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The meaning, history and political rhetoric surrounding the term abortion ‘ban’

Experts say ‘ban’ has emerged as shorthand for nearly all abortion prohibitions. the blunt term often leaves room for political spin..

Ban: Merriam-Webster  defines  it as “a legal or formal prohibition.”

But in the 2024 election cycle — the first general election since Roe v. Wade, the landmark ruling that enshrined a constitutional right to an abortion, was  overturned  — the term has morphed into polarizing political rhetoric. “Ban” has become synonymous with abortion and the wave of anti-abortion laws enacted in states across the country.

For example, on President Joe Biden’s reelection campaign website, the  abortion policy page’s  title reads: “Donald Trump wants to ban abortion nationwide. Re-elect Joe Biden to stop him and protect reproductive freedom.”

Trump appointed three of the U.S. Supreme Court justices who voted to overturn Roe. After years of inconsistency, Trump  most recently  has said that laws on abortion should be left to the states and that he wouldn’t sign a national abortion ban.

Many Democrats and abortion rights activists have also zeroed in on down-ballot Republicans, accusing them of supporting abortion “bans,” even if their position allows for some access.

“Yesterday, we celebrated Mother’s Day. Today, I remind you that politicians like Bernie Moreno, who supports a national abortion ban, don’t want moms making their own healthcare decisions. Abortion rights are on Ohio’s ballot again in 2024,” Ohio Democrat Allison Russo wrote May 13  on X .

Moreno, who has Trump’s support, is a Republican running for Senate in Ohio against Democratic incumbent Sen. Sherrod Brown. Moreno  has said  that he would vote for a 15-week national abortion ban.

Political discourse experts say “ban” has emerged as shorthand for nearly all abortion prohibitions. The blunt term, nuanced in its myriad interpretations, often leaves room for political spin.

What exactly is a ban?

“Ban” is not a medical term; people across the political spectrum on abortion define it differently.

The word has two main rhetorical functions, political discourse experts said. When people talk to like-minded people about a particular issue, it can reinforce the group’s beliefs. Or, it can label opponents as “extreme.”

“For example, when Joe Biden talks about an assault weapon ban, he’s not trying to convert skeptics — he’s signaling to people who already agree with them that they’re on the same team,” said Ryan Skinnell, an associate professor of rhetoric and writing at San Jose State University. “But the other way ‘ban’ works is to identify someone you disagree with as extreme. Groups who want to keep certain books out of libraries, for instance, rarely describe themselves as in support of book banning. Their opponents adopt that language.”

This dual usage reflects in the abortion fight. Abortion-rights activists use “ban” to signal an infringement on personal freedom and autonomy over medical decisions. Anti-abortion proponents may use “ban” to signal a protection of fetal life. For example, when introducing legislation that ban abortion at various stages,  Republican   politicians  have often framed the bills as moral imperatives that protect unborn life.

Peter Loge, a George Washington University professor who directs the school’s Project on Ethics in Political Communication, said ban has historically meant “to eliminate” or “not have,” but politicians employ a strategic ambiguity that allows listeners to assign their own meaning. Loge, who served as a senior adviser in former President Barack Obama’s Food and Drug Administration, said Obama did this with one of his campaign slogans: “Change We Can Believe In.”

“Well, what does ‘change’ mean? Clearly, it means whatever he thinks it means, but as a listener you will ascribe it to mean whatever you think it means,” Loge said. “So, if I think most abortions should be illegal and in some cases it’s OK, I can support a ban, because it’s a ban with exceptions. The listener plugs in whatever caveats they prefer and ascribes them to the speaker. This is a technique as far back as Aristotle, who wrote that the listener provides the reasoning for themselves.”

Loge, like Skinnell, said “ban” is often used in politics to showcase extremism and the threat of something being taken away.

“It’s the rhetoric of anger. ‘They want to take your rights from you. … Now it’s an ideological divide and it works because we’re going to be more motivated to vote,” Loge said. “People are more concerned about losing something they have than they are interested in getting something new. We are risk-averse.”

Nathan Stormer, a rhetoric professor at the University of Maine and an expert in abortion rhetoric, said the term usually shows up when people refer to making abortion illegal in pregnancy’s earlier stages. But, he added, although common usage typically refers to a first trimester threshold, there is “no set of rules.”

“Because it is not a consistently used term, I think when people do not specify what they are referring to, others may take them to mean at conception or very early, but one has to inquire about context,” Stormer wrote in an email.

How abortion ban rhetoric evolved

Before the 1970s, there was little discussion about abortion bans.

Although legal abortion existed in various states at various stages before the  Supreme Court decided Roe v. Wade in 1973,  the ruling’s enshrinement of abortion rights across the country, helped galvanize opposition and mobilize anti-abortion groups.

“There were book bans, pornography bans, dancing bans, and so on. But even most conservative politicians and church groups weren’t especially concerned with abortion as an issue, and there was virtually no concerted political interest in bans,” Skinnell, from San Jose University, said. “That began to change with Richard Nixon.”

Skinnell said the former president’s advisers, in coordination with evangelical Christian church leaders, determined they could connect abortion to left-wing social movements, such as feminism, by linking them consistently in speeches and campaign materials.

“The idea of abortion bans came directly out of that partnership,” Skinnell said, “and it gathered steam in right-wing and conservative circles throughout the next few decades.”

Republicans further popularized the term in the mid-1990s, when they advocated for the Partial-Birth Abortion Ban Act, which President George W. Bush  signed into law  in 2003. The campaign to pass that legislation, experts said, introduced the term “ban” as the abortion restriction’s “stated intent.”

Political rhetoric experts said much of the medical literature and media coverage before Roe v. Wade often used terms such as “illegal” because abortion was considered a criminal act in most states.

“Even in the early stages of criminalizing abortion in the U.S., I don’t think ban was a common term,” Stormer said. “When a restriction is being put in place where before there was not one, people tend to resort to the word ban.”

Emily Winderman, a University of Minnesota professor specializing in the rhetorical study of health and medicine, said that over time abortion “bans” have manifested  as “incremental” restrictions throughout gestational development to the complete prohibitions seen in multiple states today.

For instance, she said, “heartbeat bills,” which typically refer to laws that make abortion illegal as early as six weeks of pregnancy, were controversial when they emerged around 2010, but have become more prevalent since the Trump administration and Roe’s overturning.

Winderman also said bans can appear via code and ordinance restrictions, such as banning  the type of use for a particular piece of real estate — making abortion clinics impossible to place.

“It’s important to understand bans as a complex strategy that includes gestational limits as well as limitations on who can provide care and where,” she said.

Shifting abortion laws across the U.S. have made “ban” an increasingly common term.  Forty-one states  now ban abortion at different points in pregnancy — 14 enforce total bans, three enforce six-week bans and others restrict abortion before fetal viability.

Stormer, from the University of Maine, pointed to Arizona’s Supreme Court reinstating an 1864 law that completely banned abortion. (It  has since been repealed. ) At the time the law was written, conception was not well understood, and there was no clear sense of fertilization or how it worked.

“Reinstating that law was a great example of how the conflict over abortion has remained steady and largely recognizable, but its terms and understandings have been constantly moving, which says something,” Stormer said. “So, specific words do important work, but they do not capture what is happening rhetorically, in my opinion. The moving terminologies are the waves crashing, but the tides are the thing.”

This fact check was originally published by PolitiFact , which is part of the Poynter Institute. See the sources for this fact check here .

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Key Facts on Abortion in the United States

Usha Ranji , Karen Diep , and Alina Salganicoff Published: Nov 21, 2023

Note: This brief was updated on January 4, 2024 to correct the description of the data collected by the federal CDC Abortion Surveillance System. On June 24, 2022, the Supreme Court issued a ruling in Dobbs v. Jackson Women’s Health Organization that overturned the constitutional right to abortion as well as the federal standards of abortion access, established by prior decisions in the cases Roe v. Wade and Planned Parenthood v. Casey . Prior to the Dobbs ruling, the federal standard was that abortions were permitted up to fetal viability. That federal standard has been eliminated, allowing states to set policies regarding the legality of abortions and establish limits. Access to and availability of abortions varies widely between states , with some states banning almost all abortions and some states protecting abortion access.

This issue brief answers some key questions about abortion in the United States and presents data collected before and new data that was published shortly after the overturn of Roe v. Wade .

What is abortion?

How safe are abortions, how often do abortions occur, who gets abortions, at what point in pregnancy do abortions occur, where do people get abortion care, how much do abortions cost, does private insurance or medicaid cover abortions, what are public opinions about abortion.

Abortion is the medical termination of a pregnancy. It is a common medical service that many women obtain at some point in their life. There are different types of abortion methods, which the National Academy of Sciences, Engineering, and Medicine (NASEM ) places in four categories:

• Medication Abortion – Medication abortion, also known as medical abortion or abortion with pills, is a pregnancy termination protocol that involves taking oral medications. There are two widely accepted protocols for medication abortion. In the U.S., the most common protocol involves taking two different drugs, Mifepristone and Misoprostol. Typically, an individual using medication abortion takes Mifepristone first, followed by misoprostol 24-48 hours later. In the U.S., the Food and Drug Administration (FDA) has approved this protocol of medication abortion for use up to the first 70 days (10 weeks) of pregnancy, and its use has been rising for years. Another medication abortion protocol uses misoprostol alone . Patients can take 800 µg (4 pills) of misoprostol sublingually or vaginally every three hours for a total of 12 pills. The regimen is also recommended for up to 70 days (10 weeks) of pregnancy, but it is not currently approved by the FDA and is more commonly used in other countries.

Guttmacher Institute estimates that in 2020, medication was used for more than half (53%) of all abortions. While medication abortion has been available in the U.S. for more than 20 years, studies have found that many adults and women of reproductive age have not heard of medication abortion. Many have confused emergency contraception ( EC ) pills with medication abortion pills, but EC does not terminate a pregnancy. EC works by delaying or inhibiting ovulation and will not affect an established pregnancy.

• Aspiration , a minimally invasive and commonly used gynecological procedure, is the most common form of procedural abortion. It can be used to conduct abortions up to 14-16 weeks of gestation. Aspiration is also commonly used in cases of early pregnancy loss (miscarriage).
• Dilation and evacuation abortions (D&E) are usually performed after the 14th week of pregnancy. The cervix is dilated, and the pregnancy tissue is evacuated using forceps or suction.
• Induction abortions are rare and conducted later in pregnancy. They involve the use of medications to induce labor and delivery of the fetus.

( Back to top )

Decades of research have shown that abortion is a very safe medical service.

Despite its strong safety profile, abortion is the most highly regulated medical service in the country and is now banned in several states. In addition to bans on abortion altogether and telehealth, many states impose other limitations on abortion that are not medically indicated, including waiting periods, ultrasound requirements, gestational age limits, and parental notification and consent requirements. These restrictions typically delay receipt of services.

• NASEM completed an exhaustive review on the safety and effectiveness of abortion care and concluded that complications from abortion are rare and occur far less frequently than during childbirth.
• NASEM also concluded that safety is enhanced when the abortion is performed earlier in the pregnancy. State level restrictions such as waiting periods, ultrasound requirements, and gestational limits that impede access and delay abortion provision likely make abortions less safe.
• When medication abortion pills, which account for the majority of abortions, are administered at 9 weeks’ gestation or less, the pregnancy is terminated successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%).
• Medication abortion pills can be provided in a clinical setting or via telehealth (without an in-person visit). Research has found that the provision of medication abortion via telehealth is as safe and effective as the provision of the pills at an in person visit.
• Studies on procedural abortions, which include aspiration and D&E, have also found that they are very safe. Research on aspiration abortions, the most common procedural method, have found the rate of major complications of less than 1%.

There are three major data sources on abortion incidence and the characteristics of people who obtain abortions in the U.S: the Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, and most recently, the Society of Family Planning’s (SFP) #WeCount project.

The federal CDC Abortion Surveillance System requests data from the central health agencies of the 50 states, DC, and New York City to document the number and characteristics of women obtaining abortions. Most states collect data from facilities where abortions are provided on the demographic characteristics of patients, gestational age, and type of abortion procedure. Reporting these data to the CDC is voluntary and not all states participate in the surveillance system. Notably, California, Maryland, and New Hampshire have not reported data on abortions to the CDC system for years. CDC publishes available data from the surveillance system annually.

Guttmacher Institute , an independent research and advocacy organization, is another major source of data on abortions in the U.S. Prior to the Dobbs ruling, Guttmacher conducted the Abortion Provider Census (APC) periodically which has provided data on abortion incidence, abortion facilities, and characteristics of abortion patients. Data from this Census are based primarily on questionnaires collected from all known facilities that provide abortion in the country, information obtained from state health departments, and Guttmacher estimates for a small portion of facilities. The most recent APC reports data from 2020.

The CDC and Guttmacher data differ in terms of methods, timeframe, and completeness, but both have shown similar trends in abortion rates over the past decade. One notable difference is that Guttmacher’s study includes continuous reporting from California, D.C., Maryland, and New Hampshire, which explains at least in part the higher number of abortions in their data.

Since the Dobbs ruling, the Guttmacher Institute has established the Monthly Abortion Provision Study to track abortion volume within the formal United States health care system. This ongoing effort collects data on and provides national and state-level estimates on procedural and medication abortions while also tracking the changes in abortion volume since 2020. The Monthly Abortion Provision Study was designed to complement Guttmacher’s APC along with other data collection efforts to allow for quick snapshots of the changing abortion landscape in the United States.

Society of Family Planning’s (SFP) #WeCount is another national reporting effort that measures changes in abortion access following the Dobbs ruling. The project reports on the number of abortions per month by state and includes data on abortions provided through clinics, private practices, hospitals, and virtual-only providers. The report does not include data on self-managed abortions that are performed without clinical supervision. The most recent #WeCount report analyzes data from April 2022 to data from June 2023, marking one full year of abortion data since Dobbs. The effort represents 83% of all providers known to #WeCount who agreed to participate in their research.

This KFF issue brief uses data from the CDC, Guttmacher, and SFP as well as other research organizations.

How has the abortion rate changed over time?

For most of the decade prior to the Dobbs ruling, there was a steady decline in abortion rates nationally, but there was a slight increase in the years just before the ruling.

In their most recent national data, Guttmacher Institute reported 930,160 abortions in 2020 and a rate of 14.4 per 1,000 women. CDC reported 622,108 abortions in 2021 and a rate of 11.6 abortions per 1,000 women (excludes CA, DC, MD, NH). Guttmacher’s study showed an upward trend in abortion from 2017 to 2020 whereas CDC’s report showed an increase in abortions from 2017 to 2021 except for a slight decrease in 2020.

While most attribute the long-term decline in abortion rates to increased use of more effective methods of contraception , several states had reduced access to low- or no-cost contraceptive care as a result of reductions in the Title X network under the Trump Administration, which may have contributed to the slight rise in abortions prior to the Dobbs ruling. Other factors that may have contributed to the increase could include greater coverage under Medicaid that subsequently made abortions more affordable in some states and broader financial support from abortion funds to help individuals pay for the costs of abortion care.

Even prior to the Dobbs ruling, abortion rates varied widely between states.

National averages can mask local and more granular differences. Lower state-level abortion rates do not reflect less need. Some of the variation has been due to the wide differences in state policies, with some states historically placing restrictions on abortion that make access and availability to nearly out of reach and, on the other side, some states enshrining protections in state Constitutions and legislation.

• In 2020, the abortion rate (per 1,000 women ages 15-44) ranged from 0.1 in Missouri to 48.9 in the District of Columbia (DC). Trends also varied between states. While the national rate of abortion increased between 2017 and 2019, some states saw declines, with particularly sharp drops in states where heavy restrictions were put into place.

While the number of abortions in the U.S. dropped immediately following the Dobbs decision, new data show that the number of abortions increased overall one year following the ruling. However, the upswing obscures the declines in abortion care in states with bans.

SFP’s #WeCount estimates there were 2,200 cumulative more abortions in the year following Dobbs (July 2022 to June 2023) compared to the pre- Dobbs period (April 2022 and May 2022). Nationally, the number of abortions varied month-by-month, with the largest decrease observed in November 2022 (73,930 abortions; 8,185 fewer abortions than pre- Dobbs period ) and the largest increase in March 2023 (92,680 abortions; 10,565 more abortions than pre- Dobbs period). The states with the largest cumulative increases in the total number of abortions provided by a clinician during the 12-month period include Illinois, Florida, North Carolina, California, and New Mexico. States with abortion bans experienced the largest cumulative decreases in the number of abortions, including Texas, Georgia, Tennessee, and Louisiana (data varies by month in each state; data not shown).

States without abortion bans experienced an increase of abortions following the Dobbs ruling likely due to a combination of reasons: increased interstate travel for abortion access, expanded in-person and virtual/telehealth capacity to see patients, increased measures to protect and cover abortion care for residents and out-of-state patients, and potentially reduced abortion-related stigma as a result of community mobilization around abortion care.

However, the overall national increase in the number of abortions masks the absence and/or scarcity of abortion care in states with total abortion bans or severe restrictions. States with total bans experienced observed 94,930 fewer clinician-provided abortions a year following the ruling (data not shown). Note, this figure is an underestimate due several state policies that restricted abortion access during the pre- Dobbs period. These estimates do not include abortions that may have been performed through self-managed means.

Most of the information about people who receive abortions comes from data prior to the Dobbs ruling. In 2021, women across a range of age groups, socioeconomic status, and racial and ethnic backgrounds obtained abortions, but the majority were obtained by women who were in their twenties, low-income, and women of color.

• Women in their twenties accounted for more than half (57%) of abortions. Nearly one-third (31%) were among women in their thirties and a small share were among women in their 40s (4%) and teens (8%).
• Seven in ten abortion patients were of women of color. Black women comprised 42% of abortion recipients, White women 30% , Hispanic women 22%, and 7% women of other races/ethnicities.
• Many women who sought abortions have children. More than six in 10 (61%) abortion patients in 2021 had at least one previous birth.

The vast majority (94%) of abortions occur during the first trimester of pregnancy according to data available from before the Dobbs decision.

Before the 2022 ruling in Dobbs, there was a federal constitutional right to abortion before the pregnancy is considered to be viable, that is, can survive outside of a pregnant person’s uterus. Viability is generally considered around 24 weeks of pregnancy. Most abortions, though, occur well before the point of fetal viability.

• Data from 2021 found that more than four in ten (45%) abortions occurred by six weeks of gestation, a third (36%) occurred between seven and nine weeks, and 13% at 10-13 weeks. Just 7% of abortions occurred after the first trimester.
• Prior to the decision in the Dobbs case, almost half of states (22) had enacted laws that ban abortion at a certain gestational age. Most of these limits are in the second trimester, but some are in the first trimester, well before fetal viability. Many of these laws were blocked because they violated the federal standard established by Roe v Wade. Some states have enacted laws banning abortions after fetal cardiac activity can be detected, or around 6 weeks of pregnancy, which is often before a person knows they are pregnant. In addition to banning abortion, states can now establish pre-viability gestational restrictions because the federal standard has been overturned.

Just over half of abortions were provided at clinics that specialize in abortion care in 2020. Others were provided at clinics that offer abortion care in addition to other family planning services.

Guttmacher Institute estimated that 96% of abortions were provided at clinics and just 4% were provided in doctors’ offices or hospitals in 2020. Most clinic-based abortions were provided at clinics that specialize in providing abortion care, but many were provided at clinics that offer a wide range of other sexual and reproductive health services like contraception and STI care. Most abortions are provided by physicians. However, in 19 states and D.C., Advanced Practice Clinicians (APCs) such as Nurse Practitioners and midwives may provide medication abortions. Conversely, 31 states prohibit clinicians other than physicians from providing abortion care.

Even prior to the ruling in Dobbs , access to abortion services was very uneven across the country though. The proliferation of restrictions in many states, particularly in the South, had greatly shrunk the availability of services in some areas. In the wake of overturning Roe v. Wade , these geographic disparities are likely to widen as more states ban abortion services altogether.

Telehealth has grown as a delivery mechanism for abortion services.

While procedural abortions must be provided in a clinical setting, medication abortion can be provided in a clinical setting or via telehealth. Access to medication abortion via telehealth had been limited for many years by a Food and Drug Administration (FDA) restriction that had permitted only certified clinicians to dispense mifepristone in a health care setting. The drug could not be mailed or picked up at a retail pharmacy. However, in December 2021, the FDA permanently revised its policy and no longer requires clinicians to dispense the drug in person. Additionally, in January 2023, the FDA finalized a change that allows retail pharmacies to dispense medication abortion pills to patients with a prescription.

While some states are regulating the use of mifepristone as an abortion method, the Biden Administration has asserted that the FDA has regulatory power over all drugs, including mifepristone. This could result in future legal action as the authority of the state to regulate health care will be pitted against the authority of the federal government to regulate drugs through the FDA will be contested.

• In a telehealth abortion, the patient typically completes an online questionnaire to assess (1) confirmation of pregnancy, (2) gestational age and (3) blood type. If determined eligible by a remote clinician, the patient is mailed the medications. This model does not require an ultrasound for pregnancy dating if the patient has regular periods and is sure of the date of their last menstrual period (in line with  ACOG ’s guidelines for pregnancy dating). If the patient has irregular periods or is unsure how long they have been pregnant, they must obtain an ultrasound to confirm gestational age and rule out an ectopic pregnancy 3 and send in the images for review before receiving their medications. If the patient does not know their blood type or has Rh negative blood, the  provider  may prompt the patient to visit a nearby clinic for an injection to prevent adverse reactions between maternal and fetal blood ( RhoGAM ), The follow-up visit with a clinician can also happen via a telehealth visit.
• However, even in some of the states that have not banned abortion altogether, telehealth may not be available. Many states had established restrictions prior to the Dobbs ruling that limit the use of telehealth abortions by either requiring abortion patients to take the pills at a physical clinic, require ultrasounds for all abortions, set their own policies regarding the dispensing of the medications used for abortion care, or directly ban the use of telehealth for abortion care. As of November 2022, of the 33 states that have not banned abortion, eight had at least one of these restrictions, effectively prohibiting telehealth for medication abortion.
• Medication abortion has emerged as a major legal front in the battle over abortion access across the nation. Multiple cases have been filed in federal courts regarding aspects of the FDA’s regulation of medication abortion as well as the mailing of medications. One notable ongoing case is Alliance for Hippocratic Medicine v. FDA , where the plaintiffs are challenging the FDA’s authority and approval process for mifepristone. The plaintiffs also contend that an 1873 anti-obscenity law, the Comstock Act, prohibits the mailing of any medication used for abortion. In April 2023, a US Supreme Court ruling allowed current FDA rules to remain in effect as the case proceeds through the courts. This means that mifepristone remains available for medication abortion either in a clinic or via telehealth where state law permits.

Data from SFP’s October 2023 #WeCount report show that abortions provided by virtual-only clinics represent approximately 5% of all abortions post- Roe . The number of telehealth abortions increased 72% from a monthly average of 4,045 abortions in April and May 2022 to 6,950 abortions per month in the 12 months post- Dobbs . Nearly all of these abortions occurred in states that permit abortions.

Self-managed abortions are provided without a clinician visit.

Self-managed abortions typically involve obtaining medication abortion pills from an online pharmacy that will send the pills by mail or by purchasing the pills from a pharmacy in another country. This does not typically involve a direct consultation with a clinician either in person or via telehealth.

Research has found that prior to Dobbs , more than one in ten patients who obtained abortions at clinics had considered self-managing their abortions. This is likely to increase going forward since abortion care is not available in many states, and there have already been reports of people ordering pills from online markets outside the U.S. medical system. Tracking information on these online orders can help fill in gaps in abortion count estimates but can also be difficult. Some companies may not share data on purchases, and it would also be unclear whether patients take the abortion medication after receiving it in the mail.

The median costs of abortion services exceed $500.

Obtaining an abortion can be costly. On average, the costs are higher for abortions in the second trimester than in the first trimester. State restrictions can also raise the costs, as people may have to travel if abortions are prohibited or not available in their area. Many people pay for abortion services out of pocket, but some people can obtain assistance from local abortion funds.

• In 2021, the median costs for people paying out of pocket in the first trimester were $568 for a medication abortion and $625 for a procedural abortion. The Federal Reserve estimates that nationally about one-third of people do not have $400 on hand for unexpected expenses. For low-income people, who are more likely to need abortion care, these costs are often unaffordable.
• The costs of abortion are higher in the second trimester compared to the first, with median self-pay of $775. In the second trimester, more intensive procedures may be needed, more are likely to be conducted in a hospital setting (although still a minority), and local options are more limited in many communities that have fewer facilities. This results in additional nonmedical costs for transportation, childcare, lodging, and lost wages. nonmedical costs for transportation, childcare, lodging, and lost wages.
• Abortion funds are independent organizations that help some people pay for the costs of abortion services. Most abortion funds are regional and have connections to clinics in their area. Funds vary, but they typically provide assistance with the costs of medical care, travel, and accommodations if needed. However, they do not reach all people seeking services, and many people are not able to afford the costs of obtaining an abortion because they cannot pay for the abortion itself or cover the costs of travel, lodging or missed work.

Insurance coverage for abortion services is heavily restricted in certain private insurance plans and public programs like Medicaid and Medicare.

Private insurance covers most women of reproductive age, and states have the responsibility to regulate fully insured private plans in their state, whereas the federal government regulates self-funded plans under the Employee Retirement Income Security Act (ERISA). States can choose whether abortion coverage is included or excluded in private plans that are not self-insured.

• Prior to the Dobbs ruling, several states had enacted private plan restrictions and banned abortion coverage from ACA Marketplace plans. Currently, there are 11 states that have policies restricting abortion coverage in private plans and 26 that ban coverage in any Marketplace plans. Since the Dobbs ruling, some of these states have also banned the provision of abortion services altogether.
• A handful of states ( 9 ), however, have enacted laws that require private plans to cover abortion.
• The Medicaid program covers approximately one in five women of reproductive age and four in ten who are low-income. For decades, the Hyde Amendment has banned the use of federal funds for abortion in Medicaid and other public programs unless the pregnancy is a result of rape, incest, or it endangers the woman’s life.
• States have the option to use state-only funds to cover abortions under other circumstances for women on Medicaid, which 16 states do currently. However, more than half (56% ) of women covered by Medicaid live in Hyde states.
• According to a Guttmacher Institute survey of patients in the year prior to the Dobbs ruling, a quarter (26%) of abortion patients in the study used Medicaid to pay for abortion services, 11% used private insurance, and 60% paid out of pocket. People in states with more restrictive abortion policies were less likely to use Medicaid or private insurance and more likely to pay out of pocket compared to people living in less restrictive states.
• Federal law also restricts abortion funding under the Indian Health Service, Medicare, and the Children’s Health Insurance Program. Over the years, language similar to that in the Hyde Amendment has been incorporated into a range of other federal programs that provide or pay for health services to women including: the military’s TRICARE program, federal prisons, the Peace Corps, and the Federal Employees Health Benefits Program.

National polls have consistently found that a majority of the public did not want to see Roe v . Wade overturned and that most people feel that abortion is a personal medical decision. The public also strongly opposes the criminalization of abortion both among people who get abortion and the clinicians who provide abortion services. Nearly three quarters of adults (74%) and 79% of reproductive age women say that obtaining an abortion should be a personal choice rather than regulated by law (data not shown). For example, two-thirds of the public are concerned that bans on abortion may lead to unnecessary health problems for people experiencing pregnancy complications.

Additional KFF resources:

Abortion in the US Dashboard

Access and Coverage of Abortion Services

Issue Brief: Abortion at SCOTUS: Dobbs v. Jackson Women’s Health

Issue Brief: State Actions to Protect and Expand Access to Abortion Services

Policy Watch: A Year After Dobbs: Policies Restricting Access to Abortion in States Even Where It’s Not Banned

Policy Watch: Employer Coverage of Travel Costs for Out-of-State Abortion

Issue Brief: Exclusion of Abortion Coverage from Employer-Sponsored Health Plans

Interactive: How State Policies Shape Access to Abortion Coverage

Medication Abortion

Issue Brief: Legal Challenges to the FDA Approval of Medication Abortion Pills

Infographic: The Availability and Use of Medication Abortion Care

Fact Sheet: The Availability and Use of Medication Abortion

Issue Brief: The Intersection of State and Federal Policies on Access to Medication Abortion Via Telehealth

Public Opinion on Abortion

Web Event: Americans’ Knowledge and Attitudes About Abortion Access and The Pending Supreme Court Ruling

KFF Health Tracking Poll: Early 2023 Update On Public Awareness On Abortion and Emergency Contraception

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As the Supreme Court considers Roe v. Wade, a look at how abortion became legal

Nina Totenberg

The future of abortion, always a contentious issue, is up at the Supreme Court on Dec. 1. Arguments are planned challenging Roe v. Wade and Planned Parenthood v. Casey , the court's major decisions over the last half-century that guarantee a woman's right to an abortion nationwide. J. Scott Applewhite/AP hide caption

The future of abortion, always a contentious issue, is up at the Supreme Court on Dec. 1. Arguments are planned challenging Roe v. Wade and Planned Parenthood v. Casey , the court's major decisions over the last half-century that guarantee a woman's right to an abortion nationwide.

For nearly a half-century, abortion has been a constitutional right in the United States. But this week, the U.S. Supreme Court hears arguments in a Mississippi case that directly challenges Roe v. Wade and subsequent decisions.

Those rulings consistently declared that a woman has a constitutional right to terminate a pregnancy in the first two trimesters of pregnancy when a fetus is unable to survive outside the womb. But with that abortion right now in doubt, it's worth looking back at its history.

Abortion did not become illegal in most states until the mid to late 1800s. But by the 1960s, abortion, like childbirth, had become a safe procedure when performed by a doctor, and women were entering the workforce in ever larger numbers.

Still, being pregnant out of wedlock was seen as scandalous, and women increasingly sought out abortions, even though they were illegal. What's more, to be pregnant often meant that women's educations were stunted, as were their chances for getting a good job. Because of these phenomena, illegal abortion began to skyrocket and became a public health problem. Estimates of numbers each year ranged from 200,000 to over a million, a range that was so wide precisely because illegal procedures often went undocumented.

At the time, young women could see the perils for themselves. Anyone who lived in a college dormitory back then might well have seen one or more women carried out of the dorm hemorrhaging from a botched illegal abortion.

George Frampton clerked for Justice Harry Blackmun the year that his boss authored Roe v. Wade , and he remembers that until Roe , "those abortions had to be obtained undercover if you had a sympathetic doctor" and you were "wealthy enough." But most abortions were illegal and mainly took place "in backrooms by abortion quacks" using "crude tools" and "no hygiene."

By the early to mid-1960s, Frampton notes, thousands of women in large cities were arriving at hospitals, bleeding and often maimed.

One woman, in an interview with NPR, recalled "the excruciatingly painful [illegal] procedure," describing it as "the equivalent of having a hot poker stuck up your uterus and scraping the walls." She remembered that the attendant had to "hold her down on the table."

The result, says Frampton, was that by the mid-1960s, a reform movement had begun, aimed at decriminalizing abortion and treating it more like other medical procedures. Driving the reform movement were doctors, who were concerned about the effect that illegal abortions were having on women's health. Soon, the American Law Institute — a highly respected group of lawyers, judges and scholars — published a model abortion reform law supported by major medical groups, including the American Medical Association.

Many states then began to loosen their abortion restrictions. Four states legalized abortion, and a dozen or so adopted some form of the model law, which permitted abortion in cases of rape, incest and fetal abnormality, as well as to save the life or health of the mother.

By the early 1970s, when nearly half the states had adopted reform laws, there was a small backlash. Still, as Frampton observes, "it wasn't a big political or ideological issue at all."

In fact, the justices in 1973 were mainly establishment conservatives. Six were Republican appointees, including the court's only Catholic. And five were generally conservative, as defined at the time, including four appointed by President Richard Nixon. Ultimately, the court voted 7-to-2 that abortion is a private matter to be decided by a woman during the first two trimesters of her pregnancy.

That framework has remained in place ever since, with the court repeatedly upholding that standard. In 1992, it reiterated the framework yet again, though it said that states could enact some limited restrictions — for example, a 24-hour waiting period — as long as the restrictions didn't impose an "undue burden" on a woman's right to abortion.

Frampton says that the court established the viability framework because of the medical consensus that a fetus could not survive outside the womb until the last trimester. He explains that "the justices thought that this was going to dispose of the constitutional issues about abortion forever."

Although many had thought that fetal viability might change substantially, that has not happened. But in the years that followed, the backlash to the court's abortion decisions grew louder and louder, until the Republican Party, which had earlier supported Roe , officially abandoned it in 1984.

Looking at the politicization of the Supreme Court nomination and confirmation process in recent years, one can't help but wonder whether Roe played a part in that polarization. What does Frampton think?

"I'm afraid," he concedes, "that analysis is absolutely spot on. I think they [the justices] saw it as a very important landmark constitutional decision but had no idea that it would become so politicized and so much a subject of turmoil."

Just why is abortion such a controversial issue in the United States but not in so many other countries where abortion is now legal? Florida State University law professor Mary Ziegler, author of Abortion and the Law in America , points out that in many countries, the abortion question has been resolved through democratic means — in some countries by national referendum, in others by parliamentary votes and, in some, by the courts. In most of those countries, however, abortions, with some exceptions, must be performed earlier, by week 12, 15 or 18.

But — and it is a big but — in most of those countries, unlike in the U.S., national health insurance guarantees easy access to abortions.

Lastly, Ziegler observes, "there are a lot of people in the United States who have a stake in our polarized politics. ... It's a way to raise money. It's a way to get people out to the polls."

And it's striking, she adds, how little our politics resemble what most people say they want. Public opinion polls consistently show that large majorities of Americans support the right to abortion in all or most cases. A poll conducted last May by the Pew Research Center found 6 in 10 Americans say that abortion should be legal in all or most cases. And a Washington Post -ABC poll conducted last month found that Americans by a roughly 2-to-1 margin say the Supreme Court should uphold its landmark Roe v. Wade decision.

But an NPR poll conducted in 2019 shows just how complex — and even contradictory — opinions are about abortion. The poll found that 77% of Americans support Roe . But that figure dropped to 34% in the second trimester. Other polls had significantly higher support for second trimester abortions. A Reuters poll pegged the figure at 47% in 2021. And an Associated Press poll found that 49% of poll respondents supported legal abortion for anyone who wants one "for any reason," while 50% believed that this should not be the case. And 86% said they would support abortion at any time during a pregnancy to protect the life or health of the woman.

All this would seem to suggest that there is overwhelming support for abortion rights earlier in pregnancy, but less support later in pregnancy, and overwhelming support for abortions at any time to protect the life or, importantly, the health of the mother. That, however, is not where the abortion debate is in the 25 or so states that have enacted very strict anti-abortion laws, including outright bans, in hopes that the Supreme Court will overturn Roe .

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Is Abortion Sacred?

By Jia Tolentino

Twenty years ago, when I was thirteen, I wrote an entry in my journal about abortion, which began, “I have this huge thing weighing on me.” That morning, in Bible class, which I’d attended every day since the first grade at an evangelical school, in Houston, my teacher had led us in an exercise called Agree/Disagree. He presented us with moral propositions, and we stood up and physically chose sides. “Abortion is always wrong,” he offered, and there was no disagreement. We all walked to the wall that meant “agree.”

Then I raised my hand and, according to my journal, said, “I think it is always morally wrong and absolutely murder, but if a woman is raped, I respect her right to get an abortion.” Also, I said, if a woman knew the child would face a terrible life, the child might be better off. “Dead?” the teacher asked. My classmates said I needed to go to the other side, and I did. “I felt guilty and guilty and guilty,” I wrote in my journal. “I didn’t feel like a Christian when I was on that side of the room. I felt terrible, actually. . . . But I still have that thought that if a woman was raped, she has her right. But that’s so strange—she has a right to kill what would one day be her child? That issue is irresolved in my mind and it will eat at me until I sort it out.”

I had always thought of abortion as it had been taught to me in school: it was a sin that irresponsible women committed to cover up another sin, having sex in a non-Christian manner. The moral universe was a stark battle of virtue and depravity, in which the only meaningful question about any possible action was whether or not it would be sanctioned in the eyes of God. Men were sinful, and the goodness of women was the essential bulwark against the corruption of the world. There was suffering built into this framework, but suffering was noble; justice would prevail, in the end, because God always provided for the faithful. It was these last tenets, prosperity-gospel principles that neatly erase the material causes of suffering in our history and our social policies—not only regarding abortion but so much else—which toppled for me first. By the time I went to college, I understood that I was pro-choice.

America is, in many ways, a deeply religious country—the only wealthy Western democracy in which more than half of the population claims to pray every day. (In Europe, the figure is twenty-two per cent.) Although seven out of ten American women who get abortions identify as Christian, the fight to make the procedure illegal is an almost entirely Christian phenomenon. Two-thirds of the national population and nearly ninety per cent of Congress affirm a tradition in which a teen-age girl continuing an unplanned pregnancy allowed for the salvation of the world, in which a corrupt government leader who demanded a Massacre of the Innocents almost killed the baby Jesus and damned us all in the process, and in which the Son of God entered the world as what the godless dare to call a “clump of cells.”

For centuries, most Christians believed that human personhood began months into the long course of pregnancy. It was only in the twentieth century that a dogmatic narrative, in which every pregnancy is an iteration of the same static story of creation, began both to shape American public policy and to occlude the reality of pregnancy as volatile and ambiguous—as a process in which creation and destruction run in tandem. This newer narrative helped to erase an instinctive, long-held understanding that pregnancy does not begin with the presence of a child, and only sometimes ends with one. Even within the course of the same pregnancy, a person and the fetus she carries can shift between the roles of lover and beloved, host and parasite, vessel and divinity, victim and murderer; each body is capable of extinguishing the other, although one cannot survive alone. There is no human relationship more complex, more morally unstable than this.

The idea that a fetus is not just a full human but a superior and kinglike one—a being whose survival is so paramount that another person can be legally compelled to accept harm, ruin, or death to insure it—is a recent invention. For most of history, women ended unwanted pregnancies as they needed to, taking herbal or plant-derived preparations on their own or with the help of female healers and midwives, who presided over all forms of treatment and care connected with pregnancy. They were likely enough to think that they were simply restoring their menstruation, treating a blockage of blood. Pregnancy was not confirmed until “quickening,” the point at which the pregnant person could feel fetal movement, a measurement that relied on her testimony. Then as now, there was often nothing that distinguished the result of an abortion—the body expelling fetal tissue—from a miscarriage.

Ancient records of abortifacient medicine are plentiful; ancient attempts to regulate abortion are rare. What regulations existed reflect concern with women’s behavior and marital propriety, not with fetal life. The Code of the Assura, from the eleventh century B.C.E., mandated death for married women who got abortions without consulting their husbands; when husbands beat their wives hard enough to make them miscarry, the punishment was a fine. The first known Roman prohibition on abortion dates to the second century and prescribes exile for a woman who ends her pregnancy, because “it might appear scandalous that she should be able to deny her husband of children without being punished.” Likewise, the early Christian Church opposed abortion not as an act of murder but because of its association with sexual sin. (The Bible offers ambiguous guidance on the question of when life begins: Genesis 2:7 arguably implies that it begins at first breath; Exodus 21:22-24 suggests that, in Old Testament law, a fetus was not considered a person; Jeremiah 1:5 describes God’s hand in creation even “before I formed you in the womb.” Nowhere does the Bible clearly and directly address abortion.) Augustine, in the fourth century, favored the idea that God endowed a fetus with a soul only after its body was formed—a point that Augustine placed, in line with Aristotelian tradition, somewhere between forty and eighty days into its development. “There cannot yet be a live soul in a body that lacks sensation when it is not formed in flesh, and so not yet endowed with sense,” he wrote. This was more or less the Church’s official position; it was affirmed eight centuries later by Thomas Aquinas.

In the early modern era, European attitudes began to change. The Black Death had dramatically lowered the continent’s population, and dealt a blow to most forms of economic activity; the Reformation had weakened the Church’s position as the essential intermediary between the layman and God. The social scientist Silvia Federici has argued, in her book “ Caliban and the Witch ,” that church and state waged deliberate campaigns to force women to give birth, in service of the emerging capitalist economy. “Starting in the mid-16th century, while Portuguese ships were returning from Africa with their first human cargoes, all the European governments began to impose the severest penalties against contraception, abortion, and infanticide,” Federici notes. Midwives and “wise women” were prosecuted for witchcraft, a catchall crime for deviancy from procreative sex. For the first time, male doctors began to control labor and delivery, and, Federici writes, “in the case of a medical emergency” they “prioritized the life of the fetus over that of the mother.” She goes on: “While in the Middle Ages women had been able to use various forms of contraceptives, and had exercised an undisputed control over the birthing process, from now on their wombs became public territory, controlled by men and the state.”

Martin Luther and John Calvin, the most influential figures of the Reformation, did not address abortion at any length. But Catholic doctrine started to shift, albeit slowly. In 1588, Pope Sixtus V labelled both abortion and contraception as homicide. This pronouncement was reversed three years later, by Pope Gregory XIV, who declared that abortion was only homicide if it took place after ensoulment, which he identified as occurring around twenty-four weeks into a pregnancy. Still, theologians continued to push the idea of embryonic humanity; in 1621, the physician Paolo Zacchia, an adviser to the Vatican, proclaimed that the soul was present from the moment of conception. Still, it was not until 1869 that Pope Pius IX affirmed this doctrine, proclaiming abortion at any point in pregnancy to be a sin punishable by excommunication.

When I found out I was pregnant, at the beginning of 2020, I wondered how the experience would change my understanding of life, of fetal personhood, of the morality of reproduction. It’s been years since I traded the echo chamber of evangelical Texas for the echo chamber of progressive Brooklyn, but I can still sometimes feel the old world view flickering, a photographic negative underneath my vision. I have come to believe that abortion should be universally accessible, regulated only by medical codes and ethics, and not by the criminal-justice system. Still, in passing moments, I can imagine upholding the idea that our sole task when it comes to protecting life is to end the practice of abortion; I can imagine that seeming profoundly moral and unbelievably urgent. I would only need to think of the fetus in total isolation—to imagine that it were not formed and contained by another body, and that body not formed and contained by a family, or a society, or a world.

As happens to many women, though, I became, if possible, more militant about the right to an abortion in the process of pregnancy, childbirth, and caregiving. It wasn’t just the difficult things that had this effect—the paralyzing back spasms, the ragged desperation of sleeplessness, the thundering doom that pervaded every cell in my body when I weaned my child. And it wasn’t just my newly visceral understanding of the anguish embedded in the facts of American family life. (A third of parents in one of the richest countries in the world struggle to afford diapers ; in the first few months of the pandemic , as Jeff Bezos’s net worth rose by forty-eight billion dollars, sixteen per cent of households with children did not have enough to eat.) What multiplied my commitment to abortion were the beautiful things about motherhood: in particular, the way I felt able to love my baby fully and singularly because I had chosen to give my body and life over to her. I had not been forced by law to make another person with my flesh, or to tear that flesh open to bring her into the world; I hadn’t been driven by need to give that new person away to a stranger in the hope that she would never go to bed hungry. I had been able to choose this permanent rearrangement of my existence. That volition felt sacred.

Abortion is often talked about as a grave act that requires justification, but bringing a new life into the world felt, to me, like the decision that more clearly risked being a moral mistake. The debate about abortion in America is “rooted in the largely unacknowledged premise that continuing a pregnancy is a prima facie moral good,” the pro-choice Presbyterian minister Rebecca Todd Peters writes . But childbearing, Peters notes, is a morally weighted act, one that takes place in a world of limited and unequally distributed resources. Many people who get abortions—the majority of whom are poor women who already have children—understand this perfectly well. “We ought to take the decision to continue a pregnancy far more seriously than we do,” Peters writes.

I gave birth in the middle of a pandemic that previewed a future of cross-species viral transmission exacerbated by global warming, and during a summer when ten million acres on the West Coast burned . I knew that my child would not only live in this degrading world but contribute to that degradation. (“Every year, the average American emits enough carbon to melt ten thousand tons of ice in the Antarctic ice sheets,” David Wallace-Wells writes in his book “ The Uninhabitable Earth .”) Just before COVID arrived, the science writer Meehan Crist published an essay in the London Review of Books titled “Is it OK to have a child?” (The title alludes to a question that Alexandria Ocasio-Cortez once asked in a live stream, on Instagram.) Crist details the environmental damage that we are doing, and the costs for the planet and for us and for those who will come after. Then she turns the question on its head. The idea of choosing whether or not to have a child, she writes, is predicated on a fantasy of control that “quickly begins to dissipate when we acknowledge that the conditions for human flourishing are distributed so unevenly, and that, in an age of ecological catastrophe, we face a range of possible futures in which these conditions no longer reliably exist.”

In late 2021, as Omicron brought New York to another COVID peak, a Gen Z boy in a hoodie uploaded a TikTok , captioned “yall better delete them baby names out ya notes its 60 degrees in december.” By then, my baby had become a toddler. Every night, as I set her in the crib, she chirped good night to the elephants, koalas, and tigers on the wall, and I tried not to think about extinction. My decision to have her risked, or guaranteed, additional human suffering; it opened up new chances for joy and meaning. There is unknowability in every reproductive choice.

As the German historian Barbara Duden writes in her book “ Disembodying Women ,” the early Christians believed that both the bodies that created life and the world that sustained it were proof of the “continual creative activity of God.” Women and nature were aligned, in this view, as the material sources of God’s plan. “The word nature is derived from nascitura , which means ‘birthing,’ and nature is imagined and felt to be like a pregnant womb, a matrix, a mother,” Duden writes. But, in recent decades, she notes, the natural world has begun to show its irreparable damage. The fetus has been left as a singular totem of life and divinity, to be protected, no matter the costs, even if everything else might fall.

The scholar Katie Gentile argues that, in times of cultural crisis and upheaval, the fetus functions as a “site of projected and displaced anxieties,” a “fantasy of wholeness in the face of overwhelming anxiety and an inability to have faith in a progressive, better future.” The more degraded actual life becomes on earth, the more fervently conservatives will fight to protect potential life in utero. We are locked into the destruction of the world that birthed all of us; we turn our attention, now, to the worlds—the wombs—we think we can still control.

By the time that the Catholic Church decided that abortion at any point, for any reason, was a sin, scientists had identified the biological mechanism behind human reproduction, in which a fetus develops from an embryo that develops from a zygote, the single-celled organism created by the union of egg and sperm. With this discovery, in the mid-nineteenth century, women lost the most crucial point of authority over the stories of their pregnancies. Other people would be the ones to tell us, from then on, when life began.

At the time, abortion was largely unregulated in the United States, a country founded and largely populated by Protestants. But American physicians, through the then newly formed American Medical Association, mounted a campaign to criminalize it, led by a gynecologist named Horatio Storer, who once described the typical abortion patient as a “wretch whose account with the Almighty is heaviest with guilt.” (Storer was raised Unitarian but later converted to Catholicism.) The scholars Paul Saurette and Kelly Gordon have argued that these doctors, whose profession was not as widely respected as it would later become, used abortion “as a wedge issue,” one that helped them portray their work “as morally and professionally superior to the practice of midwifery.” By 1910, abortion was illegal in every state, with exceptions only to save the life of “the mother.” (The wording of such provisions referred to all pregnant people as mothers, whether or not they had children, thus quietly inserting a presumption of fetal personhood.) A series of acts known as the Comstock laws had rendered contraception, abortifacient medicine, and information about reproductive control widely inaccessible, by criminalizing their distribution via the U.S. Postal Service. People still sought abortions, of course: in the early years of the Great Depression, there were as many as seven hundred thousand abortions annually. These underground procedures were dangerous; several thousand women died from abortions every year.

This is when the contemporary movements for and against the right to abortion took shape. Those who favored legal abortion did not, in these years, emphasize “choice,” Daniel K. Williams notes in his book “ Defenders of the Unborn .” They emphasized protecting the health of women, protecting doctors, and preventing the births of unwanted children. Anti-abortion activists, meanwhile, argued, as their successors do, that they were defending human life and human rights. The horrors of the Second World War gave the movement a lasting analogy: “Logic would lead us from abortion to the gas chamber,” a Catholic clergyman wrote, in October, 1962.

Ultrasound imaging, invented in the nineteen-fifties, completed the transformation of pregnancy into a story that, by default, was narrated to women by other people—doctors, politicians, activists. In 1965, Life magazine published a photo essay by Lennart Nilsson called “ Drama of Life Before Birth ,” and put the image of a fetus at eighteen weeks on its cover. The photos produced an indelible, deceptive image of the fetus as an isolated being—a “spaceman,” as Nilsson wrote, floating in a void, entirely independent from the person whose body creates it. They became totems of the anti-abortion movement; Life had not disclosed that all but one had been taken of aborted fetuses, and that Nilsson had lit and posed their bodies to give the impression that they were alive.

In 1967, Colorado became the first state to allow abortion for reasons other than rape, incest, or medical emergency. A group of Protestant ministers and Jewish rabbis began operating an abortion-referral service led by the pastor of Judson Memorial Church, in Manhattan; the resulting network of pro-choice clerics eventually spanned the country, and referred an estimated four hundred and fifty thousand women to safe abortions. The evangelical magazine Christianity Today held a symposium of prominent theologians, in 1968, which resulted in a striking statement: “Whether or not the performance of an induced abortion is sinful we are not agreed, but about the necessity and permissibility for it under certain circumstances we are in accord.” Meanwhile, the priest James McHugh became the director of the National Right to Life Committee, and equated fetuses to the other vulnerable people whom faithful Christians were commanded to protect: the old, the sick, the poor. As states began to liberalize their abortion laws, the anti-abortion movement attracted followers—many of them antiwar, pro-welfare Catholics—using the language of civil rights, and adopted the label “pro-life.”

W. A. Criswell, a Dallas pastor who served as president of the Southern Baptist Convention from 1968 to 1970, said, shortly after the Supreme Court issued its decision in Roe v. Wade , that “it was only after a child was born and had life separate from his mother that it became an individual person,” and that “it has always, therefore, seemed to me that what is best for the mother and the future should be allowed.” But the Court’s decision accelerated a political and theological transformation that was already under way: by 1979, Criswell, like the S.B.C., had endorsed a hard-line anti-abortion stance. Evangelical leadership, represented by such groups as Jerry Falwell’s Moral Majority , joined with Catholics to oppose the secularization of popular culture, becoming firmly conservative—and a powerful force in Republican politics. Bible verses that express the idea of divine creation, such as Psalm 139 (“For you created my innermost being; you knit me together in my mother’s womb,” in the New International Version’s translation), became policy explanations for prohibiting abortion.

In 1984, scientists used ultrasound to detect fetal cardiac activity at around six weeks’ gestation—a discovery that has been termed a “fetal heartbeat” by the anti-abortion movement, though a six-week-old fetus hasn’t yet formed a heart, and the electrical pulses are coming from cell clusters that can be replicated in a petri dish. At six weeks, in fact, medical associations still call the fetus an embryo; as I found out in 2020, you generally can’t even schedule a doctor’s visit to confirm your condition until you’re eight weeks along.

So many things that now shape the cultural experience of pregnancy in America accept and reinforce the terms of the anti-abortion movement, often with the implicit goal of making pregnant women feel special, or encouraging them to buy things. “Your baby,” every app and article whispered to me sweetly, wrongly, many months before I intuited personhood in the being inside me, or felt that the life I was forming had moved out of a liminal realm.

I tried to learn from that liminality. Hope was always predicated on uncertainty; there would be no guarantees of safety in this or any other part of life. Pregnancy did not feel like soft blankets and stuffed bunnies—it felt cosmic and elemental, like volcanic rocks grinding, or a wild plant straining toward the sun. It was violent even as I loved it. “Even with the help of modern medicine, pregnancy still kills about 800 women every day worldwide,” the evolutionary biologist Suzanne Sadedin points out in an essay titled “War in the womb.” Many of the genes that activate during embryonic development also activate when a body has been invaded by cancer, Sadedin notes; in ectopic pregnancies, which are unviable by definition and make up one to two per cent of all pregnancies, embryos become implanted in the fallopian tube rather than the uterus, and “tunnel ferociously toward the richest nutrient source they can find.” The result, Sadedin writes, “is often a bloodbath.”

The Book of Genesis tells us that the pain of childbearing is part of the punishment women have inherited from Eve. The other part is subjugation to men: “Your desire will be for your husband and he will rule over you,” God tells Eve. Tertullian, a second-century theologian, told women, “You are the devil’s gateway: you are the unsealer of the (forbidden) tree: you are the first deserter of the divine law: you are she who persuaded him whom the devil was not valiant enough to attack.” The idea that guilt inheres in female identity persists in anti-abortion logic: anything a woman, or a girl, does with her body can justify the punishment of undesired pregnancy, including simply existing.

If I had become pregnant when I was a thirteen-year-old Texan , I would have believed that abortion was wrong, but I am sure that I would have got an abortion. For one thing, my Christian school did not allow students to be pregnant. I was aware of this, and had, even then, a faint sense that the people around me grasped, in some way, the necessity of abortion—that, even if they believed that abortion meant taking a life, they understood that it could preserve a life, too.

One need not reject the idea that life in the womb exists or that fetal life has meaning in order to favor the right to abortion; one must simply allow that everything, not just abortion, has a moral dimension, and that each pregnancy occurs in such an intricate web of systemic and individual circumstances that only the person who is pregnant could hope to evaluate the situation and make a moral decision among the options at hand. A recent survey found that one-third of Americans believe life begins at conception but also that abortion should be legal. This is the position overwhelmingly held by American Buddhists, whose religious tradition casts abortion as the taking of a human life and regards all forms of life as sacred but also warns adherents against absolutism and urges them to consider the complexity of decreasing suffering, compelling them toward compassion and respect.

There is a Buddhist ritual practiced primarily in Japan, where it is called mizuko kuyo : a ceremony of mourning for miscarriages, stillbirths, and aborted fetuses. The ritual is possibly ersatz; critics say that it fosters and preys upon women’s feelings of guilt. But the scholar William LaFleur argues, in his book “ Liquid Life ,” that it is rooted in a medieval Japanese understanding of the way the unseen world interfaces with the world of humans—in which being born and dying are both “processes rather than fixed points.” An infant was believed to have entered the human world from the realm of the gods, and move clockwise around a wheel as she grew older, eventually passing back into the spirit realm on the other side. But some infants were mizuko , or water babies: floating in fluids, ontologically unstable. These were the babies who were never born. A mizuko , whether miscarried or aborted—and the two words were similar: kaeru , to go back, and kaesu , to cause to go back—slipped back, counterclockwise, across the border to the realm of the gods.

There is a loss, I think, entailed in abortion—as there is in miscarriage, whether it occurs at eight or twelve or twenty-nine weeks. I locate this loss in the irreducible complexity of life itself, in the terrible violence and magnificence of reproduction, in the death that shimmered at the edges of my consciousness in the shattering moment that my daughter was born. This understanding might be rooted in my religious upbringing—I am sure that it is. But I wonder, now, how I would square this: that fetuses were the most precious lives in existence, and that God, in His vision, already chooses to end a quarter of them. The fact that a quarter of women, regardless of their beliefs, also decide to end pregnancies at some point in their lifetimes: are they not acting in accordance with God’s plan for them, too? ♦

More on Abortion and Roe v. Wade

In the post-Roe era, letting pregnant patients get sicker— by design .

The study that debunks most anti-abortion arguments .

Of course the Constitution has nothing to say about abortion .

How the real Jane Roe shaped the abortion wars.

Black feminists defined abortion rights as a matter of equality, not just “choice.”

Recent data suggest that taking abortion pills at home is as safe as going to a clinic. 

When abortion is criminalized, women make desperate choices .

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By Sarah Stillman

By Adam Gopnik

By Rachel Aviv

By Benjamin Wallace-Wells

Princeton Legal Journal

The First Amendment and the Abortion Rights Debate

Sofia Cipriano

4 Prin.L.J.F. 12

Following Dobbs v. Jackson ’s (2022) reversal of Roe v. Wade (1973) — and the subsequent revocation of federal abortion protection — activists and scholars have begun to reconsider how to best ground abortion rights in the Constitution. In the past year, numerous Jewish rights groups have attempted to overturn state abortion bans by arguing that abortion rights are protected by various state constitutions’ free exercise clauses — and, by extension, the First Amendment of the U.S. Constitution. While reframing the abortion rights debate as a question of religious freedom is undoubtedly strategic, the Free Exercise Clause is not the only place to locate abortion rights: the Establishment Clause also warrants further investigation. 

Roe anchored abortion rights in the right to privacy — an unenumerated right with a long history of legal recognition. In various cases spanning the past two centuries, t he Supreme Court located the right to privacy in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments . Roe classified abortion as a fundamental right protected by strict scrutiny, meaning that states could only regulate abortion in the face of a “compelling government interest” and must narrowly tailor legislation to that end. As such, Roe ’s trimester framework prevented states from placing burdens on abortion access in the first few months of pregnancy. After the fetus crosses the viability line — the point at which the fetus can survive outside the womb  — states could pass laws regulating abortion, as the Court found that   “the potentiality of human life”  constitutes a “compelling” interest. Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) later replaced strict scrutiny with the weaker “undue burden” standard, giving states greater leeway to restrict abortion access. Dobbs v. Jackson overturned both Roe and Casey , leaving abortion regulations up to individual states. 

While Roe constituted an essential step forward in terms of abortion rights, weaknesses in its argumentation made it more susceptible to attacks by skeptics of substantive due process. Roe argues that the unenumerated right to abortion is implied by the unenumerated right to privacy — a chain of logic which twice removes abortion rights from the Constitution’s language. Moreover, Roe’s trimester framework was unclear and flawed from the beginning, lacking substantial scientific rationale. As medicine becomes more and more advanced, the arbitrariness of the viability line has grown increasingly apparent.  

As abortion rights supporters have looked for alternative constitutional justifications for abortion rights, the First Amendment has become increasingly more visible. Certain religious groups — particularly Jewish groups — have argued that they have a right to abortion care. In Generation to Generation Inc v. Florida , a religious rights group argued that Florida’s abortion ban (HB 5) constituted a violation of the Florida State Constitution: “In Jewish law, abortion is required if necessary to protect the health, mental or physical well-being of the woman, or for many other reasons not permitted under the Act. As such, the Act prohibits Jewish women from practicing their faith free of government intrusion and thus violates their privacy rights and religious freedom.” Similar cases have arisen in Indiana and Texas. Absent constitutional protection of abortion rights, the Christian religious majorities in many states may unjustly impose their moral and ethical code on other groups, implying an unconstitutional religious hierarchy. 

Cases like Generation to Generation Inc v. Florida may also trigger heightened scrutiny status in higher courts; The Religious Freedom Restoration Act (1993) places strict scrutiny on cases which “burden any aspect of religious observance or practice.”

But framing the issue as one of Free Exercise does not interact with major objections to abortion rights. Anti-abortion advocates contend that abortion is tantamount to murder. An anti-abortion advocate may argue that just as religious rituals involving human sacrifice are illegal, so abortion ought to be illegal. Anti-abortion advocates may be able to argue that abortion bans hold up against strict scrutiny since “preserving potential life” constitutes a “compelling interest.”

The question of when life begins—which is fundamentally a moral and religious question—is both essential to the abortion debate and often ignored by left-leaning activists. For select Christian advocacy groups (as well as other anti-abortion groups) who believe that life begins at conception, abortion bans are a deeply moral issue. Abortion bans which operate under the logic that abortion is murder essentially legislate a definition of when life begins, which is problematic from a First Amendment perspective; the Establishment Clause of the First Amendment prevents the government from intervening in religious debates. While numerous legal thinkers have associated the abortion debate with the First Amendment, this argument has not been fully litigated. As an amicus brief filed in Dobbs by the Freedom From Religion Foundation, Center for Inquiry, and American Atheists  points out, anti-abortion rhetoric is explicitly religious: “There is hardly a secular veil to the religious intent and positions of individuals, churches, and state actors in their attempts to limit access to abortion.” Justice Stevens located a similar issue with anti-abortion rhetoric in his concurring opinion in Webster v. Reproductive Health Services (1989) , stating: “I am persuaded that the absence of any secular purpose for the legislative declarations that life begins at conception and that conception occurs at fertilization makes the relevant portion of the preamble invalid under the Establishment Clause of the First Amendment to the Federal Constitution.” Judges who justify their judicial decisions on abortion using similar rhetoric blur the line between church and state. 

Framing the abortion debate around religious freedom would thus address the two main categories of arguments made by anti-abortion activists: arguments centered around issues with substantive due process and moral objections to abortion. 

Conservatives may maintain, however, that legalizing abortion on the federal level is an Establishment Clause violation to begin with, since the government would essentially be imposing a federal position on abortion. Many anti-abortion advocates favor leaving abortion rights up to individual states. However, in the absence of recognized federal, constitutional protection of abortion rights, states will ban abortion. Protecting religious freedom of the individual is of the utmost importance  — the United States government must actively intervene in order to uphold the line between church and state. Protecting abortion rights would allow everyone in the United States to act in accordance with their own moral and religious perspectives on abortion. 

Reframing the abortion rights debate as a question of religious freedom is the most viable path forward. Anchoring abortion rights in the Establishment Clause would ensure Americans have the right to maintain their own personal and religious beliefs regarding the question of when life begins. In the short term, however, litigants could take advantage of Establishment Clauses in state constitutions. Yet, given the swing of the Court towards expanding religious freedom protections at the time of writing, Free Exercise arguments may prove better at securing citizens a right to an abortion. 

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There’s a Better Way to Debate Abortion

Caution and epistemic humility can guide our approach.

If Justice Samuel Alito’s draft majority opinion in Dobbs v. Jackson Women’s Health Organization becomes law, we will enter a post– Roe v. Wade world in which the laws governing abortion will be legislatively decided in 50 states.

In the short term, at least, the abortion debate will become even more inflamed than it has been. Overturning Roe , after all, would be a profound change not just in the law but in many people’s lives, shattering the assumption of millions of Americans that they have a constitutional right to an abortion.

This doesn’t mean Roe was correct. For the reasons Alito lays out, I believe that Roe was a terribly misguided decision, and that a wiser course would have been for the issue of abortion to have been given a democratic outlet, allowing even the losers “the satisfaction of a fair hearing and an honest fight,” in the words of the late Justice Antonin Scalia. Instead, for nearly half a century, Roe has been the law of the land. But even those who would welcome its undoing should acknowledge that its reversal could convulse the nation.

From the December 2019 issue: The dishonesty of the abortion debate

If we are going to debate abortion in every state, given how fractured and angry America is today, we need caution and epistemic humility to guide our approach.

We can start by acknowledging the inescapable ambiguities in this staggeringly complicated moral question. No matter one’s position on abortion, each of us should recognize that those who hold views different from our own have some valid points, and that the positions we embrace raise complicated issues. That realization alone should lead us to engage in this debate with a little more tolerance and a bit less certitude.

Many of those on the pro-life side exhibit a gap between the rhetoric they employ and the conclusions they actually seem to draw. In the 1990s, I had an exchange, via fax, with a pro-life thinker. During our dialogue, I pressed him on what he believed, morally speaking , should be the legal penalty for a woman who has an abortion and a doctor who performs one.

My point was a simple one: If he believed, as he claimed, that an abortion even moments after conception is the killing of an innocent child—that the fetus, from the instant of conception, is a human being deserving of all the moral and political rights granted to your neighbor next door—then the act ought to be treated, if not as murder, at least as manslaughter. Surely, given what my interlocutor considered to be the gravity of the offense, fining the doctor and taking no action against the mother would be morally incongruent. He was understandably uncomfortable with this line of questioning, unwilling to go to the places his premises led. When it comes to abortion, few people are.

Humane pro-life advocates respond that while an abortion is the taking of a human life, the woman having the abortion has been misled by our degraded culture into denying the humanity of the child. She is a victim of misinformation; she can’t be held accountable for what she doesn’t know. I’m not unsympathetic to this argument, but I think it ultimately falls short. In other contexts, insisting that people who committed atrocities because they truly believed the people against whom they were committing atrocities were less than human should be let off the hook doesn’t carry the day. I’m struggling to understand why it would in this context.

There are other complicating matters. For example, about half of all fertilized eggs are aborted spontaneously —that is, result in miscarriage—usually before the woman knows she is pregnant. Focus on the Family, an influential Christian ministry, is emphatic : “Human life begins at fertilization.” Does this mean that when a fertilized egg is spontaneously aborted, it is comparable—biologically, morally, ethically, or in any other way—to when a 2-year-old child dies? If not, why not? There’s also the matter of those who are pro-life and contend that abortion is the killing of an innocent human being but allow for exceptions in the case of rape or incest. That is an understandable impulse but I don’t think it’s a logically sustainable one.

The pro-choice side, for its part, seldom focuses on late-term abortions. Let’s grant that late-term abortions are very rare. But the question remains: Is there any point during gestation when pro-choice advocates would say “slow down” or “stop”—and if so, on what grounds? Or do they believe, in principle, that aborting a child up to the point of delivery is a defensible and justifiable act; that an abortion procedure is, ethically speaking, the same as removing an appendix? If not, are those who are pro-choice willing to say, as do most Americans, that the procedure gets more ethically problematic the further along in a pregnancy?

Read: When a right becomes a privilege

Plenty of people who consider themselves pro-choice have over the years put on their refrigerator door sonograms of the baby they are expecting. That tells us something. So does biology. The human embryo is a human organism, with the genetic makeup of a human being. “The argument, in which thoughtful people differ, is about the moral significance and hence the proper legal status of life in its early stages,” as the columnist George Will put it.

These are not “gotcha questions”; they are ones I have struggled with for as long as I’ve thought through where I stand on abortion, and I’ve tried to remain open to corrections in my thinking. I’m not comfortable with those who are unwilling to grant any concessions to the other side or acknowledge difficulties inherent in their own position. But I’m not comfortable with my own position, either—thinking about abortion taking place on a continuum, and troubled by abortions, particularly later in pregnancy, as the child develops.

The question I can’t answer is where the moral inflection point is, when the fetus starts to have claims of its own, including the right to life. Does it depend on fetal development? If so, what aspect of fetal development? Brain waves? Feeling pain? Dreaming? The development of the spine? Viability outside the womb? Something else? Any line I might draw seems to me entirely arbitrary and capricious.

Because of that, I consider myself pro-life, but with caveats. My inability to identify a clear demarcation point—when a fetus becomes a person—argues for erring on the side of protecting the unborn. But it’s a prudential judgment, hardly a certain one.

At the same time, even if one believes that the moral needle ought to lean in the direction of protecting the unborn from abortion, that doesn’t mean one should be indifferent to the enormous burden on the woman who is carrying the child and seeks an abortion, including women who discover that their unborn child has severe birth defects. Nor does it mean that all of us who are disturbed by abortion believe it is the equivalent of killing a child after birth. In this respect, my view is similar to that of some Jewish authorities , who hold that until delivery, a fetus is considered a part of the mother’s body, although it does possess certain characteristics of a person and has value. But an early-term abortion is not equivalent to killing a young child. (Many of those who hold this position base their views in part on Exodus 21, in which a miscarriage that results from men fighting and pushing a pregnant woman is punished by a fine, but the person responsible for the miscarriage is not tried for murder.)

“There is not the slightest recognition on either side that abortion might be at the limits of our empirical and moral knowledge,” the columnist Charles Krauthammer wrote in 1985. “The problem starts with an awesome mystery: the transformation of two soulless cells into a living human being. That leads to an insoluble empirical question: How and exactly when does that occur? On that, in turn, hangs the moral issue: What are the claims of the entity undergoing that transformation?”

That strikes me as right; with abortion, we’re dealing with an awesome mystery and insoluble empirical questions. Which means that rather than hurling invective at one another and caricaturing those with whom we disagree, we should try to understand their views, acknowledge our limitations, and even show a touch of grace and empathy. In this nation, riven and pulsating with hate, that’s not the direction the debate is most likely to take. But that doesn’t excuse us from trying.

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• Rom J Morphol Embryol
• v.61(1); Jan-Mar 2020

A research on abortion: ethics, legislation and socio-medical outcomes. Case study: Romania

Andreea mihaela niţă.

1 Faculty of Social Sciences, University of Craiova, Romania

Cristina Ilie Goga

This article presents a research study on abortion from a theoretical and empirical point of view. The theoretical part is based on the method of social documents analysis, and presents a complex perspective on abortion, highlighting items of medical, ethical, moral, religious, social, economic and legal elements. The empirical part presents the results of a sociological survey, based on the opinion survey method through the application of the enquiry technique, conducted in Romania, on a sample of 1260 women. The purpose of the survey is to identify Romanians perception on the decision to voluntary interrupt pregnancy, and to determine the core reasons in carrying out an abortion.

The analysis of abortion by means of medical and social documents

Abortion means a pregnancy interruption “before the fetus is viable” [ 1 ] or “before the fetus is able to live independently in the extrauterine environment, usually before the 20 th week of pregnancy” [ 2 ]. “Clinical miscarriage is both a common and distressing complication of early pregnancy with many etiological factors like genetic factors, immune factors, infection factors but also psychological factors” [ 3 ]. Induced abortion is a practice found in all countries, but the decision to interrupt the pregnancy involves a multitude of aspects of medical, ethical, moral, religious, social, economic, and legal order.

In a more simplistic manner, Winston Nagan has classified opinions which have as central element “abortion”, in two major categories: the opinion that the priority element is represented by fetus and his entitlement to life and the second opinion, which focuses around women’s rights [ 4 ].

From the medical point of view, since ancient times there have been four moments, generally accepted, which determine the embryo’s life: ( i ) conception; ( ii ) period of formation; ( iii ) detection moment of fetal movement; ( iv ) time of birth [ 5 ]. Contemporary medicine found the following moments in the evolution of intrauterine fetal: “ 1 . At 18 days of pregnancy, the fetal heartbeat can be perceived and it starts running the circulatory system; 2 . At 5 weeks, they become more clear: the nose, cheeks and fingers of the fetus; 3 . At 6 weeks, they start to function: the nervous system, stomach, kidneys and liver of the fetus, and its skeleton is clearly distinguished; 4 . At 7 weeks (50 days), brain waves are felt. The fetus has all the internal and external organs definitively outlined. 5 . At 10 weeks (70 days), the unborn child has all the features clearly defined as a child after birth (9 months); 6 . At 12 weeks (92 days, 3 months), the fetus has all organs definitely shaped, managing to move, lacking only the breath” [ 6 ]. Even if most of the laws that allow abortion consider the period up to 12 weeks acceptable for such an intervention, according to the above-mentioned steps, there can be defined different moments, which can represent the beginning of life. Nowadays, “abortion is one of the most common gynecological experiences and perhaps the majority of women will undergo an abortion in their lifetimes” [ 7 ]. “Safe abortions carry few health risks, but « every year, close to 20 million women risk their lives and health by undergoing unsafe abortions » and 25% will face a complication with permanent consequences” [ 8 , 9 ].

From the ethical point of view, most of the times, the interruption of pregnancy is on the border between woman’s right over her own body and the child’s (fetus) entitlement to life. Judith Jarvis Thomson supported the supremacy of woman’s right over her own body as a premise of freedom, arguing that we cannot force a person to bear in her womb and give birth to an unwanted child, if for different circumstances, she does not want to do this [ 10 ]. To support his position, the author uses an imaginary experiment, that of a violinist to which we are connected for nine months, in order to save his life. However, Thomson debates the problem of the differentiation between the fetus and the human being, by carrying out a debate on the timing which makes this difference (period of conception, 10 weeks of pregnancy, etc.) and highlighting that for people who support abortion, the fetus is not an alive human being [ 10 ].

Carol Gilligan noted that women undergo a true “moral dilemma”, a “moral conflict” with regards to voluntary interruption of pregnancy, such a decision often takes into account the human relationships, the possibility of not hurting the others, the responsibility towards others [ 11 ]. Gilligan applied qualitative interviews to a number of 29 women from different social classes, which were put in a position to decide whether or not to commit abortion. The interview focused on the woman’s choice, on alternative options, on individuals and existing conflicts. The conclusion was that the central moral issue was the conflict between the self (the pregnant woman) and others who may be hurt as a result of the potential pregnancy [ 12 ].

From the religious point of view, abortion is unacceptable for all religions and a small number of abortions can be seen in deeply religious societies and families. Christianity considers the beginning of human life from conception, and abortion is considered to be a form of homicide [ 13 ]. For Christians, “at the same time, abortion is giving up their faith”, riot and murder, which means that by an abortion we attack Jesus Christ himself and God [ 14 ]. Islam does not approve abortion, relying on the sacral life belief as specified in Chapter 6, Verse 151 of the Koran: “Do not kill a soul which Allah has made sacred (inviolable)” [ 15 ]. Buddhism considers abortion as a negative act, but nevertheless supports for medical reasons [ 16 ]. Judaism disapproves abortion, Tanah considering it to be a mortal sin. Hinduism considers abortion as a crime and also the greatest sin [ 17 ].

From the socio-economic point of view, the decision to carry out an abortion is many times determined by the relations within the social, family or financial frame. Moreover, studies have been conducted, which have linked the legalization of abortions and the decrease of the crime rate: “legalized abortion may lead to reduced crime either through reductions in cohort sizes or through lower per capita offending rates for affected cohorts” [ 18 ].

Legal regulation on abortion establishes conditions of the abortion in every state. In Europe and America, only in the XVIIth century abortion was incriminated and was considered an insignificant misdemeanor or a felony, depending on when was happening. Due to the large number of illegal abortions and deaths, two centuries later, many states have changed legislation within the meaning of legalizing voluntary interruption of pregnancy [ 6 ]. In contemporary society, international organizations like the United Nations or the European Union consider sexual and reproductive rights as fundamental rights [ 19 , 20 ], and promotes the acceptance of abortion as part of those rights. However, not all states have developed permissive legislation in the field of voluntary interruption of pregnancy.

Currently, at national level were established four categories of legislation on pregnancy interruption area:

( i )  Prohibitive legislations , ones that do not allow abortion, most often outlining exceptions in abortion in cases where the pregnant woman’s life is endangered. In some countries, there is a prohibition of abortion in all circumstances, however, resorting to an abortion in the case of an imminent threat to the mother’s life. Same regulation is also found in some countries where abortion is allowed in cases like rape, incest, fetal problems, etc. In this category are 66 states, with 25.5% of world population [ 21 ].

( ii )  Restrictive legislation that allow abortion in cases of health preservation . Loosely, the term “health” should be interpreted according to the World Health Organization (WHO) definition as: “health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [ 22 ]. This type of legislation is adopted in 59 states populated by 13.8% of the world population [ 21 ].

( iii )  Legislation allowing abortion on a socio-economic motivation . This category includes items such as the woman’s age or ability to care for a child, fetal problems, cases of rape or incest, etc. In this category are 13 countries, where we have 21.3% of the world population [ 21 ].

( iv )  Legislation which do not impose restrictions on abortion . In the case of this legislation, abortion is permitted for any reason up to 12 weeks of pregnancy, with some exceptions (Romania – 14 weeks, Slovenia – 10 weeks, Sweden – 18 weeks), the interruption of pregnancy after this period has some restrictions. This type of legislation is adopted in 61 countries with 39.5% of the world population [21].

The Centre for Reproductive Rights has carried out from 1998 a map of the world’s states, based on the legislation typology of each country (Figure ​ (Figure1 1 ).

The analysis of states according to the legislation regarding abortion. Source: Centre for Reproductive Rights. The World’s Abortion Laws, 2018 [ 23 ]

An unplanned pregnancy, socio-economic context or various medical problems [ 24 ], lead many times to the decision of interrupting pregnancy, regardless the legislative restrictions. In the study “Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008” issued in 2011 by the WHO , it was determined that within the states with restrictive legislation on abortion, we may also encounter a large number of illegal abortions. The illegal abortions may also be resulting in an increased risk of woman’s health and life considering that most of the times inappropriate techniques are being used, the hygienic conditions are precarious and the medical treatments are incorrectly administered [ 25 ]. Although abortions done according to medical guidelines carry very low risk of complications, 1–3 unsafe abortions contribute substantially to maternal morbidity and death worldwide [ 26 ].

WHO has estimated for the year 2008, the fact that worldwide women between the ages of 15 and 44 years carried out 21.6 million “unsafe” abortions, which involved a high degree of risk and were distributed as follows: 0.4 million in the developed regions and a number of 21.2 million in the states in course of development [ 25 ].

Case study: Romania

Legal perspective on abortion

In Romania, abortion was brought under regulation by the first Criminal Code of the United Principalities, from 1864.

The Criminal Code from 1864, provided the abortion infringement in Article 246, on which was regulated as follows: “Any person, who, using means such as food, drinks, pills or any other means, which will consciously help a pregnant woman to commit abortion, will be punished to a minimum reclusion (three years).

The woman who by herself shall use the means of abortion, or would accept to use means of abortion which were shown or given to her for this purpose, will be punished with imprisonment from six months to two years, if the result would be an abortion. In a situation where abortion was carried out on an illegitimate baby by his mother, the punishment will be imprisonment from six months to one year.

Doctors, surgeons, health officers, pharmacists (apothecary) and midwives who will indicate, will give or will facilitate these means, shall be punished with reclusion of at least four years, if the abortion took place. If abortion will cause the death of the mother, the punishment will be much austere of four years” (Art. 246) [ 27 ].

The Criminal Code from 1864, reissued in 1912, amended in part the Article 246 for the purposes of eliminating the abortion of an illegitimate baby case. Furthermore, it was no longer specified the minimum of four years of reclusion, in case of abortion carried out with the help of the medical staff, leaving the punishment to the discretion of the Court (Art. 246) [ 28 ].

The Criminal Code from 1936 regulated abortion in the Articles 482–485. Abortion was defined as an interruption of the normal course of pregnancy, being punished as follows:

“ 1 . When the crime is committed without the consent of the pregnant woman, the punishment was reformatory imprisonment from 2 to 5 years. If it caused the pregnant woman any health injury or a serious infirmity, the punishment was reformatory imprisonment from 3 to 6 years, and if it has caused her death, reformatory imprisonment from 7 to 10 years;

2 . When the crime was committed by the unmarried pregnant woman by herself, or when she agreed that someone else should provoke the abortion, the punishment is reformatory imprisonment from 3 to 6 months, and if the woman is married, the punishment is reformatory imprisonment from 6 months to one year. Same penalty applies also to the person who commits the crime with the woman’s consent. If abortion was committed for the purpose of obtaining a benefit, the punishment increases with another 2 years of reformatory imprisonment.

If it caused the pregnant woman any health injuries or a severe disablement, the punishment will be reformatory imprisonment from one to 3 years, and if it has caused her death, the punishment is reformatory imprisonment from 3 to 5 years” (Art. 482) [ 29 ].

The criminal legislation from 1936 specifies that it is not considered as an abortion the interruption from the normal course of pregnancy, if it was carried out by a doctor “when woman’s life was in imminent danger or when the pregnancy aggravates a woman’s disease, putting her life in danger, which could not be removed by other means and it is obvious that the intervention wasn’t performed with another purpose than that of saving the woman’s life” and “when one of the parents has reached a permanent alienation and it is certain that the child will bear serious mental flaws” (Art. 484, Par. 1 and Par. 2) [ 29 ].

In the event of an imminent danger, the doctor was obliged to notify prosecutor’s office in writing, within 48 hours after the intervention, on the performance of the abortion. “In the other cases, the doctor was able to intervene only with the authorization of the prosecutor’s office, given on the basis of a medical certificate from hospital or a notice given as a result of a consultation between the doctor who will intervene and at least a professor doctor in the disease which caused the intervention. General’s Office Prosecutor, in all cases provided by this Article, shall be obliged to maintain the confidentiality of all communications or authorizations, up to the intercession of any possible complaints” (Art. 484) [ 29 ].

The legislation of 1936 provided a reformatory injunction from one to three years for the abortions committed by doctors, sanitary agents, pharmacists, apothecary or midwives (Art. 485) [ 29 ].

Abortion on demand has been legalized for the first time in Romania in the year 1957 by the Decree No. 463, under the condition that it had to be carried out in a hospital and to be carried out in the first quarter of the pregnancy [ 30 ]. In the year 1966, demographic policy of Romania has dramatically changed by introducing the Decree No. 770 from September 29 th , which prohibited abortion. Thus, the voluntary interruption of pregnancy became a crime, with certain exceptions, namely: endangering the mother’s life, physical or mental serious disability; serious or heritable illness, mother’s age over 45 years, if the pregnancy was a result of rape or incest or if the woman gave birth to at least four children who were still in her care (Art. 2) [ 31 ].

In the Criminal Code from 1968, the abortion crime was governed by Articles 185–188.

The Article 185, “the illegal induced abortion”, stipulated that “the interruption of pregnancy by any means, outside the conditions permitted by law, with the consent of the pregnant woman will be punished with imprisonment from one to 3 years”. The act referred to above, without the prior consent from the pregnant woman, was punished with prison from two to five years. If the abortion carried out with the consent of the pregnant woman caused any serious body injury, the punishment was imprisonment from two to five years, and when it caused the death of the woman, the prison sentence was from five to 10 years. When abortion was carried out without the prior consent of the woman, if it caused her a serious physical injury, the punishment was imprisonment from three to six years, and if it caused the woman’s death, the punishment was imprisonment from seven to 12 years (Art. 185) [ 32 ].

“When abortion was carried out in order to obtain a material benefit, the maximum punishment was increased by two years, and if the abortion was made by a doctor, in addition to the prison punishment could also be applied the prohibition to no longer practice the profession of doctor”.

Article 186, “abortion caused by the woman”, stipulated that “the interruption of the pregnancy course, committed by the pregnant woman, was punished with imprisonment from 6 months to 2 years”, quoting the fact that by the same punishment was also sanctioned “the pregnant woman’s act to consent in interrupting the pregnancy course made out by another person” (Art. 186) [ 26 ].

The Regulations of the Criminal Code in 1968, also provided the crime of “ownership of tools or materials that can cause abortion”, the conditions of this holding being met when these types of instruments were held outside the hospital’s specialized institutions, the infringement shall be punished with imprisonment from three months to one year (Art. 187) [ 32 ].

Furthermore, the doctors who performed an abortion in the event of extreme urgency, without prior legal authorization and if they did not announce the competent authority within the legal deadline, they were punished by imprisonment from one month to three months (Art. 188) [ 32 ].

In the year 1985, it has been issued the Decree No. 411 of December 26 th , by which the conditions imposed by the Decree No. 770 of 1966 have been hardened, meaning that it has increased the number of children, that a woman could have in order to request an abortion, from four to five children [ 33 ].

The Articles 185–188 of the Criminal Code and the Decree No. 770/1966 on the interruption of the pregnancy course have been abrogated by Decree-Law No. 1 from December 26 th , 1989, which was published in the Official Gazette No. 4 of December 27 th , 1989 (Par. 8 and Par. 12) [ 34 ].

The Criminal Code from 1968, reissued in 1997, maintained Article 185 about “the illegal induced abortion”, but drastically modified. Thus, in this case of the Criminal Code, we identify abortion as “the interruption of pregnancy course, by any means, committed in any of the following circumstances: ( a ) outside medical institutions or authorized medical practices for this purpose; ( b ) by a person who does not have the capacity of specialized doctor; ( c ) if age pregnancy has exceeded 14 weeks”, the punishment laid down was the imprisonment from 6 months to 3 years” (Art. 185, Par. 1) [ 35 ]. For the abortion committed without the prior consent of the pregnant woman, the punishment consisted in strict prison conditions from two to seven years and with the prohibition of certain rights (Art. 185, Par. 2) [ 35 ].

For the situation of causing serious physical injury to the pregnant woman, the punishment was strict prison from three to 10 years and the removal of certain rights, and if it had as a result the death of the pregnant woman, the punishment was strict prison from five to 15 years and the prohibition of certain rights (Art. 185, Par. 3) [ 35 ].

The attempt was punished for the crimes specified in the various cases of abortion.

Consideration should also be given in the Criminal Code reissued in 1997 for not punishing the interruption of the pregnancy course carried out by the doctor, if this interruption “was necessary to save the life, health or the physical integrity of the pregnant woman from a grave and imminent danger and that it could not be removed otherwise; in the case of a over fourteen weeks pregnancy, when the interruption of the pregnancy course should take place from therapeutic reasons” and even in a situation of a woman’s lack of consent, when it has not been given the opportunity to express her will, and abortion “was imposed by therapeutic reasons” (Art. 185, Par. 4) [ 35 ].

Criminal Code from 2004 covers abortion in Article 190, defined in the same way as in the prior Criminal Code, with the difference that it affects the limits of the punishment. So, in the event of pregnancy interruption, in accordance with the conditions specified in Paragraph 1, “the penalty provided was prison time from 6 months to one year or days-fine” (Art. 190, Par. 1) [ 36 ].

Nowadays, in Romania, abortion is governed by the criminal law of 2009, which entered into force in 2014, by the section called “aggression against an unborn child”. It should be specified that current criminal law does not punish the woman responsible for carrying out abortion, but only the person who is involved in carrying out the abortion. There is no punishment for the pregnant woman who injures her fetus during pregnancy.

In Article 201, we can find the details on the pregnancy interruption infringement. Thus, the pregnancy interruption can be performed in one of the following circumstances: “outside of medical institutions or medical practices authorized for this purpose; by a person who does not have the capacity of specialist doctor in Obstetrics and Gynecology and the right of free medical practice in this specialty; if gestational age has exceeded 14 weeks”, the punishment is the imprisonment for six months to three years, or fine and the prohibition to exercise certain rights (Art. 201, Par. 1) [ 37 ].

Article 201, Paragraph 2 specifies that “the interruption of the pregnancy committed under any circumstances, without the prior consent of the pregnant woman, can be punished with imprisonment from 2 to 7 years and with the prohibition to exercise some rights” (Art. 201, Par. 1) [ 37 ].

If by facts referred to above (Art. 201, Par. 1 and Par. 2) [ 37 ] “it has caused the pregnant woman’s physical injury, the punishment is the imprisonment from 3 to 10 years and the prohibition to exercise some rights, and if it has had as a result the pregnant woman’s death, the punishment is the imprisonment from 6 to 12 years and the prohibition to exercise some rights” (Art. 201, Par. 3) [ 37 ]. When the facts have been committed by a doctor, “in addition to the imprisonment punishment, it will also be applied the prohibition to exercise the profession of doctor (Art. 201, Par. 4) [ 37 ].

Criminal legislation specifies that “the interruption of pregnancy does not constitute an infringement with the purpose of a treatment carried out by a specialist doctor in Obstetrics and Gynecology, until the pregnancy age of twenty-four weeks is reached, or the subsequent pregnancy interruption, for the purpose of treatment, is in the interests of the mother or the fetus” (Art. 201, Par. 6) [ 37 ]. However, it can all be found in the phrases “therapeutic purposes” and “the interest of the mother and of the unborn child”, which predisposes the text of law to an interpretation, finally the doctors are the only ones in the position to decide what should be done in such cases, assuming direct responsibility [ 38 ].

Article 202 of the Criminal Code defines the crime of harming an unborn child, pointing out the punishments for the various types of injuries that can occur during pregnancy or in the childbirth period and which can be caused by the mother or by the persons who assist the birth, with the specification that the mother who harms her fetus during pregnancy is not punished and does not constitute an infringement if the injury has been committed during pregnancy or during childbirth period if the facts have been “committed by a doctor or by an authorized person to assist the birth or to follow the pregnancy, if they have been committed in the course of the medical act, complying with the specific provisions of his profession and have been made in the interest of the pregnant woman or fetus, as a result of the exercise of an inherent risk in the medical act” (Art. 202, Par. 6) [ 37 ].

The fact situation in Romania

During the period 1948–1955, called “the small baby boom” [ 39 ], Romania registered an average fertility rate of 3.23 children for a woman. Between 1955 and 1962, the fertility rate has been less than three children for a woman, and in 1962, fertility has reached an average of two children for a woman. This phenomenon occurred because of the Decree No. 463/1957 on liberalization of abortion. After the liberalization from 1957, the abortion rate has increased from 220 abortions per 100 born-alive children in the year 1960, to 400 abortions per 100 born-alive children, in the year 1965 [ 40 ].

The application of provisions of Decrees No. 770 of 1966 and No. 411 of 1985 has led to an increase of the birth rate in the first three years (an average of 3.7 children in 1967, and 3.6 children in 1968), followed by a regression until 1989, when it was recorded an average of 2.2 children, but also a maternal death rate caused by illegal abortions, raising up to 85 deaths of 100 000 births in the year of 1965, and 170 deaths in 1983. It was estimated that more than 80% of maternal deaths between 1980–1989 was caused by legal constraints [ 30 ].

After the Romanian Revolution in December 1989 and after the communism fall, with the abrogation of Articles 185–188 of the Criminal Code and of the Decree No. 770/1966, by the Decree of Law No. 1 of December 26 th , 1989, abortion has become legal in Romania and so, in the following years, it has reached the highest rate of abortion in Europe. Subsequently, the number of abortion has dropped gradually, with increasing use of birth control [ 41 ].

Statistical data issued by the Ministry of Health and by the National Institute of Statistics (INS) in Romania show corresponding figures to a legally carried out abortion. The abortion number is much higher, if it would take into account the number of illegal abortion, especially those carried out before 1989, and those carried out in private clinics, after the year 1990. Summing the declared abortions in the period 1958–2014, it is to be noted the number of them, 22 037 747 exceeds the current Romanian population. A detailed statistical research of abortion rate, in terms of years we have exposed in Table ​ Table1 1 .

The number of abortions declared in Romania in the period 1958–2016

Source: Pro Vita Association (Bucharest, Romania), National Institute of Statistics (INS – Romania), EUROSTAT [ 42 , 43 , 44 ]

Data issued by the United Nations International Children’s Emergency Fund (UNICEF) in June 2016, for the period 1989–2014, in matters of reproductive behavior, indicates a fertility rate for Romania with a continuous decrease, in proportion to the decrease of the number of births, but also a lower number of abortion rate reported to 100 deliveries (Table ​ (Table2 2 ).

Reproductive behavior in Romania in 1989–2014

Source: United Nations International Children’s Emergency Fund (UNICEF), Transformative Monitoring for Enhanced Equity (TransMonEE) Data. Country profiles: Romania, 1989–2015 [ 45 ].

By analyzing data issued for the period 1990–2015 by the International Organization of Health , UNICEF , United Nations Fund for Population Activity (UNFPA), The World Bank and the United Nations Population Division, it is noticed that maternal mortality rate has currently dropped as compared with 1990 (Table ​ (Table3 3 ).

Maternal mortality estimation in Romania in 1990–2015

Source: World Health Organization (WHO), Global Health Observatory Data. Maternal mortality country profiles: Romania, 2015 [ 46 ].

Opinion survey: women’s opinion on abortion

Argument for choosing the research theme

Although the problematic on abortion in Romania has been extensively investigated and debated, it has not been carried out in an ample sociological study, covering Romanian women’s perception on abortion. We have assumed making a study at national level, in order to identify the opinion on abortion, on the motivation to carry out an abortion, and to identify the correlation between religious convictions and the attitude toward abortion.

Examining the literature field of study

In the conceptual register of the research, we have highlighted items, such as the specialized literature, legislation, statistical documents.

Formulation of hypotheses and objectives

The first hypothesis was that Romanian women accept abortion, having an open attitude towards this act. Thus, the first objective of the research was to identify Romanian women’s attitude towards abortion.

The second hypothesis, from which we started, was that high religious beliefs generate a lower tolerance towards abortion. Thus, the second objective of our research has been to identify the correlation between the religious beliefs and the attitude towards abortion.

The third hypothesis of the survey was that, the main motivation in carrying out an abortion is the fact that a woman does not want a baby, and the main motivation for keeping the pregnancy is that the person wants a baby. In this context, the third objective of the research was to identify main motivation in carrying out an abortion and in maintaining a pregnancy.

Another hypothesis was that modern Romanian legislation on the abortion is considered fair. Based on this hypothesis, we have assumed the fourth objective, which is to identify the degree of satisfaction towards the current regulatory provisions governing the abortion.

Research methodology

The research method is that of a sociological survey by the application of the questionnaire technique. We used the sampling by age and residence looking at representative numbers of population from more developed as well as underdeveloped areas.

Determination of the sample to be studied

Because abortion is a typical women’s experience, we have chosen to make the quantitative research only among women. We have constructed the sample by selecting a number of 1260 women between the ages of 15 and 44 years (the most frequently encountered age among women who give birth to a child). We also used the quota sampling techniques, taking into account the following variables: age group and the residence (urban/rural), so that the persons included in the sample could retain characteristic of the general population.

By the sample of 1260 women, we have made a percentage of investigation of 0.03% of the total population.

The Questionnaires number applied was distributed as follows (Table ​ (Table4 4 ).

The sampling rates based on the age, and the region of residence

Source: Sample built, based on the population data issued by the National Institute of Statistics (INS – Romania) based on population census conducted in 2011 [ 47 ].

Data collection

Data collection was carried out by questionnaires administered by 32 field operators between May 1 st –May 31 st , 2018.

The analysis of the research results

In the next section, we will present the main results of the quantitative research carried out at national level.

Almost three-quarters of women included in the sample agree with carrying out an abortion in certain circumstances (70%) and only 24% have chosen to support the answer “ No, never ”. In modern contemporary society, abortion is the first solution of women for which a pregnancy is not desired. Even if advanced medical techniques are a lot safer, an abortion still carries a health risk. However, 6% of respondents agree with carrying out abortion regardless of circumstances (Table ​ (Table5 5 ).

Opinion on the possibility of carrying out an abortion

Although abortions carried out after 14 weeks are illegal, except for medical reasons, more than half of the surveyed women stated they would agree with abortion in certain circumstances. At the opposite pole, 31% have mentioned they would never agree on abortions after 14 weeks. Five percent were totally accepting the idea of abortion made to a pregnancy that has exceeded 14 weeks (Table ​ (Table6 6 ).

Opinion on the possibility of carrying out an abortion after the period of 14 weeks of pregnancy

For 53% of respondents, abortion is considered a crime as well as the right of a women. On the other hand, 28% of the women considered abortion as a crime and 16% associate abortion with a woman’s right (Table ​ (Table7 7 ).

Opinion on abortion: at the border between crime and a woman’s right

Opinions on what women abort at the time of the voluntary pregnancy interruption are split in two: 59% consider that it depends on the time of the abortion, and more specifically on the pregnancy development stage, 24% consider that regardless of the period in which it is carried out, women abort a child, and 14% have opted a fetus (Table ​ (Table8 8 ).

Abortion of a child vs. abortion of a fetus

Among respondents who consider that women abort a child or a fetus related to the time of abortion, 37.5% have considered that the difference between a baby and a fetus appears after 14 weeks of pregnancy (the period legally accepted for abortion). Thirty-three percent of them have mentioned that the distinction should be performed at the first few heartbeats; 18.1% think it is about when the child has all the features definitively outlined and can move by himself; 2.8% consider that the difference appears when the first encephalopathy traces are being felt and the child has formed all internal and external organs. A percentage of 1.7% of respondents consider that this difference occurs at the beginning of the central nervous system, and 1.4% when the unborn child has all the features that we can clearly see to a newborn child (Table ​ (Table9 9 ).

The opinion on the moment that makes the difference between a fetus and a child

We noticed that highly religious people make a clear association between abortion and crime. They also consider that at the time of pregnancy interruption it is aborted a child and not a fetus. However, unexpectedly, we noticed that 27% of the women, who declare themselves to be very religious, have also stated that they see abortion as a crime but also as a woman’s right. Thirty-one percent of the women, who also claimed profound religious beliefs, consider that abortion may be associated with the abortion of a child but also of a fetus, this depending on the time of abortion (Tables ​ (Tables10 10 and ​ and11 11 ).

The correlation between the level of religious beliefs and the perspective on abortion seen as a crime or a right

The correlation between the level of religious beliefs and the perspective on abortion procedure conducted on a fetus or a child

More than half of the respondents have opted for the main reason for abortion the appearance of medical problems to the child. Baby’s health represents the main concern of future mothers, and of each parent, and the birth of a child with serious health issues, is a factor which frightens any future parent, being many times, at least theoretically, one good reason for opting for abortion. At the opposite side, 12% of respondents would not choose abortion under any circumstances. Other reasons for which women would opt for an abortion are: if the woman would have a medical problem (22%) or would not want the child (10%) (Table ​ (Table12 12 ).

Potential reasons for carrying out an abortion

Most of the women want to give birth to a child, 56% of the respondents, representing also the reason that would determine them to keep the child. Morality (26%), faith (10%) or legal restrictions (4%), are the three other reasons for which women would not interrupt a pregnancy. Only 2% of the respondents have mentioned other reasons such as health or age.

A percentage of 23% of the surveyed people said that they have done an abortion so far, and 77% did not opted for a surgical intervention either because there was no need, or because they have kept the pregnancy (Table ​ (Table13 13 ).

Rate of abortion among women in the sample

Most respondents, 87% specified that they have carried out an abortion during the first 14 weeks – legally accepted limit for abortion: 43.6% have made abortion in the first four weeks, 39.1% between weeks 4–8, and 4.3% between weeks 8–14. It should be noted that 8.7% could not appreciate the pregnancy period in which they carried out abortion, by opting to answer with the option “ I don’t know ”, and a percentage of 4.3% refused to answer to this question.

Performing an abortion is based on many reasons, but the fact that the women have not wanted a child is the main reason mentioned by 47.8% of people surveyed, who have done minimum an abortion so far. Among the reasons for the interruption of pregnancy, it is also included: women with medical problems (13.3%), not the right time to be a mother (10.7%), age motivation (8.7%), due to medical problems of the child (4.3%), the lack of money (4.3%), family pressure (4.3%), partner/spouse did not wanted. A percentage of 3.3% of women had different reasons for abortion, as follows: age difference too large between children, career, marital status, etc. Asked later whether they regretted the abortion, a rate of 69.6% of women who said they had at least one abortion regret it (34.8% opted for “ Yes ”, and 34.8% said “ Yes, partially ”). 26.1% of surveyed women do not regret the choice to interrupted the pregnancy, and 4.3% chose to not answer this question. We noted that, for women who have already experienced abortion, the causes were more diverse than the grounds on which the previous question was asked: “What are the reasons that determined you to have an abortion?” (Table ​ (Table14 14 ).

The reasons that led the women in the sample to have an abortion

The majority of the respondents (37.5%) considered that “nervous depression” is the main consequence of abortion, followed by “insomnia and nightmares” (24.6%), “disorders in alimentation” and “affective disorders” (each for 7.7% of respondents), “deterioration of interpersonal relationships” and “the feeling of guilt”(for 6.3% of the respondents), “sexual disorders” and “panic attacks” (for 6.3% of the respondents) (Table ​ (Table15 15 ).

Opinion on the consequences of abortion

Over half of the respondents believe that abortion should be legal in certain circumstances, as currently provided by law, 39% say it should be always legal, and only 6% opted for the illegal option (Table ​ (Table16 16 ).

Opinion on the legal regulation of abortion

Although the current legislation does not punish pregnant women who interrupt pregnancy or intentionally injured their fetus, survey results indicate that 61% of women surveyed believe that the national law should punish the woman and only 28% agree with the current legislation (Table ​ (Table17 17 ).

Opinion on the possibility of punishing the woman who interrupts the course of pregnancy or injures the fetus

For the majority of the respondents (40.6%), the penalty provided by the current legislation, the imprisonment between six months and three years or a fine and deprivation of certain rights for the illegal abortion is considered fair, for a percentage of 39.6% the punishment is too small for 9.5% of the respondents is too high. Imprisonment between two and seven years and deprivation of certain rights for an abortion performed without the consent of the pregnant woman is considered too small for 65% of interviewees. Fourteen percent of them think it is fair and only 19% of respondents consider that Romanian legislation is too severe with people who commit such an act considering the punishment as too much. The imprisonment from three to 10 years and deprivation of certain rights for the facts described above, if an injury was caused to the woman, is considered to be too small for more than half of those included in the survey, 64% and almost 22% for nearly a quarter of them. Only 9% of the respondents mentioned that this legislative measure is too severe for such actions (Table ​ (Table18 18 ).

Opinion on the regulation of abortion of the Romanian Criminal Code (Art. 201)

Conclusions

After analyzing the results of the sociological research regarding abortion undertaken at national level, we see that 76% of the Romanian women accept abortion, indicating that the majority accepts only certain circumstances (a certain period after conception, for medical reasons, etc.). A percentage of 64% of the respondents indicated that they accept the idea of abortion after 14 weeks of pregnancy (for solid reasons or regardless the reason). This study shows that over 50% of Romanian women see abortion as a right of women but also a woman’s crime and believe that in the moment of interruption of a pregnancy, a fetus is aborted. Mostly, the association of abortion with crime and with the idea that a child is aborted is frequently found within very religious people. The main motivation for Romanian women in taking the decision not to perform an abortion is that they would want the child, and the main reason to perform an abortion is the child’s medical problems. However, it is noted that, in real situations, in which women have already done at least one abortion, most women resort to abortion because they did not want the child towards the hypothetical situation in which women felt that the main reason of abortion is a medical problem. Regarding the satisfaction with the current national legislation of the abortion, the situation is rather surprising. A significant percentage (61%) of respondents felt as necessary to punish the woman who performs an illegal abortion, although the legislation does not provide a punishment. On the other hand, satisfaction level to the penalties provided by law for various violations of the legal conditions for conducting abortion is low, on average only 25.5% of respondents are being satisfied with these, the majority (average 56.2%) considering the penalties as unsatisfactory. Understood as a social phenomenon, intensified by human vulnerabilities, of which the most obvious is accepting the comfort [ 48 ], abortion today is no longer, in Romanian society, from a legal or religious perspective, a problem. Perceptions on the legislative sanction, moral and religious will perpetual vary depending on beliefs, environment, education, etc. The only and the biggest social problem of Romania is truly represented by the steadily falling birth rate.

Conflict of interests

The authors declare that they have no conflict of interests.

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Is There a Constitutional Right to Talk About Abortion?

By Linda Greenhouse

Ms. Greenhouse, the recipient of a 1998 Pulitzer Prize, reported on the Supreme Court for The Times from 1978 to 2008 and was a contributing Opinion writer from 2009 to 2021.

There has hardly ever been as fierce a defender of free speech as the current Supreme Court.

Since John Roberts became chief justice almost 19 years ago, the court has expanded the protective net of the First Amendment to cover such activities as selling videos depicting animal torture, spending unlimited amounts of money in support of political candidates and refusing to pay dues (or a dues-like fee) to a public employee union.

This last decision, Janus v. American Federation of State, County and Municipal Employees, Council 31, overturned a 41-year-old precedent and led a dissenting justice, Elena Kagan, to accuse the majority of “weaponizing the First Amendment.” In the 303 Creative case last year, the court gave a Christian web designer the First Amendment right not to do business with would-be customers whose same-sex wedding websites would violate her views about marriage.

The court’s version of free speech has become a powerful tool against government regulation. Six years ago, effectively striking down a California law, the court gave so-called crisis pregnancy centers — offices that try to imitate abortion clinics but strive to persuade women to continue their pregnancies — a First Amendment right not to provide information on where a woman could actually get an abortion. The state said the notice was needed to help women who came to such centers under the false impression that they provided abortions. In his majority opinion, Justice Clarence Thomas said the “unduly burdensome” requirement amounted to unconstitutionally compelled speech.

Now the question is whether the court’s solicitude toward those who would rather not talk about abortion extends in the other direction. What about state laws that prohibit rather than require offering information about where to get an abortion?

While there is not yet such a case on the Supreme Court’s docket, lower courts have been tightening a First Amendment noose around efforts by anti-abortion states to curb the flow of information about how to obtain legal abortion care across state lines. Federal District Courts in Indiana and Alabama both ruled this month that while states in the wake of Roe v. Wade’s demise can ban abortion, they cannot make it illegal to give abortion-related advice, including advice to minors seeking abortions without parental consent.

A federal magistrate judge issued a similar ruling last November on Idaho’s abortion law, one of the most extreme in the country, which makes it a crime to assist a minor in obtaining an abortion in any state without a parent’s consent. Idaho could criminalize abortion, the judge, Debora Grasham, wrote. “What the state cannot do,” she went on, “is craft a statute muzzling the speech and expressive activities of a particular viewpoint with which the state disagrees under the guise of parental rights.” The United States Court of Appeals for the Ninth Circuit heard Idaho’s appeal on May 7.

With the Supreme Court extremely unlikely to revisit its decision 23 months ago in Dobbs v. Jackson Women’s Health Organization that eradicated the constitutional right to abortion, the question of how far states can go to prevent their citizens from finding alternative ways to terminate a pregnancy will become increasingly urgent. In his concurring opinion in the Dobbs case, Justice Brett Kavanaugh raised the question of whether a state could now “bar a resident of that state from traveling to another state to obtain an abortion.” The answer was “no,” he continued, “based on the constitutional right to interstate travel.” It is worth noting that Justice Kavanaugh wrote only for himself; none of the other conservatives who made up the Dobbs majority joined him. “Other abortion-related legal questions may emerge in the future,” Justice Kavanaugh offered noncommittally.

The future arrived quickly enough in the form of the two abortion-related cases awaiting decision before the court’s current term, which concludes at the end of June or in early July. Both are anomalous in that they involve questions of federal rather than state authority.

One, Food and Drug Administration v. Alliance for Hippocratic Medicine , concerns the government’s approval of the expanded use of the medication that first received F.D.A. approval 24 years ago. Medication abortion now accounts for more than half of abortions in the United States. The case contains an off-ramp for the court that, based on the argument in March, the justices appear likely to take: Because the anti-abortion doctors, dentists and medical groups who challenged the F.D.A. suffered no harm from the availability of the medication, and are unlikely to suffer harm in the future, they never had standing to bring the case in the first place.

The other, Moyle v. United States, results from a clash between the federal government and Idaho over whether federal law requires the state to provide emergency abortion care in its hospitals. The outcome largely depends on whether the court accepts the Biden administration’s view that there is no abortion exception to the law at issue, which prohibits hospitals from turning away people who need emergency care.

In the abortion cases in Indiana, Idaho and Alabama that may yet find their way to the Supreme Court, the justices would face the acute dilemma of reconciling their fealty to the First Amendment with the profound anti-abortion sentiment the Dobbs majority opinion displayed.

In defending their laws, the states argue that what they are prohibiting is not actually speech but conduct, namely inducing criminal activity. Rejecting this argument in the Indiana case, Judge Sarah Evans Barker of Federal District Court wrote that the Planned Parenthood affiliate that challenged the law simply “seeks to provide truthful information to clients regarding out-of-state options and medical referrals to out-of-state providers for abortion services that are legal in those states.” A prohibition on providing such information, the judge said, “does not further any interest Indiana may have in investigating criminal conduct within its borders.” In the Alabama case, another Federal District Court judge, Myron Thompson, observed that “unable to proscribe out-of-state abortions, the attorney general interprets state law as punishing the speech necessary to obtain them.”

From the cases they are in the process of deciding this term, the justices are well aware that their effort to wash their hands of the nettlesome business of abortion has failed. One or more of the First Amendment cases is likely to reach the court during its next term. I wonder if the justices have a clue about how much pain lies ahead when they have to decide whether the right to speak inevitably encompasses the right to choose.

Linda Greenhouse, the recipient of a 1998 Pulitzer Prize, reported on the Supreme Court for The Times from 1978 to 2008 and was a contributing Opinion writer from 2009 to 2021.

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Abortion Surveillance Findings and Reports

At a glance.

Find reports and data from CDC's Abortion Surveillance System for 2011 to 2021.

Findings and Reports

Abortion Surveillance 2021

In 2021, 625,978 legal induced abortions were reported to CDC from 48 reporting areas. Among 47 reporting areas with data each year during 2012–2021, in 2021, a total of 622,108 abortions were reported, the abortion rate was 11.6 abortions per 1,000 women aged 15–44 years, and the abortion ratio was 204 abortions per 1,000 live births.

From 2020 to 2021, the number of abortions increased 5%, the abortion rate increased 5%, and the abortion ratio increased 4%. From 2012 to 2021, the number, rate, and ratio of reported abortions decreased 8%, 11%, and 1%, respectively.

Similar to previous years, in 2021, women in their twenties accounted for more than half of abortions (57.0%). Nearly all abortions in 2021 took place early in gestation: 93.5% of abortions were performed at ≤13 weeks' gestation; a smaller number of abortions (5.7%) were performed at 14–20 weeks' gestation, and even fewer (0.9%) were performed at ≥21 weeks' gestation. Early medication abortion is defined as the administration of medication(s) to induce an abortion at ≤9 completed weeks' gestation, consistent with the current Food and Drug Administration labeling for mifepristone (implemented in 2016). In 2021, 53.0% of all abortions were early medication abortions. Use of early medication abortion increased 3% from 2020 to 2021 and 137% from 2012 to 2021.

Available Data

Besides the data available in the annual Abortion Surveillance report, data from 2012 to 2021 are also available for abortions distributed by area of residence and area of clinical service. These data are consistent with data reported to CDC for each year's Abortion Surveillance report. No additional data are available for public use. For other abortion data, search the National Library of Medicine's MEDLINE/PubMed or MedlinePlus bibliographic reference.

Abortions Distributed by Area of Residence and Area of Clinical Service

• 2012–2021
• Kortsmit K, Nguyen AT, Mandel MG, et al. Abortion Surveillance—United States, 2021. MMWR Surveill Summ . 2023;72(9):1–29.

Reproductive Health

CDC’s Division of Reproductive Health focuses on issues related to reproductive health, maternal health, and infant health.

For Everyone

Public health.

Why confusion over key pregnancy facts makes for uninformed debate over abortion limits

Editor’s note:  The views expressed in this commentary are solely those of the writer. CNN is showcasing the work of  The Conversation , a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.

Most Americans don’t know two key facts about pregnancy, including how they are dated and how long a trimester is – and this could matter, as a growing number of states place restrictions on abortion.

Florida enacted a new law  on May 1, 2024, that bans abortions after six weeks of pregnancy, with  a few exceptions  – including documented rape, incest and to save the life of the mother.

Florida joins the majority of  Southern states  that now have complete bans or highly restrictive abortion laws, enacted since the Supreme Court overturned the  federal right to get an abortion  in June 2022. Many of the restrictive laws ban abortion after a set number of weeks.

Florida Republicans supporting the bill have labeled it a  reasonable compromise between a full abortion ban and few abortion restrictions.

READ MORE: Mexico is a destination for Americans seeking reproductive health services

Some OB-GYNs  have explained that  many women  do not even know they are pregnant at  six weeks .  Research shows that women  on average find out they are pregnant at five and a half weeks. About 23% do not know until seven weeks of pregnancy or later.

So, do Americans, including those enacting six-week bans, actually understand how the timing or dating of pregnancy works?

We are  scholars  of  political science ,  gender and public opinion  and are writing a book about public opinion on abortion after the Supreme Court’s reversal of the federal right to get an abortion in June 2022.

How does pregnancy work?

To gain insights into this issue, we developed a few pregnancy questions and included them in a research survey in late September 2023. The survey had 1,356 respondents, who were broadly representative of the U.S. population. The respondents’ median age was 46. Approximately 49% of these people were men, while 70% were white and 29% were college graduates. Meanwhile, 43% of them were Democrats, and 38% were Republicans.

READ MORE: Fetal personhood rulings could nullify a pregnant patient’s wishes for end-of-life care

The first question asked respondents how pregnancies are dated.  The correct answer  is that pregnancies are dated using the first day of the woman’s last menstrual period, which is often two to three weeks before conception.

The second question asked about trimesters. Many Americans are familiar with the term trimester, and  polling consistently shows  that Americans find abortion most acceptable during the first trimester. We asked Americans if they knew approximately how many weeks a trimester was. The correct answer is 13.

Americans’ pregnancy knowledge

We found that only one-third of respondents knew how pregnancy is dated. A majority – approximately 60% – falsely thought that pregnancy is dated from conception or in the weeks since the woman last had sex. Less than one-fourth of the respondents answered both pregnancy knowledge questions correctly.

In our survey, we also asked respondents whether they support a six-week abortion ban. Similar to other  national surveys , we find that most Americans oppose strict abortion restrictions – only 35% support six-week bans.

Importantly, we find that those who support six-week abortion bans are significantly less likely than others to correctly understand the timing of pregnancy. The statistically significant relationship between having low levels of pregnancy timing knowledge and support for a six-week abortion ban holds in analyses controlling for potentially confounding variables.

Some anti-abortion lawmakers  have demonstrated  their  ignorance   about pregnancy  before.

There is, for example, a long history of some anti-abortion politicians saying, incorrectly, that it is  extremely rare  for a person who is raped to get pregnant. Our survey shows that a large swath of those opposing abortion lack knowledge about the basics of pregnancy.

A gender disparity

Perhaps not surprisingly, women in this survey knew more about pregnancy than men. The question about how pregnancies are dated, for example, was answered correctly by 43% of women compared with only 23% of men. As mentioned above, a majority of Americans incorrectly believe pregnancy is dated from conception, but significantly more men than women think this is true.

This finding is particularly important when considering the gender breakdown of the Florida state lawmakers who approved the six-week ban. Although we do not have data on the pregnancy knowledge of those legislators, we do know that those who voted for the ban were  overwhelmingly men .

Florida’s six-week ban will make it much harder for anyone to get abortions there – and it will also affect people in  neighboring states  who want or need an abortion. In 2023, Florida was home to the closest abortion clinic for  6.4 million women  living in the South. In 2023,  around 7,700 women  from other Southern states,  where abortion is now largely banned , traveled to Florida to get abortions.

Overall, our findings raise serious questions about whether Americans without medical training – much like those in our state legislatures – have the necessary knowledge needed to regulate abortion access.

Correction: This story has been updated to remove an incorrect reference to the Susan B. Anthony Pro-Life America group’s position on an abortion ban after six weeks.

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Pro-Choice Does Not Mean Pro-Abortion: An Argument for Abortion Rights Featuring the Rev. Carlton Veazey

Since the Supreme Court’s historic 1973 decision in Roe v. Wade , the issue of a woman’s right to an abortion has fostered one of the most contentious moral and political debates in America. Opponents of abortion rights argue that life begins at conception – making abortion tantamount to homicide. Abortion rights advocates, in contrast, maintain that women have a right to decide what happens to their bodies – sometimes without any restrictions.

To explore the case for abortion rights, the Pew Forum turns to the Rev. Carlton W. Veazey, who for more than a decade has been president of the Religious Coalition for Reproductive Choice. Based in Washington, D.C., the coalition advocates for reproductive choice and religious freedom on behalf of about 40 religious groups and organizations. Prior to joining the coalition, Veazey spent 33 years as a pastor at Zion Baptist Church in Washington, D.C.

A counterargument explaining the case against abortion rights is made by the Rev. J. Daniel Mindling, professor of moral theology at Mount St. Mary’s Seminary.

Featuring: The Rev. Carlton W. Veazey, President, Religious Coalition for Reproductive Choice

Interviewer: David Masci, Senior Research Fellow, Pew Forum on Religion & Public Life

Question & Answer

Can you explain how your Christian faith informs your views in support of abortion rights?

I grew up in a Christian home. My father was a Baptist minister for many years in Memphis, Tenn. One of the things that he instilled in me – I used to hear it so much – was free will, free will, free will. It was ingrained in me that you have the ability to make choices. You have the ability to decide what you want to do. You are responsible for your decisions, but God has given you that responsibility, that option to make decisions.

I had firsthand experience of seeing black women and poor women being disproportionately impacted by the fact that they had no choices about an unintended pregnancy, even if it would damage their health or cause great hardship in their family. And I remember some of them being maimed in back-alley abortions; some of them died. There was no legal choice before Roe v. Wade .

But in this day and time, we have a clearer understanding that men and women are moral agents and equipped to make decisions about even the most difficult and complex matters. We must ensure a woman can determine when and whether to have children according to her own conscience and religious beliefs and without governmental interference or coercion. We must also ensure that women have the resources to have a healthy, safe pregnancy, if that is their decision, and that women and families have the resources to raise a child with security.

The right to choose has changed and expanded over the years since Roe v. Wade . We now speak of reproductive justice – and that includes comprehensive sex education, family planning and contraception, adequate medical care, a safe environment, the ability to continue a pregnancy and the resources that make that choice possible. That is my moral framework.

You talk about free will, and as a Christian you believe in free will. But you also said that God gave us free will and gave us the opportunity to make right and wrong choices. Why do you believe that abortion can, at least in some instances, be the right choice?

Dan Maguire, a former Jesuit priest and professor of moral theology and ethics at Marquette University, says that to have a child can be a sacred choice, but to not have a child can also be a sacred choice.

And these choices revolve around circumstances and issues – like whether a person is old enough to care for a child or whether a woman already has more children than she can care for. Also, remember that medical circumstances are the reason many women have an abortion – for example, if they are having chemotherapy for cancer or have a life-threatening chronic illness – and most later-term abortions occur because of fetal abnormalities that will result in stillbirth or the death of the child. These are difficult decisions; they’re moral decisions, sometimes requiring a woman to decide if she will risk her life for a pregnancy.

Abortion is a very serious decision and each decision depends on circumstances. That’s why I tell people: I am not pro-abortion, I am pro-choice. And that’s an important distinction.

You’ve talked about the right of a woman to make a choice. Does the fetus have any rights?

First, let me say that the religious, pro-choice position is based on respect for human life, including potential life and existing life.

But I do not believe that life as we know it starts at conception. I am troubled by the implications of a fetus having legal rights because that could pit the fetus against the woman carrying the fetus; for example, if the woman needed a medical procedure, the law could require the fetus to be considered separately and equally.

From a religious perspective, it’s more important to consider the moral issues involved in making a decision about abortion. Also, it’s important to remember that religious traditions have very different ideas about the status of the fetus. Roman Catholic doctrine regards a fertilized egg as a human being. Judaism holds that life begins with the first breath.

What about at the very end of a woman’s pregnancy? Does a fetus acquire rights after the point of viability, when it can survive outside the womb? Or let me ask it another way: Assuming a woman is healthy and her fetus is healthy, should the woman be able to terminate her pregnancy until the end of her pregnancy?

There’s an assumption that a woman would end a viable pregnancy carelessly or without a reason. The facts don’t bear this out. Most abortions are performed in the first 12 weeks of pregnancy. Late abortions are virtually always performed for the most serious medical and health reasons, including saving the woman’s life.

But what if such a case came before you? If you were that woman’s pastor, what would you say?

I would talk to her in a helpful, positive, respectful way and help her discuss what was troubling her. I would suggest alternatives such as adoption.

Let me shift gears a little bit. Many Americans have said they favor a compromise, or reaching a middle-ground policy, on abortion. Do you sympathize with this desire and do you think that both sides should compromise to end this rancorous debate?

I have been to more middle-ground and common-ground meetings than I can remember and I’ve never been to one where we walked out with any decision.

That being said, I think that we all should agree that abortion should be rare. How do we do that? We do that by providing comprehensive sex education in schools and in religious congregations and by ensuring that there is accurate information about contraception and that contraception is available. Unfortunately, the U.S. Congress has not been willing to pass a bill to fund comprehensive sex education, but they are willing to put a lot of money into failed and harmful abstinence-only programs that often rely on scare tactics and inaccurate information.

Former Surgeon General David Satcher has shown that abstinence-only programs do not work and that we should provide young people with the information to protect themselves. Education that stresses abstinence and provides accurate information about contraception will reduce the abortion rate. That is the ground that I stand on. I would say that here is a way we can work together to reduce the need for abortions.

Abortion has become central to what many people call the “culture wars.” Some consider it to be the most contentious moral issue in America today. Why do many Catholics, evangelical Christians and other people of faith disagree with you?

I was raised to respect differing views so the rigid views against abortion are hard for me to understand. I will often tell someone on the other side, “I respect you. I may disagree with your theological perspective, but I respect your views. But I think it’s totally arrogant for you to tell me that I need to believe what you believe.” It’s not that I think we should not try to win each other over. But we have to respect people’s different religious beliefs.

But what about people who believe that life begins at conception and that terminating a pregnancy is murder? For them, it may not just be about respecting or tolerating each other’s viewpoints; they believe this is an issue of life or death. What do you say to people who make that kind of argument?

I would say that they have a right to their beliefs, as do I. I would try to explain that my views are grounded in my religion, as are theirs. I believe that we must ensure that women are treated with dignity and respect and that women are able to follow the dictates of their conscience – and that includes their reproductive decisions. Ultimately, it is the government’s responsibility to ensure that women have the ability to make decisions of conscience and have access to reproductive health services.

Some in the anti-abortion camp contend that the existence of legalized abortion is a sign of the self-centeredness and selfishness of our age. Is there any validity to this view?

Although abortion is a very difficult decision, it can be the most responsible decision a person can make when faced with an unintended pregnancy or a pregnancy that will have serious health consequences.

Depending on the circumstances, it might be selfish to bring a child into the world. You know, a lot of people say, “You must bring this child into the world.” They are 100 percent supportive while the child is in the womb. As soon as the child is born, they abort the child in other ways. They abort a child through lack of health care, lack of education, lack of housing, and through poverty, which can drive a child into drugs or the criminal justice system.

So is it selfish to bring children into the world and not care for them? I think the other side can be very selfish by neglecting the children we have already. For all practical purposes, children whom we are neglecting are being aborted.

This transcript has been edited for clarity, spelling and grammar.

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ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

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