is closely associated with high maternal mortality rates. Therefore, laws that force women to resort to unsafe procedures infringe upon women's right to life.

Several United Nations (UN) human rights bodies have framed maternal deaths due to unsafe abortion as a violation of women's right to life. As a result, they have called on States to review restrictive laws that criminalize abortion and increase access to family planning and sexual and reproductive health information, in order to reduce the number of unsafe abortions.

The right to health can be interpreted to require governments to take appropriate measures to ensure that women have the necessary information and the ability to make crucial decisions about their reproductive lives.

While the phrase "right to life" has been associated with the campaigns of those who oppose abortion, it has not been interpreted in any international setting to require restrictions on abortion. Most recently, the European Court of Human Rights, in the case Vo v. France, ruled that "it is neither desirable, nor even possible as matters stand, to answer in the abstract the question whether the unborn child is a person for the purpose of Article 2 of the Convention ..." (providing that "[e]veryone's right to life shall be protected by law"). The court therefore refused to adopt a ruling that would have called into question the validity of laws permitting abortion in 39 member states of the Council of Europe.

International law guarantees women the right to "the highest attainable standard of physical and mental health." The right to health requires governments to provide health care and to work toward creating conditions conducive to the enjoyment of good health. In 2000, the Committee on Economic, Social and Cultural Rights recognized that the right to health includes "the right to control one's health and body, including sexual and reproductive freedom, and the right to be free from interference." Furthermore, the right to health "requires the removal of all barriers interfering with access to health services, education and information, including in the area of sexual and reproductive health."

The Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa (Maputo Protocol) explicitly recognizes that the right to health includes access to safe and legal abortion, at a minimum, in certain circumstances. It requires States Parties to "ensure that the right to health of women, including sexual and reproductive health is respected and promoted" by taking appropriate measures to authorize abortion "in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus."

Safe Abortion Services Protect Women

The right to health can be interpreted to require governments to take appropriate measures to ensure that women have the necessary information and the ability to make crucial decisions about their reproductive lives, such as determining whether or not to continue a pregnancy, and to guarantee that women are not exposed to the risks of unsafe abortion, which can have devastating effects on their health, leading to long-term disabilities, such as uterine perforation, chronic pelvic pain or pelvic inflammatory disease. Such measures include removing barriers that interfere with women's access to health services, such as legal restrictions on abortion, and ensuring access to high-quality abortion information and services.

Laws that restrict abortion have the effect and purpose of preventing a woman from exercising any of her human rights or fundamental freedoms on a basis of equality with men.

Several UN human rights bodies have recognized the deleterious impact of restrictive abortion laws on women's health and have consistently raised general concerns about the inaccessibility of safe abortion services.

The Programme of Action adopted at the International Conference on Population and Development (ICPD) in 1994 called upon governments to consider the consequences of unsafe abortion on women's health. It states that governments should "deal with the health impact of unsafe abortion as a major public health concern."

At the 1995 Fourth World Conference on Women, the international community reiterated this language and urged governments to "consider reviewing laws containing punitive measures against women who have undergone illegal abortions." In addition, in a paragraph addressing research on women's health, the Platform for Action adopted at this conference urges governments "to understand and better address the determinants and consequences of unsafe abortion."

In 1999, at the five-year review of the ICPD, governments recognized the need for greater safety and availability of abortion services. They affirmed that "in circumstances where abortion is not against the law, health systems should train and equip health-service providers and should take other measures to ensure that such abortion is safe and accessible. Additional measures should be taken to safeguard women's health."

Women's Right to Equality and Nondiscrimination

The right to gender equality is a fundamental principle of human rights law. All major human rights instruments require freedom from discrimination in the enjoyment of protected human rights. According to the Convention on the Elimination of All Forms of Discrimination against Women, "discrimination against women" includes laws that have either the "effect" or the "purpose" of preventing a woman from exercising any of her human rights or fundamental freedoms on a basis of equality with men. In 1999, the Committee on the Elimination of Discrimination against Women (CEDAW Committee) recognized "laws that criminalize medical procedures only needed by women and that punish women who undergo those procedures" as a barrier to women's access to appropriate health care.

Denying Women Access to Abortion Is a Form of Gender Discrimination

Laws that restrict abortion have the effect and purpose of preventing a woman from exercising any of her human rights or fundamental freedoms on a basis of equality with men.

Restricting abortion has the effect of denying women access to a procedure that may be necessary for their equal enjoyment of the right to health. Only women must live with the physical consequences of unwanted pregnancy. Some women suffer maternity-related injuries, such as hemorrhage or obstructed labor. Women are consequently exposed to health risks not experienced by men.

Laws that deny access to abortion, whatever their stated objectives, have the discriminatory purpose of both denigrating and undermining women's capacity to make responsible decisions about their bodies and their lives. Indeed, it is not surprising that unwillingness to allow women to make decisions about their own bodies often coincides with the tendency to deny women decision-making roles in the areas of political, economic, social, and cultural affairs.

The CEDAW Committee has consistently expressed concern about restrictive laws that criminalize abortion. Furthermore, the Human Rights Committee has recognized that criminalizing abortion, even in cases of rape, is incompatible with the States' obligation to ensure the equal right of men and women to the civil and political rights set forth in the ICCPR. Additionally, it has indicated that the problem of maternal mortality due to unsafe abortion is evidence of discrimination against women.

The Human Rights Committee has recognized that denying women access to legal abortion services is an arbitrary interference in their private lives.

Women's Right to Reproductive Self-Determination

Human rights instruments provide the basis for the right of women to make decisions regarding their own bodies. In particular, they require the right to freedom in decision-making about private matters. Such provisions include protections of the right to physical integrity, the right to decide freely and responsibly the number and spacing of one's children and the right to privacy.

When a pregnancy is unwanted, its continuation can take a heavy toll on a woman's physical and emotional well-being. Decisions one makes about one's body, particularly one's reproductive capacity, lie squarely in the domain of private decision-making. A pregnant woman may seek advice from others, but only she knows whether she is ready to have a child, and governments should play no role in making that decision for her.

The Human Rights Committee has recognized that denying women access to legal abortion services is an arbitrary interference in their private lives.

The European Court of Human Rights has underscored the connection between pregnancy and a woman's private life, which includes her physical and psychological integrity. It has recognized that States have a positive obligation to effectively secure the physical integrity of pregnant women. This obligation requires them to establish procedural safeguards to ensure that women can make an informed decision about whether or not to terminate a pregnancy and access safe and legal abortion services in a timely manner.

Women's Right to Be Free from Cruel, Inhuman, or Degrading Treatment

International law recognizes that women have a right to be free from cruel, inhuman, or degrading treatment. The Human Rights Committee has stated that cruel, inhuman, or degrading treatment is not restricted to acts that cause physical pain, but also applies to mental suffering, which often accompanies denials of access to abortion services.

As a result of restrictive abortion laws and policies, many women experiencing complications of pregnancy and needing therapeutic abortion are forced to suffer from painful, frightening and life-threatening conditions.

Human rights bodies have recognized that restrictive abortion laws can lead to violations of the right to be free from cruel, inhuman and degrading treatment. The Committee against Torture has recognized the impact of restrictive laws, which force women to carry unwanted pregnancies to term or to undergo illegal abortions that often place their health and lives in danger, and noted that the failure of States to take steps to prevent these acts constitutes cruel and inhuman treatment.

Specifically, it has indicated that a total prohibition on abortion, which forces a woman to carry a pregnancy resulting from a crime of gender-based violence, such as rape, "entails constant exposure to the violation committed against her and causes serious traumatic stress and a risk of long-lasting psychological problems such as anxiety and depression." The Human Rights Committee has stated that criminalizing abortion is incompatible with the right to be free from cruel, inhuman or degrading treatment.

The denial of access to abortion services in certain circumstances, regardless of the legality of the procedure, constitutes cruel, inhuman or degrading treatment.

Women Suffer Without Access to Abortion

Women may also undergo severe suffering and anguish when legal abortion services are inaccessible.

In many countries, healthcare personnel refuse to provide legal abortion services because of their own objection or discriminatory attitudes towards abortions. In the case of L.M.R. v. Argentina, the Human Rights Committee found that the State's failure to ensure a woman's access to abortion services to which she was legally entitled, caused her physical and mental suffering, which constituted cruel, inhuman or degrading treatment.

Additionally, in the case of R.R. v. Poland, the European Court of Human Rights established a violation of the right to be free from inhumane and degrading treatment because of the suffering experienced by R.R., due to the knowledge that she could not terminate her pregnancy even though the fetus had an incurable deformity and she was entitled to have an abortion under the Polish law. The Court stated that "[s]he suffered acute anguish through having to think about how she and her family would be able to ensure the child's welfare, happiness and appropriate long-term medical care."

Furthermore, the denial of access to abortion services in certain circumstances, regardless of the legality of the procedure, constitutes cruel, inhuman or degrading treatment.

In the landmark decision of K.L. v. Peru, the Human Rights Committee found that the depression and emotional distress experienced by a 17-year old girl were foreseeable consequences of the State's failure to enable her to benefit from a therapeutic abortion, and constituted a violation of her fundamental right to be free from cruel, inhuman, or degrading treatment. Notably, this ruling did not depend on the legality of abortion.

Women's Right to the Enjoyment of the Benefits of Scientific Progress

The Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights enshrine the right to enjoy the benefits of scientific progress.

As the medical and scientific communities make advances in abortion technologies, this right entitles women to access the full range of technologies for the safest abortion care.

The right to the benefits of scientific progress is particularly salient in the context of abortion because numerous safe, effective and low-cost health interventions, such as medical abortions, can substantially improve women's access to safe abortion services, thereby reducing the incidence of unsafe abortion, and decreasing the attendant maternal morbidity and mortality rates. Medical abortion is an alternative to surgical abortion that generally uses two medicines to end a pregnancy. The most common regimen calls for an oral dose of Mifepristone, followed by a dose of Misoprostol up to 48 hours later. This regimen, which can be initiated as soon as pregnancy is confirmed, is approximately 95% effective. In 2005, the WHO added Mifepristone and Misoprostol to its Model List of Essential Medicines, a list intended to guide governments in their prioritization of necessary drugs for budgetary allocations and procurement in their national health systems.

Permitting medical abortion can significantly improve women's overall access to safe abortion because it can be provided in a broad range of settings, such as in practitioner's offices, and can be offered by non-physicians, which helps to expand the pool of providers available to perform safe abortions. Additionally, reducing reliance on physicians can reduce costs and help make abortion more available and accessible to women. By approving medical abortion protocols, training providers and removing barriers to the regimen, governments can ensure that women have access to medical abortion in a safe setting, which allows them to enjoy their right to the benefits of scientific progress.

Books

Randy C. Alcorn Why Pro-Life? Caring for the Unborn and Their Mothers. Peabody, MA: Hendrickson, 2012.

Jennifer Baumgardner Abortion and Life. New York: Akashic, 2008.

Daniel Becker Personhood: A Pragmatic Guide to Pro-Life Victory in the 21st Century. Alpharetta, GA: TKS Publications, 2011.

Francis J. Beckwith Defending Life: A Moral and Legal Case Against Abortion Choice. New York: Cambridge University Press, 2007.

Sarah Erdreich Generation Roe: Inside the Future of the Pro-Choice Movement. New York: Seven Stories, 2013.

Clarke D. Forsythe Abuse of Discretion: The Inside Story of Roe v. Wade. New York: Encounter, 2013.

Merle Hoffman Intimate Wars: The Life and Times of the Woman Who Brought Abortion from the Back Alley to the Board Room. New York: Feminist Press, 2012.

N.E.H. Hull and Peter Charles Hoffer Roe v. Wade: The Abortion Rights Controversy in American History, 2nd ed. Lawrence: University Press of Kansas, 2010.

Abby Johnson Unplanned: The Dramatic True Story of a Former Planned Parenthood Leader's Eye-Opening Journey Across the Life Line. Carol Stream, IL: Tyndale Momentum, 2011.

Patricia Miller Good Catholics: The Battle over Abortion in the Catholic Church. Berkeley: University of California Press, 2014.

Cristina Page How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex. New York: Basic Books, 2006.

Rickie Solinger Reproductive Politics: What Everyone Needs to Know. New York: Oxford University Press, 2013.

Michael Tooley et al. Abortion: Three Perspectives. New York: Oxford University Press, 2009.

Susan Wicklund and Alan S. Kesselheim This Common Secret: My Journey as an Abortion Doctor. New York: PublicAffairs, 2008.

Joshua Wilson The Street Politics of Abortion: Speech, Violence, and America's Culture Wars. Palo Alto, CA: Stanford Law Books, 2013.

Periodicals and Internet Sources

Charlene Aaron "Pro-Life Leaders Mourn Black Genocide," Christian Broadcasting Network, February 28, 2011. www.cbn.com.

AbortionFacts.com "Fact #18: Abortion Disproportionally Targets Minority Babies," 2014. www.abortionfacts.com.

Amy Allina et al. "Pre-Existing Conditions: How Restrictions on Abortion Coverage and Marginalization of Care Paved the Way for Discriminatory Treatment of Abortion in Health Reform and Beyond," Center for Women Policy Studies, August 2012. http://centerwomenpolicy.org.

Laura Bassett "Anti-Abortion Laws Take Dramatic Toll on Clinics Nationwide," Huffington Post, November 11, 2013. www.huffingtonpost.com.

Daniel Burke "Six Surprising Changes to the Anti-Abortion March for Life," CNN, January 21, 2014. http://religion.blogs.cnn.com.

Aaron E. Carroll "How Hobby Lobby Ruling Could Limit Access to Birth Control," New York Times, June 30, 2014.

David Crary "Abortion in Cases of Rape Dividing Pro-Life Movement," Southeast Missourian, April 13, 2014. www.semissourian.com.

Lizzie Crocker "Pro-Lifers Descend on UN, Decrying Abortion as an 'Act of Violence,'" Daily Beast, March 8, 2013. www.thedailybeast.com.

Tara Culp-Ressler "Scientists Studying 'Fetal Pain' Don't Actually Want Their Research to Justify Abortion Bans," Think Progress, September 17, 2013. http://thinkprogress.org.

Daily Beast "The Geography of Abortion Access," January 22, 2013. www.thedailybeast.com.

Daily Beast "Roe v. Wade Turns 40," January 2013. www.thedailybeast.com.

Erik Eckholm "Abortions Declining in US, Study Finds," New York Times, February 3, 2014.

Juliet Eilperin "So Abortion Will Be an Issue in 2014. Where Could It Make a Difference?," Washington Post, July 8, 2013.

Susan Estrich "The Abortion Fight-40 Years Later," Courier, April 3, 2014.

Guttmacher Institute "Restricting Insurance Coverage of Abortion, State Policies in Brief," March 2014. www.guttmacher.org.

Nicco Hines "How Widespread Is Sex-Selective Abortion?," Daily Beast, January 16, 2014. www.thedailybeast.com.

Bari Hussain and Ishrat Zerin "Is Abortion a Human Right for Women?," Daily Star, August 6, 2013.

Pete Kasperowicz "House Votes to Limit Abortion Coverage Under Affordable Care Act," The Hill, January 28, 2014. http://thehill.com.

Neil King Jr. "Late-Term Abortion Bans Have Support," Wall Street Journal, July 24, 2013.

Anu Kumar "Do US Abortion Restrictions Violate Human Rights?," Huffington Post, October 25, 2011. www.huffingtonpost.com.

Joshua Lang "What Happens to Women Who Are Denied Abortions?," New York Times, June 12, 2013.

Alexandra Le Tellier "Are Women Stupid? New Texas Abortion Bill Treats Them That Way," Los Angeles Times, July 31, 2013.

Dana Liebelson and Sydney Brownstone "Imagine You Were Raped. Got Pregnant. Then Your Rapist Sought Custody," Mother Jones, August 24, 2012.

Adam Liptak "Supreme Court Rejects Contraceptives Mandate for Some Corporations," New York Times, June 30, 2014.

David Masci "The New Legal Battlefield over Abortion," Pew Research Center, July 31, 2013. www.pewresearch.org.

Kate Michelman "Long Road Since 'Roe,'" Philly.com, April 23, 2014. www.philly.com.

R. Albert Mohler Jr. "Why the Abortion Issue Won't Go Away," CNN, January 23, 2012. http://religion.blogs.cnn.com.

Andrew Napolitano "Is Rape a Moral Justification for Abortion?," Reason, August 23, 2012.

NARAL Pro-Choice America "Congress Should Not Legitimize the Mythical 'Post-Abortion Syndrome,'" January 1, 2014. www.prochoiceamerica.org.

NARAL Pro-Choice America "Mandatory Parental-Involvement Laws Threaten Young Women's Safety," January 1, 2013. www.prochoiceamerica.org.

NARAL Pro-Choice America "Refusal Laws: Dangerous for Women's Health," January 1, 2014. www.prochoiceamerica.org.

National Abortion Federation "Post-Abortion Syndrome," 2010. www.prochoice.org.

National Conference of State Legislatures "Pharmacist Conscience Clauses: Laws and Information," May 2012. www.ncsl.org.

National Organization for Women "War on Women's Reproductive Rights Escalates in the States in 2013," January 2014. http://now.org.

Judy Nicastro "My Abortion, at 23 Weeks," New York Times, June 20, 2013.

Randall O'Bannon "Why Do Women Have Abortions? New Study Provides Some Answers," LifeNews.com, October 10, 2013. www.lifenews.com.

Steve Osunsami "Abortion Billboards: Strong Words Spark Debate in Atlanta's Black Neighborhoods," ABC News, February 22, 2010. http://abcnews.go.com.

Kim Painter "Doctors Say Abortions Do Sometimes Save Women's Lives," USA Today, October 22, 2012.

Stephanie Pappas "Providing Abortions Can Be the Moral Choice, Doctor Says," LiveScience, September 12, 2012. www.livescience.com.

Jeremy W. Peters "Parties Seize on Abortion Issues in Midterm Race," New York Times, January 20, 2014.

Pew Research Religion &Public Life Project "A History of Key Abortion Rulings of the U.S. Supreme Court," January 16, 2013. www.pewforum.org.

Planned Parenthood USA "Medical and Social Health Benefits Since Abortion Was Made Legal in the US," January 2013. www.plannedparenthood.org.

Mary DeTurris Poust "What Children Teach Us About Abortion," US Conference of Catholic Bishops, January 23, 2013. http://usccbmedia.blogspot.com.

Kirsten Powers "Abortion Rights Community Has Become the NRA of the Left," Daily Beast, May 6, 2013. www.thedailybeast.com.

Louise Radnofsky and Ashby Jones "Support Grows for Roe v. Wade," Wall Street Journal, January 22, 2013.

Molly Redden "Hobby Lobby's Hypocrisy: The Company's Retirement Plan Invests in Contraception Manufacturers," Mother Jones, April 1, 2014.

Maya Rhodan "What We Stand to Lose," Essence, April 3, 2014.

Gregory J. Roden "Unborn Children as Constitutional Persons," Issues in Law and Medicine, Spring 2010.

Lydia Saad "Americans Still Split Along 'Pro-Choice,' 'Pro-Life' Lines," Gallup, May 23, 2011. www.gallup.com.

William Saletan "Do Most Americans Think Most Abortions Should Be Illegal?," Slate, January 22, 2014. www.slate.com.

Wesley J. Smith "Should Doctors Be Forced to Kill?," Daily Caller, December 16, 2011.

Akiba Solomon "The Missionary Movement to 'Save' Black Babies," Colorlines, May 2, 2013. http://colorlines.com.

Meredith Somers "March for Life Expands to New Cause: Obamacare," Washington Times, January 20, 2014.

Paul Stark "Is Abortion Justified When the Unborn Baby Is Disabled?," LifeNews.com, September 25, 2013. www.lifenews.com.

Emily Swanson "Abortion Poll: Vast Majority Support Legal Abortion for Rape Victims," Huffington Post, October 31, 2012. www.huffingtonpost.com.

Sarah Torre "Conscience Rights: The New Frontline in the Culture War," Heritage Foundation, April 19, 2011. http://blog.heritage.org.

Rick Ungar "Hobby Lobby Invested in Numerous Abortion and Contraception Products While Claiming Religious Objection," Forbes, April 1, 2014.

University of California, San Francisco "Turnaway Study," Advancing New Standards in Reproductive Health, 2014. www.ansirh.org.

Eddie Velosa "'Raped' by the Law: Pregnant Victims Fight for Their Rights," RYOT News, September 10, 2013. www.ryot.org.

Cheryl Wetzstein "Study IDs Reasons for Late-Term Abortions-Age of Women, Financial Issues Factor In," Washington Times, December 10, 2013.

Anna Wolfe "'Personhood' May Be Back," Jackson Free Press, March 19, 2014.

Grace Wyler "Battles over Abortion Flare in 2014," Time, February 6, 2014.

Source Citation

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Safe and Legal Abortion Is a Human Right

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In 2008, an estimated 86 million women had unintended pregnancies. The impact of unintended pregnancies vary immensely depending on such factors as a woman's health, family relationships, economic resources, and the availability of medical care. These and other factors influence her decision to either carry a pregnancy to term or to seek an abortion.

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Reproductive rights also fights more accessibility to sex education, contraception, and other services for reproductive health. There aren’t many laws that protect reproductive rights for women except one that protects her rights to terminate a pregnancy. Religious objections to abortion are to promote their views based on religion. Donald Trump nominated pro-life and conservative judges in the Supreme Court, and they were willing to “reevaluate” abortion rights.

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Reproductive rights refer to the rights of couples and individuals to determine when and whether to have children as well as their rights to access information and services related to reproductive health. Though reproductive rights are often discussed in relation to access to safe, legal abortions, these rights also relate to the availability of birth control, sex education and outreach, access to fertility resources, maternal and prenatal health care, and freedom from forced or coerced pregnancy, abortion, and sterilization.

The US Constitution does not explicitly protect reproductive rights. However, state and federal laws restricting access to reproductive services have been successfully challenged on constitutional grounds. Notably, the US Supreme Court ruled in Roe v. Wade (1973) that the Fourteenth Amendment protected a woman's right to terminate a pregnancy. Still, state and local governments determine most policies related to reproductive rights. Advocates have sought to affirm reproductive rights through legislation, litigation, and public outreach. Such advocacy has faced significant pushback from organizations that oppose family planning, particularly pregnancy termination and contraceptive use, largely due to religious objections. Like reproductive rights advocates, these organizations have used both the law and public opinion to promote their perspectives.

Despite repeated Supreme Court decisions affirming the right to abortion services, the issue remains contentious. A 2020 Gallup poll found that 50 percent of US adults believe abortion should be legal only under certain conditions, 29 percent believe it should be legal in all circumstances, and 20 percent believe it should not be permitted under any circumstances. Activists have expressed concern about the future of reproductive rights as Donald Trump caused an ideological shift in the federal courts. During his single term as president, Trump successfully nominated many pro-life federal judges, including the addition of three conservative justices to the Supreme Court. Many of Trump's appointments have expressed a willingness to reevaluate reproductive rights, particularly restrictions on abortion services.

Main Ideas

Reproductive rights involve having access to information related to reproductive health and being able to make decisions about personal reproductive health.

For many years, information related to sex, including information about contraceptive use or abortion services, could not legally be sent through the mail.

The debate over reproductive rights often focuses on a woman's right to choose whether to have an abortion and whether the laws governing abortion impede upon a woman's right to privacy or a health-care worker's ability to do their job.

Limited understanding and awareness about sex and reproductive health have been linked to increased rates of sexually transmitted infections, unwanted pregnancies, and abortions.

Though many types of birth control are covered by insurance and many forms of contraceptives can be obtained without a prescription, millions of Americans still lack access to the full range of birth control methods.

In 1973 the US Supreme Court ruled that the Fourteenth Amendment protected a woman's right to obtain an abortion. The appointment of several conservative justices has suggested that the legal precedent may be in danger of being overturned.

Access to Information

Reproductive rights advocates consider access to information about sexual health a fundamental right. Historically, such advocacy has faced opposition from groups concerned that making such information readily available or teaching sex education to young people will encourage promiscuity and contribute to moral decay throughout society. In 1873 Congress passed "an Act for the Suppression of Trade in, and Circulation of, obscene Literature and Articles of Immoral Use," the first of a series of laws known as the Comstock laws, named for US postal inspector and moral crusader Anthony Comstock. These laws forbid the use of the US postal service to transfer any material deemed obscene, including materials that might inform someone about using contraception or procuring an abortion. Several state laws also included information about family planning in their definition of obscene materials, making it illegal in many places for a person to discuss contraception or abortion with anyone other than a doctor. Provisions of the Comstock laws remained in place until the twentieth century.

Restricting people from discussing or learning about reproductive health can contribute to widely held misconceptions about the risks associated with sex. Without access to accurate information, people have resorted to dangerous methods to prevent pregnancy or induce an abortion, such as taking poisons or inserting dangerous objects into a woman's body. Because many communities discourage public discussions about sex, people may remain misinformed about or unaware of the options available to them for managing their own reproductive health. Further, better understanding of sexual health risks can help limit outbreaks of sexually transmitted infections (STIs).

Providing sex education in public schools became increasingly commonplace in the late twentieth century, prompting protests from parents who expressed concern that exposing young people to information about sex would lead them to engage in such behavior. These protests have led some districts to adopt policies of teaching abstinence-only sex education, which advises students that refraining from sexual activity is the most effective way to prevent pregnancy or the spread of STIs. Critics of this approach contend that educating people about the risks of sex is more practical because doing so enables them to make safer decisions if they do choose to become sexually active. Further, critics allege, students who do not receive information about sex from a qualified resource are likely to seek it from less reliable venues such as friends or pornography.

Access to Contraception

Birth control methods have evolved over time from superstitions, such as wearing the bones of a black cat, to the more scientific methods introduced in the 1950s, including intrauterine devices (IUDs) and hormonal birth control. Contraceptives and information about them, however, have not always been easy to obtain. State legislatures began to impose restrictions on the use and distribution of contraceptives in the mid-nineteenth century, coinciding with the first use of rubber as a material for making condoms. In 1936 the United States Circuit Court of Appeals for the Second Circuit ruled that federal law could not interfere with a physician's legitimate work, recognizing the validity of doctors prescribing contraceptives to patients for medical benefit. One year later, the American Medical Association identified birth control as a crucial component of reproductive health and encouraged further research in contraceptives and how to best educate physicians and their patients on their safe and effective use. Several states, however, maintained restrictions on contraceptive use and distribution. Condoms, cervical caps, and diaphragms remained the most common birth control methods for many years.

Nurse and social activist Margaret Sanger attracted the attention of authorities in the early twentieth century for violating the Comstock laws by promoting sex education and family planning. She promoted the use of birth control through essays, public lectures, the importation of European birth control devices, and the establishment of clinics throughout the United States and other countries. During the 1950s, through a project financed by funding secured by Sanger and the nonprofit organization Planned Parenthood, scientists developed Enovid, the first proven oral contraceptive. The US Food and Drug Administration (FDA) approved the birth control pill for regulating menstrual cycles in 1957 and as a contraceptive method in 1960.

At the time the FDA approved the pill as a contraceptive method, birth control remained illegal in Massachusetts and Connecticut. In 1961 two activists, Estelle Griswold and Dr. C. Lee Buxton, were arrested for violating Connecticut law by establishing a birth control clinic where married couples could receive prescriptions for contraceptives. They were found guilty as "accessories to providing illegal contraception." Griswold's appeal ultimately reached the US Supreme Court, where the court ruled in Griswold v. Connecticut (1965) that state bans on the use of contraceptives by married couples violated the Fourteenth Amendment of the Constitution. The Fourteenth Amendment would be used to argue subsequent cases involving reproductive rights, including Eisenstadt v. Baird (1972), in which the Supreme Court ruled that state contraceptive bans also violate the privacy expectations of unmarried people.

As part of the Patient Protection and Affordable Care Act of 2010 (ACA), commonly referred to as Obamacare, lawmakers included within the law a mandate that health insurance plans cover the entire cost of eighteen types of FDA-approved birth control methods including oral contraceptives, IUDs, and other hormonal birth control options. Several employers objected to the mandate, citing religious objections to subsidizing employee use of birth control as required by law. The owners of the arts and crafts retail chain Hobby Lobby filed a lawsuit against the US Department of Health and Human Services (HHS) in which the US Supreme Court ruled on June 30, 2014, that privately owned companies in which five or fewer people hold a majority share and demonstrate a sincere objection to providing coverage may be exempt from the mandate. The ruling also allows houses of worship such as churches and mosques to opt out of providing coverage and allows some faith-based nonprofit institutions to defer responsibility for contraceptive coverage to the employees' insurance provider.

Studies have linked access to contraception, particularly hormonal birth control, to substantial gains for women in the United States, such as increased wages, education achievement, and health outcomes. In 2020 polling conducted by the advocacy group Power to Decide revealed that most adults are grateful that birth control enables family planning but also helps manage health conditions and allows them more ability to reach educational and professional goals. However, polling indicated that 51 percent of adults worried that the conservative majority on the Supreme Court threatens the general public's ability to afford or access contraception. Further, the group's research indicates that over nineteen million women in the United States in 2020 lived in contraceptive deserts, areas in which women do not have "reasonable access to the full range of birth control methods."

Critical Thinking Questions

What is the Hyde Amendment, and do you think it should remain in place?

Do you think the government should subsidize the costs of birth control and contraceptive devices? Why or why not?

Under what circumstances, if any, do you think the government should forbid a woman from obtaining an abortion? Explain your answer.

Access to Abortion

Opponents of legal abortion, commonly identified as pro-life, contend that the government has a responsibility to protect all human life including unborn fetuses. Abortion supporters, commonly identified as pro-choice, argue that the government does not have the right to interfere with a woman's medical decisions. Since the US Supreme Court affirmed access to abortion as a constitutional right in its 1973 decisions in Roe v. Wade and Doe v. Bolton, antiabortion activists and lawmakers have sought to pass laws and implement policies that create obstacles to obtaining the procedure. Protesting outside of reproductive health clinics served as a popular form of antiabortion activism until Congress passed the Freedom of Access to Clinic Entrances (FACE) Act in 1994. The law prohibits people from using physical force or obstruction to intimidate others from entering a clinic or a house of worship. Additionally, the law authorizes the US Department of Justice to seek additional penalties for intentional property damage to clinics or houses of worship.

Several state and federal laws dictate when, if ever, federal funds can be used to fund abortion services. The 1976 Hyde Amendment, first included in the Departments of Labor and Health, Education, and Welfare appropriations bill of 1977 asserts that federal funds should not be used for abortion services except in cases of rape, incest, or in which the woman's health is threatened. As of 2020, the Hyde Amendment has been included in every subsequent annual appropriations bill. Though the Hyde Amendment has faced several legal challenges, the US Supreme Court has upheld that access to a federally funded abortion is not a constitutional right. Other laws, which vary by state, require the seeker of an abortion to undergo counseling, perform an ultrasound, endure a waiting period, or notify a parent if under age eighteen.

Legislation that imposes specific requirements on the facilities in which abortions are performed and the health-care providers that perform them, commonly referred to as Targeted Regulation of Abortion Providers (TRAP) laws, may necessitate that both medical abortions (caused by prescription medications) and surgical abortions be conducted by a licensed physician and specify the size of the rooms and hallways of the clinic as well as its proximity to an admitting hospital. In some instances, these state laws have been challenged in court with varying success. In 2016 the US Supreme Court ruled in Whole Woman's Health v. Hellerstedt that restrictions imposed by a Texas law created a substantial burden for women seeking an abortion, rendering Texas's laws to be unconstitutional. In June Medical Services, LLC v. Russo (2020), the court ruled against a Louisiana law, noting the similarity between it and the Texas restrictions it had ruled against in 2016.

Reproductive rights experts expressed concern over the 2020 appointment of Amy Coney Barrett to the US Supreme Court. Barrett had previously argued in 2013 that a Supreme Court justice should not be beholden to precedent. Further, during her confirmation, she characterized the court's rulings in both Griswold v. Connecticut and Roe v. Wade as decisions that could potentially be overruled. Should the court overrule Roe v. Wade, abortion access would be determined at the state and local level. As of December 2020, sixteen states either maintain pre-1973 abortion bans or have passed laws that would ban abortion if Roe v. Wade is overturned.

Source Citation

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Reproductive rights refer to the rights of couples and individuals to determine when and whether to have children as well as their rights to access information and services related to reproductive health.