research questions about abortion laws

Read our research on: Gun Policy | International Conflict | Election 2024

Regions & Countries

Key facts about the abortion debate in america.

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

Sign up for our weekly newsletter

Fresh data delivered Saturday mornings

Public Opinion on Abortion

Majority in u.s. say abortion should be legal in some cases, illegal in others, three-in-ten or more democrats and republicans don’t agree with their party on abortion, partisanship a bigger factor than geography in views of abortion access locally, most popular.

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 .

• Open access
• Published: 28 June 2021

Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol

• Foluso Ishola   ORCID: orcid.org/0000-0002-8644-0570 1 ,
• U. Vivian Ukah 1 &
• Arijit Nandi 1  

Systematic Reviews volume  10 , Article number:  192 ( 2021 ) Cite this article

20k Accesses

2 Citations

3 Altmetric

Metrics details

A country’s abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women’s access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women’s health services and outcomes in LMICs.

We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women’s health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description.

This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women’s health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility.

Systematic review registration

PROSPERO CRD42019126927

Peer Review reports

An estimated 25·1 million unsafe abortions occur each year, with 97% of these in developing countries [ 1 , 2 , 3 ]. Despite its frequency, unsafe abortion remains a major global public health challenge [ 4 , 5 ]. According to the World health Organization (WHO), nearly 8% of maternal deaths were attributed to unsafe abortion, with the majority of these occurring in developing countries [ 5 , 6 ]. Approximately 7 million women are admitted to hospitals every year due to complications from unsafe abortion such as hemorrhage, infections, septic shock, uterine and intestinal perforation, and peritonitis [ 7 , 8 , 9 ]. These often result in long-term effects such as infertility and chronic reproductive tract infections. The annual cost of treating major complications from unsafe abortion is estimated at US$ 232 million each year in developing countries [ 10 , 11 ]. The negative consequences on children’s health, well-being, and development have also been documented. Unsafe abortion increases risk of poor birth outcomes, neonatal and infant mortality [ 12 , 13 ]. Additionally, women who lack access to safe and legal abortion are often forced to continue with unwanted pregnancies, and may not seek prenatal care [ 14 ], which might increase risks of child morbidity and mortality.

Access to safe abortion services is often limited due to a wide range of barriers. Collectively, these barriers contribute to the staggering number of deaths and disabilities seen annually as a result of unsafe abortion, which are disproportionately felt in developing countries [ 15 , 16 , 17 ]. A recent systematic review on the barriers to abortion access in low- and middle-income countries (LMICs) implicated the following factors: restrictive abortion laws, lack of knowledge about abortion law or locations that provide abortion, high cost of services, judgmental provider attitudes, scarcity of facilities and medical equipment, poor training and shortage of staff, stigma on social and religious grounds, and lack of decision making power [ 17 ].

An important factor regulating access to abortion is abortion law [ 17 , 18 , 19 ]. Although abortion is a medical procedure, its legal status in many countries has been incorporated in penal codes which specify grounds in which abortion is permitted. These include prohibition in all circumstances, to save the woman’s life, to preserve the woman’s health, in cases of rape, incest, fetal impairment, for economic or social reasons, and on request with no requirement for justification [ 18 , 19 , 20 ].

Although abortion laws in different countries are usually compared based on the grounds under which legal abortions are allowed, these comparisons rarely take into account components of the legal framework that may have strongly restrictive implications, such as regulation of facilities that are authorized to provide abortions, mandatory waiting periods, reporting requirements in cases of rape, limited choice in terms of the method of abortion, and requirements for third-party authorizations [ 19 , 21 , 22 ]. For example, the Zambian Termination of Pregnancy Act permits abortion on socio-economic grounds. It is considered liberal, as it permits legal abortions for more indications than most countries in Sub-Saharan Africa; however, abortions must only be provided in registered hospitals, and three medical doctors—one of whom must be a specialist—must provide signatures to allow the procedure to take place [ 22 ]. Given the critical shortage of doctors in Zambia [ 23 ], this is in fact a major restriction that is only captured by a thorough analysis of the conditions under which abortion services are provided.

Additionally, abortion laws may exist outside the penal codes in some countries, where they are supplemented by health legislation and regulations such as public health statutes, reproductive health acts, court decisions, medical ethic codes, practice guidelines, and general health acts [ 18 , 19 , 24 ]. The diversity of regulatory documents may lead to conflicting directives about the grounds under which abortion is lawful [ 19 ]. For example, in Kenya and Uganda, standards and guidelines on the reduction of morbidity and mortality due to unsafe abortion supported by the constitution was contradictory to the penal code, leaving room for an ambiguous interpretation of the legal environment [ 25 ].

Regulations restricting the range of abortion methods from which women can choose, including medication abortion in particular, may also affect abortion access [ 26 , 27 ]. A literature review contextualizing medication abortion in seven African countries reported that incidence of medication abortion is low despite being a safe, effective, and low-cost abortion method, likely due to legal restrictions on access to the medications [ 27 ].

Over the past two decades, many LMICs have reformed their abortion laws [ 3 , 28 ]. Most have expanded the grounds on which abortion may be performed legally, while very few have restricted access. Countries like Uruguay, South Africa, and Portugal have amended their laws to allow abortion on request in the first trimester of pregnancy [ 29 , 30 ]. Conversely, in Nicaragua, a law to ban all abortion without any exception was introduced in 2006 [ 31 ].

Progressive reforms are expected to lead to improvements in women’s access to safe abortion and health outcomes, including reductions in the death and disabilities that accompany unsafe abortion, and reductions in stigma over the longer term [ 17 , 29 , 32 ]. However, abortion law reforms may yield different outcomes even in countries that experience similar reforms, as the legislative processes that are associated with changing abortion laws take place in highly distinct political, economic, religious, and social contexts [ 28 , 33 ]. This variation may contribute to abortion law reforms having different effects with respect to the health services and outcomes that they are hypothesized to influence [ 17 , 29 ].

Extant empirical literature has examined changes in abortion-related morbidity and mortality, contraceptive usage, fertility, and other health-related outcomes following reforms to abortion laws [ 34 , 35 , 36 , 37 ]. For example, a study in Mexico reported that a policy that decriminalized and subsidized early-term elective abortion led to substantial reductions in maternal morbidity and that this was particularly strong among vulnerable populations such as young and socioeconomically disadvantaged women [ 38 ].

To the best of our knowledge, however, the growing literature on the impact of abortion law reforms on women’s health services and outcomes has not been systematically reviewed. A study by Benson et al. evaluated evidence on the impact of abortion policy reforms on maternal death in three countries, Romania, South Africa, and Bangladesh, where reforms were immediately followed by strategies to implement abortion services, scale up accessibility, and establish complementary reproductive and maternal health services [ 39 ]. The three countries highlighted in this paper provided unique insights into implementation and practical application following law reforms, in spite of limited resources. However, the review focused only on a selection of countries that have enacted similar reforms and it is unclear if its conclusions are more widely generalizable.

Accordingly, the primary objective of this review is to summarize studies that have estimated the causal effect of a change in abortion law on women’s health services and outcomes. Additionally, we aim to examine heterogeneity in the impacts of abortion reforms, including variation across specific population sub-groups and contexts (e.g., due to variations in the intensity of enforcement and service delivery). Through this review, we aim to offer a higher-level view of the impact of abortion law reforms in LMICs, beyond what can be gained from any individual study, and to thereby highlight patterns in the evidence across studies, gaps in current research, and to identify promising programs and strategies that could be adapted and applied more broadly to increase access to safe abortion services.

The review protocol has been reported using Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines [ 40 ] (Additional file 1 ). It was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database CRD42019126927.

Eligibility criteria

Types of studies.

This review will consider quasi-experimental studies which aim to estimate the causal effect of a change in a specific law or reform and an outcome, but in which participants (in this case jurisdictions, whether countries, states/provinces, or smaller units) are not randomly assigned to treatment conditions [ 41 ]. Eligible designs include the following:

Pretest-posttest designs where the outcome is compared before and after the reform, as well as nonequivalent groups designs, such as pretest-posttest design that includes a comparison group, also known as a controlled before and after (CBA) designs.

Interrupted time series (ITS) designs where the trend of an outcome after an abortion law reform is compared to a counterfactual (i.e., trends in the outcome in the post-intervention period had the jurisdiction not enacted the reform) based on the pre-intervention trends and/or a control group [ 42 , 43 ].

Differences-in-differences (DD) designs, which compare the before vs. after change in an outcome in jurisdictions that experienced an abortion law reform to the corresponding change in the places that did not experience such a change, under the assumption of parallel trends [ 44 , 45 ].

Synthetic controls (SC) approaches, which use a weighted combination of control units that did not experience the intervention, selected to match the treated unit in its pre-intervention outcome trend, to proxy the counterfactual scenario [ 46 , 47 ].

Regression discontinuity (RD) designs, which in the case of eligibility for abortion services being determined by the value of a continuous random variable, such as age or income, would compare the distributions of post-intervention outcomes for those just above and below the threshold [ 48 ].

There is heterogeneity in the terminology and definitions used to describe quasi-experimental designs, but we will do our best to categorize studies into the above groups based on their designs, identification strategies, and assumptions.

Our focus is on quasi-experimental research because we are interested in studies evaluating the effect of population-level interventions (i.e., abortion law reform) with a design that permits inference regarding the causal effect of abortion legislation, which is not possible from other types of observational designs such as cross-sectional studies, cohort studies or case-control studies that lack an identification strategy for addressing sources of unmeasured confounding (e.g., secular trends in outcomes). We are not excluding randomized studies such as randomized controlled trials, cluster randomized trials, or stepped-wedge cluster-randomized trials; however, we do not expect to identify any relevant randomized studies given that abortion policy is unlikely to be randomly assigned. Since our objective is to provide a summary of empirical studies reporting primary research, reviews/meta-analyses, qualitative studies, editorials, letters, book reviews, correspondence, and case reports/studies will also be excluded.

Our population of interest includes women of reproductive age (15–49 years) residing in LMICs, as the policy exposure of interest applies primarily to women who have a demand for sexual and reproductive health services including abortion.

Intervention

The intervention in this study refers to a change in abortion law or policy, either from a restrictive policy to a non-restrictive or less restrictive one, or vice versa. This can, for example, include a change from abortion prohibition in all circumstances to abortion permissible in other circumstances, such as to save the woman’s life, to preserve the woman’s health, in cases of rape, incest, fetal impairment, for economic or social reasons, or on request with no requirement for justification. It can also include the abolition of existing abortion policies or the introduction of new policies including those occurring outside the penal code, which also have legal standing, such as:

National constitutions;

Supreme court decisions, as well as higher court decisions;

Customary or religious law, such as interpretations of Muslim law;

Medical ethical codes; and

Regulatory standards and guidelines governing the provision of abortion.

We will also consider national and sub-national reforms, although we anticipate that most reforms will operate at the national level.

The comparison group represents the counterfactual scenario, specifically the level and/or trend of a particular post-intervention outcome in the treated jurisdiction that experienced an abortion law reform had it, counter to the fact, not experienced this specific intervention. Comparison groups will vary depending on the type of quasi-experimental design. These may include outcome trends after abortion reform in the same country, as in the case of an interrupted time series design without a control group, or corresponding trends in countries that did not experience a change in abortion law, as in the case of the difference-in-differences design.

Outcome measures

Primary outcomes.

Access to abortion services: There is no consensus on how to measure access but we will use the following indicators, based on the relevant literature [ 49 ]: [ 1 ] the availability of trained staff to provide care, [ 2 ] facilities are geographically accessible such as distance to providers, [ 3 ] essential equipment, supplies and medications, [ 4 ] services provided regardless of woman’s ability to pay, [ 5 ] all aspects of abortion care are explained to women, [ 6 ] whether staff offer respectful care, [ 7 ] if staff work to ensure privacy, [ 8 ] if high-quality, supportive counseling is provided, [ 9 ] if services are offered in a timely manner, and [ 10 ] if women have the opportunity to express concerns, ask questions, and receive answers.

Use of abortion services refers to induced pregnancy termination, including medication abortion and number of women treated for abortion-related complications.

Secondary outcomes

Current use of any method of contraception refers to women of reproductive age currently using any method contraceptive method.

Future use of contraception refers to women of reproductive age who are not currently using contraception but intend to do so in the future.

Demand for family planning refers to women of reproductive age who are currently using, or whose sexual partner is currently using, at least one contraceptive method.

Unmet need for family planning refers to women of reproductive age who want to stop or delay childbearing but are not using any method of contraception.

Fertility rate refers to the average number of children born to women of childbearing age.

Neonatal morbidity and mortality refer to disability or death of newborn babies within the first 28 days of life.

Maternal morbidity and mortality refer to disability or death due to complications from pregnancy or childbirth.

There will be no language, date, or year restrictions on studies included in this systematic review.

Studies have to be conducted in a low- and middle-income country. We will use the country classification specified in the World Bank Data Catalogue to identify LMICs (Additional file 2 ).

Search methods

We will perform searches for eligible peer-reviewed studies in the following electronic databases.

Ovid MEDLINE(R) (from 1946 to present)

Embase Classic+Embase on OvidSP (from 1947 to present)

CINAHL (1973 to present); and

Web of Science (1900 to present)

The reference list of included studies will be hand searched for additional potentially relevant citations. Additionally, a grey literature search for reports or working papers will be done with the help of Google and Social Science Research Network (SSRN).

Search strategy

A search strategy, based on the eligibility criteria and combining subject indexing terms (i.e., MeSH) and free-text search terms in the title and abstract fields, will be developed for each electronic database. The search strategy will combine terms related to the interventions of interest (i.e., abortion law/policy), etiology (i.e., impact/effect), and context (i.e., LMICs) and will be developed with the help of a subject matter librarian. We opted not to specify outcomes in the search strategy in order to maximize the sensitivity of our search. See Additional file 3 for a draft of our search strategy.

Data collection and analysis

Data management.

Search results from all databases will be imported into Endnote reference manager software (Version X9, Clarivate Analytics) where duplicate records will be identified and excluded using a systematic, rigorous, and reproducible method that utilizes a sequential combination of fields including author, year, title, journal, and pages. Rayyan systematic review software will be used to manage records throughout the review [ 50 ].

Selection process

Two review authors will screen titles and abstracts and apply the eligibility criteria to select studies for full-text review. Reference lists of any relevant articles identified will be screened to ensure no primary research studies are missed. Studies in a language different from English will be translated by collaborators who are fluent in the particular language. If no such expertise is identified, we will use Google Translate [ 51 ]. Full text versions of potentially relevant articles will be retrieved and assessed for inclusion based on study eligibility criteria. Discrepancies will be resolved by consensus or will involve a third reviewer as an arbitrator. The selection of studies, as well as reasons for exclusions of potentially eligible studies, will be described using a PRISMA flow chart.

Data extraction

Data extraction will be independently undertaken by two authors. At the conclusion of data extraction, these two authors will meet with the third author to resolve any discrepancies. A piloted standardized extraction form will be used to extract the following information: authors, date of publication, country of study, aim of study, policy reform year, type of policy reform, data source (surveys, medical records), years compared (before and after the reform), comparators (over time or between groups), participant characteristics (age, socioeconomic status), primary and secondary outcomes, evaluation design, methods used for statistical analysis (regression), estimates reported (means, rates, proportion), information to assess risk of bias (sensitivity analyses), sources of funding, and any potential conflicts of interest.

Risk of bias and quality assessment

Two independent reviewers with content and methodological expertise in methods for policy evaluation will assess the methodological quality of included studies using the quasi-experimental study designs series risk of bias checklist [ 52 ]. This checklist provides a list of criteria for grading the quality of quasi-experimental studies that relate directly to the intrinsic strength of the studies in inferring causality. These include [ 1 ] relevant comparison, [ 2 ] number of times outcome assessments were available, [ 3 ] intervention effect estimated by changes over time for the same or different groups, [ 4 ] control of confounding, [ 5 ] how groups of individuals or clusters were formed (time or location differences), and [ 6 ] assessment of outcome variables. Each of the following domains will be assigned a “yes,” “no,” or “possibly” bias classification. Any discrepancies will be resolved by consensus or a third reviewer with expertise in review methodology if required.

Confidence in cumulative evidence

The strength of the body of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system [ 53 ].

Data synthesis

We anticipate that risk of bias and heterogeneity in the studies included may preclude the use of meta-analyses to describe pooled effects. This may necessitate the presentation of our main findings through a narrative description. We will synthesize the findings from the included articles according to the following key headings:

Information on the differential aspects of the abortion policy reforms.

Information on the types of study design used to assess the impact of policy reforms.

Information on main effects of abortion law reforms on primary and secondary outcomes of interest.

Information on heterogeneity in the results that might be due to differences in study designs, individual-level characteristics, and contextual factors.

Potential meta-analysis

If outcomes are reported consistently across studies, we will construct forest plots and synthesize effect estimates using meta-analysis. Statistical heterogeneity will be assessed using the I 2 test where I 2 values over 50% indicate moderate to high heterogeneity [ 54 ]. If studies are sufficiently homogenous, we will use fixed effects. However, if there is evidence of heterogeneity, a random effects model will be adopted. Summary measures, including risk ratios or differences or prevalence ratios or differences will be calculated, along with 95% confidence intervals (CI).

Analysis of subgroups

If there are sufficient numbers of included studies, we will perform sub-group analyses according to type of policy reform, geographical location and type of participant characteristics such as age groups, socioeconomic status, urban/rural status, education, or marital status to examine the evidence for heterogeneous effects of abortion laws.

Sensitivity analysis

Sensitivity analyses will be conducted if there are major differences in quality of the included articles to explore the influence of risk of bias on effect estimates.

Meta-biases

If available, studies will be compared to protocols and registers to identify potential reporting bias within studies. If appropriate and there are a sufficient number of studies included, funnel plots will be generated to determine potential publication bias.

This systematic review will synthesize current evidence on the impact of abortion law reforms on women’s health. It aims to identify which legislative reforms are effective, for which population sub-groups, and under which conditions.

Potential limitations may include the low quality of included studies as a result of suboptimal study design, invalid assumptions, lack of sensitivity analysis, imprecision of estimates, variability in results, missing data, and poor outcome measurements. Our review may also include a limited number of articles because we opted to focus on evidence from quasi-experimental study design due to the causal nature of the research question under review. Nonetheless, we will synthesize the literature, provide a critical evaluation of the quality of the evidence and discuss the potential effects of any limitations to our overall conclusions. Protocol amendments will be recorded and dated using the registration for this review on PROSPERO. We will also describe any amendments in our final manuscript.

Synthesizing available evidence on the impact of abortion law reforms represents an important step towards building our knowledge base regarding how abortion law reforms affect women’s health services and health outcomes; we will provide evidence on emerging strategies to influence policy reforms, implement abortion services, and scale up accessibility. This review will be of interest to service providers, policy makers and researchers seeking to improve women’s access to safe abortion around the world.

Abbreviations

Cumulative index to nursing and allied health literature

Excerpta medica database

Low- and middle-income countries

Preferred reporting items for systematic review and meta-analysis protocols

International prospective register of systematic reviews

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tuncalp O, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372–81. https://doi.org/10.1016/S0140-6736(17)31794-4 .

Article   PubMed   PubMed Central   Google Scholar  

Guttmacher Institute. Induced Abortion Worldwide; Global Incidence and Trends 2018. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide . Accessed 15 Dec 2019.

Singh S, Remez L, Sedgh G, Kwok L, Onda T. Abortion worldwide 2017: uneven progress and unequal access. NewYork: Guttmacher Institute; 2018.

Book   Google Scholar  

Fusco CLB. Unsafe abortion: a serious public health issue in a poverty stricken population. Reprod Clim. 2013;2(8):2–9.

Google Scholar  

Rehnstrom Loi U, Gemzell-Danielsson K, Faxelid E, Klingberg-Allvin M. Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health. 2015;15(1):139. https://doi.org/10.1186/s12889-015-1502-2 .

Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):E323–E33. https://doi.org/10.1016/S2214-109X(14)70227-X .

Article   PubMed   Google Scholar  

Benson J, Nicholson LA, Gaffikin L, Kinoti SN. Complications of unsafe abortion in sub-Saharan Africa: a review. Health Policy Plan. 1996;11(2):117–31. https://doi.org/10.1093/heapol/11.2.117 .

Abiodun OM, Balogun OR, Adeleke NA, Farinloye EO. Complications of unsafe abortion in South West Nigeria: a review of 96 cases. Afr J Med Med Sci. 2013;42(1):111–5.

CAS   PubMed   Google Scholar  

Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2016;123(9):1489–98. https://doi.org/10.1111/1471-0528.13552 .

Article   CAS   PubMed   Google Scholar  

Vlassoff M, Walker D, Shearer J, Newlands D, Singh S. Estimates of health care system costs of unsafe abortion in Africa and Latin America. Int Perspect Sex Reprod Health. 2009;35(3):114–21. https://doi.org/10.1363/3511409 .

Singh S, Darroch JE. Adding it up: costs and benefits of contraceptive services. Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund; 2012.

Auger N, Bilodeau-Bertrand M, Sauve R. Abortion and infant mortality on the first day of life. Neonatology. 2016;109(2):147–53. https://doi.org/10.1159/000442279 .

Krieger N, Gruskin S, Singh N, Kiang MV, Chen JT, Waterman PD, et al. Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010. SSM Popul Health. 2016;2:277–93. https://doi.org/10.1016/j.ssmph.2016.03.007 .

Banaem LM, Majlessi F. A comparative study of low 5-minute Apgar scores (< 8) in newborns of wanted versus unwanted pregnancies in southern Tehran, Iran (2006-2007). J Matern Fetal Neonatal Med. 2008;21(12):898–901. https://doi.org/10.1080/14767050802372390 .

Bhandari A. Barriers in access to safe abortion services: perspectives of potential clients from a hilly district of Nepal. Trop Med Int Health. 2007;12:87.

Seid A, Yeneneh H, Sende B, Belete S, Eshete H, Fantahun M, et al. Barriers to access safe abortion services in East Shoa and Arsi Zones of Oromia Regional State, Ethiopia. J Health Dev. 2015;29(1):13–21.

Arroyave FAB, Moreno PA. A systematic bibliographical review: barriers and facilitators for access to legal abortion in low and middle income countries. Open J Prev Med. 2018;8(5):147–68. https://doi.org/10.4236/ojpm.2018.85015 .

Article   Google Scholar  

Boland R, Katzive L. Developments in laws on induced abortion: 1998-2007. Int Fam Plan Perspect. 2008;34(3):110–20. https://doi.org/10.1363/3411008 .

Lavelanet AF, Schlitt S, Johnson BR Jr, Ganatra B. Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion. BMC Int Health Hum Rights. 2018;18(1):44. https://doi.org/10.1186/s12914-018-0183-1 .

United Nations Population Division. Abortion policies: A global review. Major dimensions of abortion policies. 2002 [Available from: https://www.un.org/en/development/desa/population/publications/abortion/abortion-policies-2002.asp .

Johnson BR, Lavelanet AF, Schlitt S. Global abortion policies database: a new approach to strengthening knowledge on laws, policies, and human rights standards. Bmc Int Health Hum Rights. 2018;18(1):35. https://doi.org/10.1186/s12914-018-0174-2 .

Haaland MES, Haukanes H, Zulu JM, Moland KM, Michelo C, Munakampe MN, et al. Shaping the abortion policy - competing discourses on the Zambian termination of pregnancy act. Int J Equity Health. 2019;18(1):20. https://doi.org/10.1186/s12939-018-0908-8 .

Schatz JJ. Zambia’s health-worker crisis. Lancet. 2008;371(9613):638–9. https://doi.org/10.1016/S0140-6736(08)60287-1 .

Erdman JN, Johnson BR. Access to knowledge and the Global Abortion Policies Database. Int J Gynecol Obstet. 2018;142(1):120–4. https://doi.org/10.1002/ijgo.12509 .

Cleeve A, Oguttu M, Ganatra B, Atuhairwe S, Larsson EC, Makenzius M, et al. Time to act-comprehensive abortion care in east Africa. Lancet Glob Health. 2016;4(9):E601–E2. https://doi.org/10.1016/S2214-109X(16)30136-X .

Berer M, Hoggart L. Medical abortion pills have the potential to change everything about abortion. Contraception. 2018;97(2):79–81. https://doi.org/10.1016/j.contraception.2017.12.006 .

Moseson H, Shaw J, Chandrasekaran S, Kimani E, Maina J, Malisau P, et al. Contextualizing medication abortion in seven African nations: A literature review. Health Care Women Int. 2019;40(7-9):950–80. https://doi.org/10.1080/07399332.2019.1608207 .

Blystad A, Moland KM. Comparative cases of abortion laws and access to safe abortion services in sub-Saharan Africa. Trop Med Int Health. 2017;22:351.

Berer M. Abortion law and policy around the world: in search of decriminalization. Health Hum Rights. 2017;19(1):13–27.

PubMed   PubMed Central   Google Scholar  

Johnson BR, Mishra V, Lavelanet AF, Khosla R, Ganatra B. A global database of abortion laws, policies, health standards and guidelines. B World Health Organ. 2017;95(7):542–4. https://doi.org/10.2471/BLT.17.197442 .

Replogle J. Nicaragua tightens up abortion laws. Lancet. 2007;369(9555):15–6. https://doi.org/10.1016/S0140-6736(07)60011-7 .

Keogh LA, Newton D, Bayly C, McNamee K, Hardiman A, Webster A, et al. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. J Fam Plann Reprod Health Care. 2017;43(1):18–24. https://doi.org/10.1136/jfprhc-2016-101541 .

Levels M, Sluiter R, Need A. A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010. Health Policy. 2014;118(1):95–104. https://doi.org/10.1016/j.healthpol.2014.06.008 .

Serbanescu F, Morris L, Stupp P, Stanescu A. The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania. Stud Fam Plann. 1995;26(2):76–87. https://doi.org/10.2307/2137933 .

Henderson JT, Puri M, Blum M, Harper CC, Rana A, Gurung G, et al. Effects of Abortion Legalization in Nepal, 2001-2010. PLoS ONE. 2013;8(5):e64775. https://doi.org/10.1371/journal.pone.0064775 .

Goncalves-Pinho M, Santos JV, Costa A, Costa-Pereira A, Freitas A. The impact of a liberalisation law on legally induced abortion hospitalisations. Eur J Obstet Gynecol Reprod Biol. 2016;203:142–6. https://doi.org/10.1016/j.ejogrb.2016.05.037 .

Latt SM, Milner A, Kavanagh A. Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries. BMC Women’s Health. 2019;19(1). https://doi.org/10.1186/s12905-018-0705-y .

Clarke D, Muhlrad H. Abortion laws and women’s health. IZA discussion papers 11890. Bonn: IZA Institute of Labor Economics; 2018.

Benson J, Andersen K, Samandari G. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh. Reprod Health. 2011;8(39). https://doi.org/10.1186/1742-4755-8-39 .

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj-Brit Med J. 2015;349.

William R. Shadish, Thomas D. Cook, Donald T. Campbell. Experimental and quasi-experimental designs for generalized causal inference. Boston, New York; 2002.

Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55. https://doi.org/10.1093/ije/dyw098 .

Bernal JL, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol. 2018;47(6):2082–93. https://doi.org/10.1093/ije/dyy135 .

Meyer BD. Natural and quasi-experiments in economics. J Bus Econ Stat. 1995;13(2):151–61.

Strumpf EC, Harper S, Kaufman JS. Fixed effects and difference in differences. In: Methods in Social Epidemiology ed. San Francisco CA: Jossey-Bass; 2017.

Abadie A, Diamond A, Hainmueller J. Synthetic control methods for comparative case studies: estimating the effect of California’s Tobacco Control Program. J Am Stat Assoc. 2010;105(490):493–505. https://doi.org/10.1198/jasa.2009.ap08746 .

Article   CAS   Google Scholar  

Abadie A, Diamond A, Hainmueller J. Comparative politics and the synthetic control method. Am J Polit Sci. 2015;59(2):495–510. https://doi.org/10.1111/ajps.12116 .

Moscoe E, Bor J, Barnighausen T. Regression discontinuity designs are underutilized in medicine, epidemiology, and public health: a review of current and best practice. Journal of Clinical Epidemiology. 2015;68(2):132–43. https://doi.org/10.1016/j.jclinepi.2014.06.021 .

Dennis A, Blanchard K, Bessenaar T. Identifying indicators for quality abortion care: a systematic literature review. J Fam Plan Reprod H. 2017;43(1):7–15. https://doi.org/10.1136/jfprhc-2015-101427 .

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4 .

Jackson JL, Kuriyama A, Anton A, Choi A, Fournier JP, Geier AK, et al. The accuracy of Google Translate for abstracting data from non-English-language trials for systematic reviews. Ann Intern Med. 2019.

Reeves BC, Wells GA, Waddington H. Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels. J Clin Epidemiol. 2017;89:30–42. https://doi.org/10.1016/j.jclinepi.2017.02.016 .

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD .

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186 .

Download references

Acknowledgements

We thank Genevieve Gore, Liaison Librarian at McGill University, for her assistance with refining the research question, keywords, and Mesh terms for the preliminary search strategy.

The authors acknowledge funding from the Fonds de recherche du Quebec – Santé (FRQS) PhD doctoral awards and Canadian Institutes of Health Research (CIHR) Operating Grant, “Examining the impact of social policies on health equity” (ROH-115209).

Author information

Authors and affiliations.

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada

Foluso Ishola, U. Vivian Ukah & Arijit Nandi

You can also search for this author in PubMed   Google Scholar

Contributions

FI and AN conceived and designed the protocol. FI drafted the manuscript. FI, UVU, and AN revised the manuscript and approved its final version.

Corresponding author

Correspondence to Foluso Ishola .

Ethics declarations

Ethics approval and consent to participate.

Not applicable

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1:.

PRISMA-P 2015 Checklist. This checklist has been adapted for use with systematic review protocol submissions to BioMed Central journals from Table 3 in Moher D et al: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015 4:1

Additional File 2:.

LMICs according to World Bank Data Catalogue. Country classification specified in the World Bank Data Catalogue to identify low- and middle-income countries

Additional File 3: Table 1

. Search strategy in Embase. Detailed search terms and filters applied to generate our search in Embase

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Ishola, F., Ukah, U.V. & Nandi, A. Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol. Syst Rev 10 , 192 (2021). https://doi.org/10.1186/s13643-021-01739-w

Download citation

Received : 02 January 2020

Accepted : 08 June 2021

Published : 28 June 2021

DOI : https://doi.org/10.1186/s13643-021-01739-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Abortion law/policies; Impact
• Unsafe abortion
• Contraception

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Introduction: The Politics of Abortion 50 Years after Roe

Katrina Kimport is a professor with the Department of Obstetrics, Gynecology, and Reproductive Sciences and a medical sociologist with the ANSIRH program at the University of California, San Francisco. Her research examines the (re)production of inequality in health and reproduction, with a topical focus on abortion, contraception, and pregnancy. She is the author of No Real Choice: How Culture and Politics Matter for Reproductive Autonomy (2022) and Queering Marriage: Challenging Family Formation in the United States (2014) and co-author, with Jennifer Earl, of Digitally Enabled Social Change (2011). She has published more than 75 articles in sociology, health research, and interdisciplinary journals.

[email protected]

Rebecca Kreitzer is an associate professor of public policy at the University of North Carolina at Chapel Hill. Her research focuses on gendered political representation and intersectional policy inequality in the US states. Much of her research focuses on the political dynamics of reproductive health care, especially surrounding contraception and abortion. She has published dozens of articles in political science, public policy, and law journals.

[email protected]

• Standard View
• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Open the PDF for in another window
• Permissions
• Cite Icon Cite
• Search Site

Katrina Kimport , Rebecca Kreitzer; Introduction: The Politics of Abortion 50 Years after Roe . J Health Polit Policy Law 1 August 2023; 48 (4): 463–484. doi: https://doi.org/10.1215/03616878-10451382

Download citation file:

• Reference Manager

Abortion is central to the American political landscape and a common pregnancy outcome, yet research on abortion has been siloed and marginalized in the social sciences. In an empirical analysis, the authors found only 22 articles published in this century in the top economics, political science, and sociology journals. This special issue aims to bring abortion research into a more generalist space, challenging what the authors term “the abortion research paradox,” wherein abortion research is largely absent from prominent disciplinary social science journals but flourishes in interdisciplinary and specialized journals. After discussing the misconceptions that likely contribute to abortion research siloization and the implications of this siloization for abortion research as well as social science knowledge more generally, the authors introduce the articles in this special issue. Then, in a call for continued and expanded research on abortion, the introduction to this special issue closes by offering three guiding practices for abortion scholars—both those new to the topic and those deeply familiar with it—in the hopes of building an ever-richer body of literature on abortion politics, policy, and law. The need for such a robust literature is especially acute following the US Supreme Court's June 2022 overturning of the constitutional right to abortion.

Abortion has been both siloed and marginalized in social science research. But because abortion is a perennially politically and socially contested issue as well as vital health care that one in four women in the United States will experience in their lifetime (Jones and Jerman 2022 ), it is imperative that social scientists make a change. This special issue brings together insightful voices from across disciplines to do just that—and does so at a particularly important historical moment. Fifty years after the United States Supreme Court's Roe v. Wade (1973) decision set a national standard amid disparate state policies on abortion, we again find ourselves in a country with a patchwork of laws about abortion. In Dobbs v. Jackson Women's Health Organization (2022), the Supreme Court overturned the constitutional right to abortion it had established in Roe , purportedly returning the question of legalization of abortion to the states. In the immediate aftermath of the Dobbs decision, state policies polarized, and public opinion shifted. This moment demands scholarly evaluation of where we have been, how we arrived at this moment, and what we should be attentive to in coming years. This special issue came about, in part, in response to the on-the-ground conditions of abortion in the United States.

As we argue below, the siloization of abortion research means that the social science literature broadly is not (yet) equipped to make sense of this moment, our history, and what the future holds. First, though, we make a case for the importance of political scientists, economists, and sociologists studying abortion. Then we describe the siloization of abortion research through what we call the “abortion research paradox,” wherein abortion research—despite its social and political import—is curiously absent from top disciplinary journals, even as it thrives in other publication venues that are often interdisciplinary and usually specialized. We theorize some reasons for this siloization and discuss the consequences, both for generalist knowledge and for scientific understanding of abortion. We then introduce the articles in this special issue, noting the breadth of methodological, topical, and theoretical approaches to abortion research they demonstrate. Finally, we offer three suggestions for scholars—both those new to abortion research and those already deeply familiar with it—embarking on abortion research in the hopes of building an ever-richer body of literature on abortion politics, policy, and law.

• Why Abortion?

Abortion has arguably shaped the American political landscape more than any other domestic policy issue in the last 50 years. Since the Supreme Court initially established a nationwide right to abortion in Roe v. Wade (1973), debate over this right has influenced elections at just about every level of office (Abramowitz 1995 ; Cook, Hartwig, and Wilcox 1993 ; Cook, Jelen, and Wilcox 1994 ; Cook, Jelen, and Wilcox 1992 ; Paolino 1995 ; Roh and Haider-Markel 2003 ), inspired political activism (Carmines and Woods 2002 ; Killian and Wilcox 2008 ; Maxwell 2002 ; Verba, Schlozman, and Brady 1995 ) and social movements (Kretschmer 2014 ; Meyer and Staggenborg 1996 , 2008 ; Munson 2010a , Munson 2010b ; Rohlinger 2006 ; Staggenborg 1991 ), and fundamentally structured partisan politics (Adams 1997; Carsey and Layman 2006 ; Killian and Wilcox 2008 ). Position on abortion is frequently used as the litmus test for those seeking political office (Flaten 2010 ; Kreitzer and Osborn 2019 ). Opponents to legal abortion have transformed the federal judiciary (Hollis-Brusky and Parry 2021 ; Hollis-Brusky and Wilson 2020 ). Indeed, abortion is often called the quintessential “morality policy” issue (Kreitzer 2015 ; Kreitzer, Kane, and Mooney 2019 ; Mooney 2001 ; Mucciaroni, Ferraiolo, and Rubado 2019 ) and “ground zero” in the prominent culture wars that have polarized Americans (Adams 1997 ; Lewis 2017 ; Mouw and Sobel 2001 ; Wilson 2013 ). Almost fifty years after Roe v. Wade , in June 2022, the US Supreme Court overturned the constitutional right to abortion in its Dobbs v. Jackson Women's Health Organization decision, ushering in a new chapter of political engagement on abortion.

But abortion is not simply an abstract political issue; it is an extremely common pregnancy outcome. Indeed, as noted above, about one in four US women will get an abortion in her lifetime (Jones and Jerman 2022 ), although the rates of unintended pregnancy and abortion vary substantially across racial and socioeconomic groups (Dehlendorf, Harris, and Weitz 2013 ; Jones and Jerman 2022 ). Despite rampant misinformation claiming otherwise, abortion is a safe procedure (Raymond and Grimes 2012 ; Upadhyay et al. 2015 ), reduces physical health consequences and mortality (Gerdts et al. 2016 ), and does not cause mental health issues (Charles et al. 2008 ; Major et al. 2009 ) or regret (Rocca et al. 2013 , 2015 , 2020 ). Abortion also has a significant impact on people's lives beyond health outcomes. Legal abortion is associated with educational attainment (Everett et al. 2019 ; Ralph et al. 2019 ; Mølland 2016 ) as well as higher female labor force participation, and it affects men's and women's long-term earning potential (Bernstein and Jones 2019 ; Bloom et al. 2009 ; Everett et al. 2019 ; Kalist 2004 ). Access to abortion also shapes relationship satisfaction and stability (Biggs et al. 2014 ; Mauldon, Foster, and Roberts 2015 ). The preponderance of evidence, in other words, demonstrates substantial benefits and no harms to allowing pregnant people to choose abortion.

Yet access to abortion in the United States has been rapidly declining for years. Most abortion care in the United States takes place in stand-alone outpatient facilities that primarily provide reproductive health care (Jones, Witwer, and Jerman 2019 ). As antiabortion legislators in some states have advanced policies that target these facilities, the number of abortion clinics has decreased (Gerdts et al. 2022 ; Venator and Fletcher 2021 ), leaving large geographical areas lacking an abortion facility (Cartwright et al. 2018 ; Cohen and Joffe 2020 ) and thus diminishing pregnant people's ability to obtain abortion care when and where they need it.

The effects of policies regulating abortion, including those that target facilities, have been unevenly experienced, with people of color (Jones and Jerman 2022 ), people in rural areas (Bearak, Burke, and Jones 2017 ), and those who are financially struggling (Cook et al. 1999 ; Roberts et al. 2019 ) disproportionately affected. Even before the Dobbs decision overturned the constitutional right to abortion, the American landscape was characterized by ever-broadening contraception deserts (Axelson, Sealy, and McDonald-Mosley 2022 ; Barber et al. 2019 ; Kreitzer et al. 2021 ; Smith et al. 2022 ), maternity care deserts (Simpson 2020 ; Taporco et al. 2021 ; Wallace et al. 2021 ), and abortion deserts (Cartwright et al. 2018 ; Cohen and Joffe 2020 ; Engle and Freeman 2022 ; McNamara et al. 2022 ; Pleasants, Cartwright, and Upadhyay 2022 ). After Dobbs , access to abortion around the country changed in a matter of weeks. In the 100 days after Roe was overturned, at least 66 clinics closed in 15 states, with 14 of those states no longer having any abortion facilities (Kirstein et al. 2022 ). In this moment of heightened contention about an issue with a long history of social and political contestation, social scientists have a rich opportunity to contribute to scientific knowledge as well as policy and practice that affect millions of lives. This special issue steps into that opportunity.

• The Abortion Research Paradox

This special issue is also motivated by what we call the abortion research paradox. As established above, abortion fundamentally shapes politics in a myriad of ways and is a very common pregnancy outcome, with research consistently demonstrating that access to abortion is consequential and beneficial to people's lives. However, social science research on abortion is rarely published in top disciplinary journals. Abortion is a topic of clear social science interest and is well suited for social science inquiry, but it is relatively underrepresented as a topic in generalist social science journals. To measure this underrepresentation empirically, we searched for original research articles about abortion in the United Sates in the top journals of political science, sociology, and economics. We identified the top three journals for each discipline by considering journal reputation within their respective discipline as well as impact factors and Google Scholar rankings. (There is room for debate about what makes a journal a “top” general interest journal, but that is beyond our scope. Whether these journals are exactly the top three is debatable; nonetheless, these are undoubtedly among the top general-interest or “flagship” disciplinary journals and thus representative of what the respective disciplines value as top scholarship.) Then we searched specified journal databases for the keyword “abortion” for articles published in this century (i.e., 2000–2021), excluding commentaries and book reviews. We found few articles about abortion: just seven in economics journals, eight in political science journals, and seven in sociology journals. We read the articles and classified each into one of three categories: articles primarily about abortion; articles about more than one aspect of reproductive health, inclusive of abortion; or articles about several policy issues, among which abortion is one ( table 1 ).

In the three top economics journals, articles about abortion focused on the relationships between abortion and crime or educational attainment, or on the impact of abortion policies on trends in the timing of first births of women (Bitler and Zavodny 2002 ; Donohue III and Levitt 2001 ; Myers 2017 ). Articles that studied abortion as one among several topics also studied “morally controversial” issues (Elías et al. 2017 ), the electoral implications of abortion (Glaeser, Ponzetto, and Shapiro 2005 ; Washington 2008 ), or contraception (Bailey 2010 ). Articles published in the three top political science journals that focused primarily on abortion evaluated judicial decision-making and legitimacy (Caldarone, Canes-Wrone, and Clark 2009 ; Zink, Spriggs, and Scott 2009 ) or public opinion (Kalla, Levine, and Broockman 2022 ; Rosenfeld, Imai, and Shapiro 2016 ). More commonly, abortion was one of several (or many) different issues analyzed, including government spending and provision of services, government help for African Americans, law enforcement, health care, education, free speech, Hatch Act restrictions, and the Clinton impeachment. The degree to which these articles are “about abortion” varies considerably. In the three top sociology journals, articles represented a slightly broader range of topics, including policy diffusion (Boyle, Kim, and Longhofer 2015 ), public opinion (Mouw and Sobel 2001 ), social movements (Ferree 2003 ), and crisis pregnancy centers (McVeigh, Crubaugh, and Estep 2017 ). Unlike in economics and political science, articles in sociology on abortion mostly focused directly on abortion.

The Journal of Health Politics, Policy and Law ( JHPPL ) would seem well positioned to publish research on abortion. Yet, even in JHPPL , abortion research is not very common. In the same time period (2000–2021), JHPPL published five articles on reproductive health: two articles on abortion (Daniels et al. 2016 ; Kimport, Johns, and Upadhyay 2018 ), one on contraception (Kreitzer et al. 2021 ), one on forced interventions on pregnant people (Paltrow and Flavin 2013 ), and one about how states could respond to the passage of the Affordable Care Act mandate regarding reproductive health (Stulberg 2013 ).

This is not to say that there is no extensive, rigorous published research on abortion in the social science literature. Interdisciplinary journals that are focused on reproductive health, such as Contraception and Perspectives on Sexual and Reproductive Health , as well as health research journals, such as the American Journal of Public Health and Social Science & Medicine , regularly published high-quality social science research on abortion during the focal time period. Research on abortion can also be found in disciplinary subfield journals. In the same time period addressed above, the Journal of Women, Politics, and Public Policy and Politics & Gender— two subfield journals focused on gender and politics—each published around 20 articles that mentioned abortion in the abstract. In practice, while this means excellent research on abortion is published, the net effect is that abortion research is siloed from other research areas in the disciplines of economics, political science, and sociology. This special issue aims to redress some of this siloization and to inspire future scholarship on abortion. Our motivation is not simply premised on quantitative counts, however. As we assert below, abortion research siloization has significant consequences for knowledge—and especially for real people's lives. First, though, we consider some of the possible reasons for this siloization.

• The Origins of Siloization

We do not know why abortion research is not more commonly published in top disciplinary journals, given the topic's clear importance in key areas of focus for these disciplines, including public discourse, politics, law, family life, and health. The siloing and marginalization of abortion is likely related to several misconceptions. For one, because of social contention on the issue, peer reviewers may not have a deep understanding of abortion as a research topic, may express hostility to the topic, or may believe that abortion is exceptional in some way—a niche or ungeneralizable research topic better published in a subfield journal. Scholars themselves may share this mischaracterization of abortion. As Borgman ( 2014 ) argues about the legal arena, and as Roberts, Schroeder, and Joffe ( 2020 ) provide evidence of in medicine, abortion is regularly treated as exceptional, making it both definitional and reasonable that abortion be treated differently in the law and in health care from other medical experiences. Scholars are not immune to social patterns that exceptionalize abortion. In their peer and editor reviews, they may inappropriately—and perhaps inadvertently—draw on their social, rather than academic, knowledge. For scholars of abortion, reviews premised on social knowledge may not be constructive to strengthening the research, and additional labor may be required to educate reviewers and editors on the academic parameters of the topic, including which social assumptions about abortion are scientifically inaccurate. Comments from authors educating editors and peer reviewers on abortion research may then counterintuitively reinforce the (mis)perception that abortion research is niche and not of general interest.

Second, authors' negative experiences while trying to publish about abortion or reproductive health in top disciplinary journals may compound as scholars share information about journals. This is the case for research on gender; evidence from political science suggests that certain journals are perceived as more or less likely to publish research on gender (Brown et al. 2020 ). Such reputations, especially for venues that do not publish abortion research, may not even be rooted in negative experiences. The absence of published articles on abortion may itself dissuade scholars from submitting to a journal based on an educated guess that the journal does not welcome abortion research. Regardless of the veracity of these perceptions, certain journals may get a reputation for publishing on abortion (or not), which then may make future submissions of abortion research to those outlets more (or less) likely. After all, authors seek publication venues where they believe their research will get a robust review and is likely to be published. This pattern may be more common for some author groups than others. Research from political science suggests women are more risk averse than men when it comes to publishing strategies and less likely to submit manuscripts to journals where the perceived likelihood of successful publication is lower (Key and Sumner 2019 ). Special issues like this one are an important way for journals without a substantial track record of publishing abortion research to establish their willingness to do so.

Third, there might be a methodological bias, which unevenly intersects with some author groups. Top disciplinary journals are more likely to publish quantitative approaches rather than qualitative ones, which can result in the exclusion of women and minority scholars who are more likely to utilize mixed or qualitative methods (Teele and Thelen 2017 ). To the extent that investigations of abortion in the social sciences have utilized qualitative rather than quantitative methods, that might contribute to the underrepresentation of abortion-focused scholarship in top disciplinary journals.

Stepping back from the idiosyncrasies of peer review and methodologies, a fourth explanation for why abortion research is not more prominent in generalist social science journals may arise far earlier than the publishing process. PhD-granting departments in the social sciences may have an undersupply of scholars with expertise in reproductive health who can mentor junior scholars interested in studying abortion. (We firmly believe one need not be an expert in reproductive health to mentor junior scholars studying reproductive health, so this explanation only goes so far.) Anecdotally, we have experienced and heard many accounts of scholars who were discouraged from focusing on abortion in dissertation research because of advisors', mentors', and senior scholars' misconceptions about the topic and about the viability of a career in abortion research. In data provided to us by Key and Sumner from their analysis of the “leaky pipeline” in the publication of research on gender at top disciplinary journals in political science (Key and Sumner 2019 ), there were only nine dissertations written between 2000 and 2013 that mention abortion in the abstract, most of which are focused on judicial behavior or political party dynamics rather than focusing on abortion policy itself. If few junior scholars focus on abortion, it makes sense there may be an undersupply of cutting-edge social science research on abortion submitted to top disciplinary journals.

• The Implications of Siloization

The relative lack of scholarly attention to abortion as a social phenomenon in generalist journals has implications for general scholarship. Most concerningly, it limits our ability to understand other social phenomena for which the case of abortion is a useful entry point. For example, the case of abortion as a common, highly safe medical procedure is useful for examining medical innovations and technologies, such as telemedicine. Similarly, given the disparities in who seeks and obtains abortion care in the United States, abortion is an excellent case study for scholars interested in race, class, and gender inequality. It also holds great potential as an opportunity for exploration of public opinion and attitudes, particularly as a case of an issue whose ties to partisan politics have solidified over time and that is often—but not always—“moralized” in policy engagement (Kreitzer, Kane, and Mooney 2019 ). Additionally, there are missed opportunities to generate theory from the specifics of abortion. For example, there is ample evidence of abortion stigma and stigmatization (Hanschmidt et al. 2016 ) and of their effects on people who obtain abortions (Sorhaindo and Lavelanet 2022 ). This research is often unmoored from existing theorization on stigmatization, however, because the bulk of the stigma literature focuses on identities; and having had an abortion is not an identity the same way as, for example, being queer is. (For a notable exception to this trend, see Beynon-Jones 2017 .)

There is, it must be noted, at least one benefit of abortion research being regularly siloed within social science disciplines. The small but growing number of researchers engaged in abortion research has often had to seek mentorship and collaborations outside their disciplines. Indeed, several of the articles included in this special issue come from multidisciplinary author teams, building bridges between disciplinary literatures and pushing knowledge forward. Social scientists studying abortion regularly engage with research by clinicians and clinician-researchers, which is somewhat rare in the academy. The interdisciplinary journals noted above that regularly publish social science abortion research ( Contraception and Perspectives on Sexual and Reproductive Health ) also regularly publish clinical articles and are read by advocates and policy makers. In other words, social scientists studying abortion frequently reach audiences that include clinicians, advocates, and policy makers, marking an opportunity for social science research to influence practice.

The siloization of abortion research in the social sciences affects more than broad social science knowledge; it also dramatically shapes our understanding of abortion. When abortion researchers are largely relegated to their own spaces, they risk missing opportunities to learn from other areas of scholarship that are not related to abortion. Lacking context from other topics, abortion scholars may inaccurately understand an aspect of abortion as exceptional that is not, or they may reinvent the proverbial theoretical wheel to describe an abortion-related phenomenon that is not actually unique to abortion. For example, scholars have studied criminalized behavior for decades, offering theoretical insights and methodological best practices for research on illegal activities. With abortion now illegal in many states, abortion researchers can benefit from drawing on that extant literature to examine the implications of illegality, identifying which aspects of abortion illegality are unique and which are common to other illegal activities. Likewise, methodologically, abortion researchers can learn from other researchers of illegal activities about how to protect participants' confidentiality.

The ontological and epistemological implications for the siloization of abortion research extend beyond reproductive health. When abortion research is not part of the central discussions in economics, political science, and sociology, our understanding of health policy, politics, and law is impoverished. We thus miss opportunities to identify and address chronic health disparities and health inequities, with both conceptual and practical consequences. These oversights matter for people's lives. Following the June 2022 Dobbs decision, millions of people with the capacity of pregnancy are now barred from one key way to control fertility: abortion. The implications of scholars' failure to comprehensively grapple with the place of abortion in health policy, politics, and law are playing out in those people's lives and the lives of their loved ones.

Articles in this Special Issue

In this landscape, we offer this special issue on “The Politics of Abortion 50 Years After Roe .” We seek in this issue to illustrate some of the many ways abortion can and should be studied, with benefits not only for scholarly knowledge about abortion and its role in policy, politics, and law but also for general knowledge about health policy, politics, and law themselves.

The issue's articles represent multiple disciplines, including several articles by multidisciplinary teams. Although public health has long been a welcoming home for abortion research, authors in this special issue point to opportunities in anthropology, sociology, and political science, among other disciplines, for the study of abortion. We do not see the differences and variations among disciplinary approaches as a competition. Rather, we believe that the more diverse the body of researchers grappling with questions about abortion, abortion provision, and abortion patients, the better our collective knowledge about abortion and its role in the social landscape.

The same goes for diversity of methodological approaches. Authors in this issue employ qualitative, quantitative, and mixed methods, showcasing compelling methodological variation. There is no singular or best methodology for answering research questions about abortion. Instead, the impressive variation in methodological approaches in this special issue highlights the vast methodological opportunities for future research. A diversity of methodologies enables a diversity of research questions. Indeed, different methods can identify, generate, and respond to different research questions, enriching the literature on abortion. The methodologies represented in this issue are certainly not exhaustive, but we believe they are suggestive of future opportunities for scholarly exploration and investigation. We hope these articles will provide a road map for rich expansions of the research literature on abortion.

By way of brief introduction, we offer short summaries of the included articles. Baker traces the history of medication abortion in the United States, cataloging the initial approval of the two-part regimen by the Food and Drug Administration (FDA), subsequent policy debates over FDA-imposed restrictions on how medication abortion is dispensed, and the work of abortion access advocates to get medication abortion to people who need it. Weaving together accounts of health care policy, abortion advocacy, and on-the-ground activism, Baker illustrates both the unique contentions specific to abortion policy and how the history of medication abortion can be seen as a case of health care advocacy.

Two of the issue's articles focus on state-level legislative policy on abortion. Roth and Lee generate an original data set cataloging the introduction and implementation of statutes on abortion and other aspects of reproductive health at the state level in the United States monthly, from 1994 to 2022. In their descriptive analysis, the authors highlight trends in abortion legislation and the emergent pattern of state polarization around abortion. Their examination adds rich longitudinal context to contemporary analyses of reproductive health legislation, providing a valuable resource for future scholarship. Carson and Carter similarly attend to state-level legislation, zeroing in on the case of abortion policy in response to the COVID-19 pandemic to show how legislation unrelated to abortion has been opportunistically used to restrict abortion access. The authors also examine how abortion is discursively constructed as a risk to public health. This latter move, they argue, builds on previous constructions of abortion as a risk to individual health and points to a new horizon of antiabortion constructions of the meaning of abortion access.

Kim et al. and Kumar examine the implementation of US abortion policies. Kim et al. use an original data set of 20 years of state supreme court decisions to investigate factors that affect state supreme court decision-making on abortion. Their regression analysis uncovers the complex relationship between state legislatures, state supreme courts, and the voting public for the case of abortion. Kumar charts how 50 years of US abortion policy have affected global access to abortion, offering insights into the underexamined international implications of US abortion policy and into social movement advocacy that has expanded abortion access around the world.

Karlin and Joffe and Heymann et al. draw on data collected when Roe was still the law of the land to investigate phenomena that are likely to become far more common now that Roe has been overturned. Karlin and Joffe utilize interviews with 40 physicians who provide abortions to examine their perspectives on people who terminate their pregnancies outside the formal health care system—an abortion pathway whose popularity increases when abortion access constricts (Aiken et al. 2022 ). By contextualizing their findings on the contradictions physicians voiced—desiring to support reproductive autonomy but invested in physician authority—in a historical overview of how mainstream medicine has marginalized abortion provision since the early days after Roe , the authors add nuance to understandings of the “formal health care system,” its members, and the stakes faced by people bypassing this system to obtain their desired health outcome. Heymann et al. investigate a process also likely to increase in the wake of the Dobbs decision: the implementation of restrictive state-level abortion policy by unelected bureaucrats. Using the case of variances for a written transfer agreement requirement in Ohio—a requirement with no medical merit that is designed to add administrative burden to stand-alone abortion clinics—Heymann et al. demonstrate how bureaucratic discretion by political appointees can increase the administrative burden of restrictive abortion laws and thus further constrain abortion access. Together, these two articles demonstrate how pre- Roe data can point scholars to areas that merit investigation after Roe has been overturned.

Finally, using mixed methods, Buyuker et al. analyze attitudes about abortion acceptability and the Roe v. Wade Supreme Court decision, distinguishing what people think about abortion from what they know about abortion policy. In addition to providing methodological insights about survey items related to abortion attitudes, the authors expose a disconnect between how people think about abortion acceptability and their support for the Roe decision. In other words, as polarized as abortion attitudes are said to be, there is unacknowledged and largely unmeasured complexity in how the general public thinks about abortion.

Future Research on Abortion

We hope that a desire to engage in abortion research prompts scholars to read the excellent articles in this special issue. We also hope that reading these pieces inspires at least some readers to engage in abortion research. Having researched abortion for nearly three decades between us, we are delighted by the emerging interest in studying abortion, whether as a focal topic or alongside a different focus. This research is essential to our collective understanding of abortion politics, policy, and law and the many millions of people whose lives are affected by US abortion politics, policy, and law annually. In light of the limitations of the current field of abortion research, we have several suggestions for scholars of abortion, regardless of their level of familiarity with the topic.

First, know and cite the existing literature on abortion. To address the siloization of abortion research, and particularly the scarcity of abortion research published in generalist journals, scholars must be sure to build on the impressive work that has been published on the topic in specialized spaces. Moreover, becoming familiar with existing research can help scholars avoid several common pitfalls in abortion research. For example, being immersed in existing literature can help scholars avoid outdated, imprecise, or inappropriate language and terminology. Smith et al. ( 2018 ), for instance, illuminate the implications of clinicians deploying seemingly everday language around “elective” abortion. They find that it muddies the distinction between the use of “elective” colloquially and in clinical settings, contributing to the stigmatization of abortion and abortion patients. Examinations like theirs advance understanding of abortion stigmatization while highlighting for scholars the importance of being sensitive to and reflective about language. Familiarity with existing research can help scholars avoid methodological pitfalls as well, such as incomplete understanding of the organization of abortion provision. Although Planned Parenthood has brand recognition for providing abortion care, the majority of abortions in the United States are performed at independent abortion clinics. Misunderstanding the provision landscape can have consequences for some study designs.

Second, we encourage scholars of abortion to think critically about the ideological underpinnings of how their research questions and findings are framed. Academic research of all kinds, including abortion, is better when it is critical of ideologically informed premises. Abortion scholars must be careful to avoid uncritically accepting both antiabortion premises and abortion-supportive premises, especially as those premises unconsciously guide much of the public discourse on abortion. Scholars have the opportunity to use methodological tools not to find an objective truth per se but to challenge the uncontested common sense claims that frequently guide public thinking on abortion. One strategy for avoiding common framing pitfalls is to construct research and analysis to center the people most affected by abortion politics, policy, and law (Kimport and McLemore 2022 ). Another strategy is to critique what Baird and Millar ( 2019 , 2020 ) have termed the performative nature of abortion scholarship. Abortion scholarship, they note, has predominantly focused on negative aspects and effects of abortion care. Research that finds and explores affirmatively positive aspects—for instance, the joy in abortion—can crucially thicken scholarly understanding.

Third, related to our discussion above, scholars of abortion face an interesting challenge regarding how abortion is and is not exceptional. Research on abortion must attend to how abortion has been exceptionalized—and marginalized—in policy and practices. But there are also numerous instances where abortion is only one example of many. In these cases, investigation of abortion under the assumption that it is exceptional is an unnecessary limitation on the work's contribution. Scholars of abortion benefit from mastery of the literature on abortion, yet knowing this literature is not sufficient. There are important bridges from scholarship on abortion to scholarship in other areas, important conversations across and within literatures, that can yield insights both about abortion and about other topical foci.

As guest coeditors of this special issue, we are delighted by the rich and growing body of scholarship on abortion, to which the articles in this special issue represent an important addition. There is still much more work to be done. Going forward, we are eager to see future scholarship on abortion build on this work and tackle new questions.

• Acknowledgments

The authors thank Krystale Littlejohn, Jon Oberlander, Ellen Key, and Jane Sumner for their helpful feedback on earlier drafts of this article. Both authors contributed equally to this article and are listed alphabetically.

• Previous Issue
• Next Article

Advertisement

Data & Figures

Number of Articles about Abortion in Top Disciplinary Journals, 2000–2021

Note : AER  =  American Economic Review ; QJE  =  Quarterly Journal of Economics ; JPE  =  Journal of Political Economy ; APSR  =  American Political Science Review ; AJPS  =  American Journal of Political Science ; JOP  =  Journal of Politics ; ASR  =  American Sociological Review ; AJS  =  American Journal of Sociology ; ARS  =  Annual Review of Sociology.

Supplements

Citing articles via, email alerts, related articles, related book chapters, related topics, affiliations.

• About Journal of Health Politics, Policy and Law
• Editorial Board
• For Authors
• Rights and Permissions Inquiry
• Online ISSN 1527-1927
• Print ISSN 0361-6878
• Copyright © 2024 Duke University Press
• Duke University Press
• 905 W. Main St. Ste. 18-B
• Durham, NC 27701
• (888) 651-0122
• International
• +1 (919) 688-5134
• Information For
• Advertisers
• Book Authors
• Booksellers/Media
• Journal Authors/Editors
• Journal Subscribers
• Prospective Journals
• Licensing and Subsidiary Rights
• View Open Positions
• email Join our Mailing List
• catalog Current Catalog
• Accessibility
• Get Adobe Reader

This Feature Is Available To Subscribers Only

Sign In or Create an Account

The independent source for health policy research, polling, and news.

Women’s Views of Abortion Access and Policies in the Dobbs Era: Insights From the KFF Health Tracking Poll

Audrey Kearney , Ashley Kirzinger , Liz Hamel , and Alina Salganicoff Published: Apr 05, 2024

• Methodology

Nearly two years after the Dobbs v. Jackson Women’s Health Organization Supreme Court ruling overturned Roe v. Wade , eliminating federal constitutional protections for abortion, abortion is banned in 14 states and limited by gestational limits in 11 others. The latest polling from KFF finds that women in states where abortion is banned are more likely to report personal connections to people who have had difficulty accessing abortion services since the overturn of Roe . Recent research has documented that many women who live in states where abortion is banned have traveled to other states to secure abortions. This can be costly and require them to take time off from work, find childcare, and in some cases make multiple visits to get abortion services. There have also been reports of women who have been denied abortions even though they meet the state standards for exemptions. Previous reporting from the KFF Health Tracking Poll examines women’s views on abortion policy including by partisanship, which is one of the strongest predictors of these views. This analysis examines women’s views by geography—specifically whether they live in a state where abortion is currently banned, limited, or legal.

One in Seven Women in States With Abortion Bans Say They or Someone They Know Has Had Difficulty Accessing an Abortion

Eight percent of women overall, rising to one in seven (14%) women of reproductive age (ages 18 to 49), say they or someone they know has had difficulty accessing an abortion due to restrictions in their state since Roe was overturned. Women living in states where abortion is banned are twice as likely to report knowing someone who had difficulty accessing an abortion compared to women living in states where abortion is limited or legal. One in seven (14%) women living in states where abortion is banned say they or someone they know has struggled to access an abortion due to restrictions on abortions in their state, including one in five (21%) women ages 18-49 living in these states. Fewer women in states where abortion is limited by gestational periods (6%) or in states where abortion is legal past 22 weeks of gestation (7%) say they or someone they know has experienced such difficulties.

A Majority of Women Living in States Where Abortion Is Banned Want Abortion To Be Legal, Support Laws Protecting Abortion Access

While there are some small differences in levels of support for abortion restrictions between women living in states where abortion is banned and those living in other states, majorities of women across states—including in those with abortion bans—think abortion should be legal in all or most cases and support a range of policies that protect abortion access.

Regardless of whether abortion in their state is banned, restricted, or legal, a majority of women think abortion should be legal in all or most cases, including two-thirds (67%) of women in states where abortion is banned and seven in ten (71%) in states where abortion is limited by gestational limits. A larger majority (81%) of women in states where abortion is currently legal say abortion should be legal in all or most cases. One in four women living in states where abortion is banned think abortion should be “illegal in most cases,” as do one in five women living in states where abortion is limited by gestational limits (19%) and women living in states where abortion is legal (17%). A small share of women, regardless of their state’s laws, say abortion should be “illegal in all cases” (8% of women living in states where abortion is banned, 10% in states with limited abortion access, 2% in states with legal abortions available).

A majority of women, regardless of the abortion laws in their state, support laws such as protecting abortion access for women experiencing pregnancy-related emergencies such as miscarriages, protecting the right to travel to get an abortion, and guaranteeing a federal right to abortion.

Regardless of the type of abortion restrictions in their state, fewer than half of women support laws that restrict or criminalize abortion access, though there are some variations in the level of support for different policies. Among women living in states where abortion is banned, just under half support establishing a federal 16-week ban on abortions (45%), and four in ten support prohibiting clinics that receive federal funding from providing abortions or referring patients to abortion providers (40%) or making it a crime for health care providers to mail abortion pills to state with abortion bans (38%). One-third support a national ban on mifepristone, the abortion medication (33%).

Fewer women in states where abortion is legal support establishing a federal ban on abortion at 16 weeks (33% vs. 45% among women in states where abortion is banned), likely reflecting underlying political differences between women who live in these types of states. In fact, four in ten (38%) women living in states where abortion is banned or limited either are or lean Republican, compared to about three in ten (28%) women living in states where abortion is legal. The largest predictor of support for these policies is political partisanship, even among women. For a further exploration on these partisanship differences, see previous reporting on this survey .

The issue of abortion access is likely to emerge in multiple forms in the November 2024 election. A number of states are moving forward with ballot initiatives to protect abortion rights at the state level. In addition, KFF polling shows that one in eight voters (12%) say abortion is the most important issue to their vote, largely comprised of adults who say abortion should be legal and support protections for abortion access. Notably, one in five women of reproductive age in states where abortion is banned say that either they or someone they personally know has had difficulty obtaining an abortion. Support for abortion protections including a federal guarantee to the right to abortion is robust among women, regardless of where they reside. While substantial minorities of women in states with abortion bans support some restrictions on abortion access, two-thirds of women living in these states think abortion should be legal in all or most cases, suggesting a disconnect between what women in these states support and the policies their state lawmakers have enacted.

• Women's Health Policy
• Reproductive Health
• Tracking Poll
• TOPLINE & METHODOLOGY

news release

• One in Five Women of Reproductive Age in States with Abortion Bans Say They or Someone They Know Has Had Difficulty Accessing an Abortion Since Dobbs

Also of Interest

• KFF Health Tracking Poll March 2024: Abortion in the 2024 Election and Beyond
• KFF Health Tracking Poll: The Public’s Views on the ACA
• KFF Health Tracking Poll: Early 2023 Update On Public Awareness On Abortion and Emergency Contraception

• Share full article

Advertisement

Supported by

Guest Essay

The Supreme Court Got It Wrong: Abortion Is Not Settled Law

By Melissa Murray and Kate Shaw

Ms. Murray is a law professor at New York University. Ms. Shaw is a contributing Opinion writer.

In his majority opinion in the case overturning Roe v. Wade, Justice Samuel Alito insisted that the high court was finally settling the vexed abortion debate by returning the “authority to regulate abortion” to the “people and their elected representatives.”

Despite these assurances, less than two years after Dobbs v. Jackson Women’s Health Organization, abortion is back at the Supreme Court. In the next month, the justices will hear arguments in two high-stakes cases that may shape the future of access to medication abortion and to lifesaving care for pregnancy emergencies. These cases make clear that Dobbs did not settle the question of abortion in America — instead, it generated a new slate of questions. One of those questions involves the interaction of existing legal rules with the concept of fetal personhood — the view, held by many in the anti-abortion movement, that a fetus is a person entitled to the same rights and protections as any other person.

The first case , scheduled for argument on Tuesday, F.D.A. v. Alliance for Hippocratic Medicine, is a challenge to the Food and Drug Administration’s protocols for approving and regulating mifepristone, one of the two drugs used for medication abortions. An anti-abortion physicians’ group argues that the F.D.A. acted unlawfully when it relaxed existing restrictions on the use and distribution of mifepristone in 2016 and 2021. In 2016, the agency implemented changes that allowed the use of mifepristone up to 10 weeks of pregnancy, rather than seven; reduced the number of required in-person visits for dispensing the drug from three to one; and allowed the drug to be prescribed by individuals like nurse practitioners. In 2021, it eliminated the in-person visit requirement, clearing the way for the drug to be dispensed by mail. The physicians’ group has urged the court to throw out those regulations and reinstate the previous, more restrictive regulations surrounding the drug — a ruling that could affect access to the drug in every state, regardless of the state’s abortion politics.

The second case, scheduled for argument on April 24, involves the Emergency Medical Treatment and Labor Act (known by doctors and health policymakers as EMTALA ), which requires federally funded hospitals to provide patients, including pregnant patients, with stabilizing care or transfer to a hospital that can provide such care. At issue is the law’s interaction with state laws that severely restrict abortion, like an Idaho law that bans abortion except in cases of rape or incest and circumstances where abortion is “necessary to prevent the death of the pregnant woman.”

Although the Idaho law limits the provision of abortion care to circumstances where death is imminent, the federal government argues that under EMTALA and basic principles of federal supremacy, pregnant patients experiencing emergencies at federally funded hospitals in Idaho are entitled to abortion care, even if they are not in danger of imminent death.

These cases may be framed in the technical jargon of administrative law and federal pre-emption doctrine, but both cases involve incredibly high-stakes issues for the lives and health of pregnant persons — and offer the court an opportunity to shape the landscape of abortion access in the post-Roe era.

These two cases may also give the court a chance to seed new ground for fetal personhood. Woven throughout both cases are arguments that gesture toward the view that a fetus is a person.

If that is the case, the legal rules that would typically hold sway in these cases might not apply. If these questions must account for the rights and entitlements of the fetus, the entire calculus is upended.

In this new scenario, the issue is not simply whether EMTALA’s protections for pregnant patients pre-empt Idaho’s abortion ban, but rather which set of interests — the patient’s or the fetus’s — should be prioritized in the contest between state and federal law. Likewise, the analysis of F.D.A. regulatory protocols is entirely different if one of the arguments is that the drug to be regulated may be used to end a life.

Neither case presents the justices with a clear opportunity to endorse the notion of fetal personhood — but such claims are lurking beneath the surface. The Idaho abortion ban is called the Defense of Life Act, and in its first bill introduced in 2024, the Idaho Legislature proposed replacing the term “fetus” with “preborn child” in existing Idaho law. In its briefs before the court, Idaho continues to beat the drum of fetal personhood, insisting that EMTALA protects the unborn — rather than pregnant women who need abortions during health emergencies.

According to the state, nothing in EMTALA imposes an obligation to provide stabilizing abortion care for pregnant women. Rather, the law “actually requires stabilizing treatment for the unborn children of pregnant women.” In the mifepristone case, advocates referred to fetuses as “unborn children,” while the district judge in Texas who invalidated F.D.A. approval of the drug described it as one that “starves the unborn human until death.”

Fetal personhood language is in ascent throughout the country. In a recent decision , the Alabama Supreme Court allowed a wrongful-death suit for the destruction of frozen embryos intended for in vitro fertilization, or I.V.F. — embryos that the court characterized as “extrauterine children.”

Less discussed but as worrisome is a recent oral argument at the Florida Supreme Court concerning a proposed ballot initiative intended to enshrine a right to reproductive freedom in the state’s Constitution. In considering the proposed initiative, the chief justice of the state Supreme Court repeatedly peppered Nathan Forrester, the senior deputy solicitor general who was representing the state, with questions about whether the state recognized the fetus as a person under the Florida Constitution. The point was plain: If the fetus was a person, then the proposed ballot initiative, and its protections for reproductive rights, would change the fetus’s rights under the law, raising constitutional questions.

As these cases make clear, the drive toward fetal personhood goes beyond simply recasting abortion as homicide. If the fetus is a person, any act that involves reproduction may implicate fetal rights. Fetal personhood thus has strong potential to raise questions about access to abortion, contraception and various forms of assisted reproductive technology, including I.V.F.

In response to the shifting landscape of reproductive rights, President Biden has pledged to “restore Roe v. Wade as the law of the land.” Roe and its successor, Planned Parenthood v. Casey, were far from perfect; they afforded states significant leeway to impose onerous restrictions on abortion, making meaningful access an empty promise for many women and families of limited means. But the two decisions reflected a constitutional vision that, at least in theory, protected the liberty to make certain intimate choices — including choices surrounding if, when and how to become a parent.

Under the logic of Roe and Casey, the enforceability of EMTALA, the F.D.A.’s power to regulate mifepristone and access to I.V.F. weren’t in question. But in the post-Dobbs landscape, all bets are off. We no longer live in a world in which a shared conception of constitutional liberty makes a ban on I.V.F. or certain forms of contraception beyond the pale.

Melissa Murray, a law professor at New York University and a host of the Supreme Court podcast “ Strict Scrutiny ,” is a co-author of “ The Trump Indictments : The Historic Charging Documents With Commentary.”

Kate Shaw is a contributing Opinion writer, a professor of law at the University of Pennsylvania Carey Law School and a host of the Supreme Court podcast “Strict Scrutiny.” She served as a law clerk to Justice John Paul Stevens and Judge Richard Posner.

• MJC Library & Learning Center
• Research Guides
• Abortion Research

Start Learning About Your Topic

Create research questions to focus your topic, featured current news, find articles in library databases, find web resources, find books in the library catalog, cite your sources, key search words.

Use the words below to search for useful information in books and articles .

• birth control
• pro-choice movement
• pro-life movement
• reproductive rights
• Roe v. Wade
• Dobbs v. Jackson Women's Health Organization (Dobbs v. Jackson)

Background Reading:

It's important to begin your research learning something about your subject; in fact, you won't be able to create a focused, manageable thesis unless you already know something about your topic.

This step is important so that you will:

• Begin building your core knowledge about your topic
• Be able to put your topic in context
• Create research questions that drive your search for information
• Create a list of search terms that will help you find relevant information
• Know if the information you’re finding is relevant and useful

If you're working from off campus , you'll be prompted to sign in if you aren't already logged in to your MJC email or Canvas. If you are prompted to sign in, use the same credentials you use for email and Canvas. 

Most current background reading 

• Issues and Controversies: Should Women in the United States Have Access to Abortion? June 2022 article (written after the Supreme Court overturned Roe v Wade) that explores both sides of the abortion debate.
• Access World News: Abortion The most recent news and opinion on abortion from US newspapers.

More sources for background information

• CQ Researcher Online This link opens in a new window Original, comprehensive reporting and analysis on issues in the news. Check the dates of results to be sure they are sufficiently current.
• Gale eBooks This link opens in a new window Authoritative background reading from specialized encyclopedias (a year or more old, so not good for the latest developments).
• Gale In Context: Global Issues This link opens in a new window Best database for exploring the topic from a global point of view.

Choose the questions below that you find most interesting or appropriate for your assignment.

• Why is abortion such a controversial issue?
• What are the medical arguments for and against abortion?
• What are the religious arguments for and against abortion?
• What are the political arguments for and against abortion?
• What are the cultural arguments for and against abortion?
• What is the history of laws concerning abortion?
• What are the current laws about abortion?
• How are those who oppose access to abortion trying to affect change?
• How are those who support access to abortion trying to affect change?
• Based on what I have learned from my research, what do I think about the issue of abortion?
• State-by-State Abortion Laws Updated regularly by the Guttmacher Institute
• What the Data Says About Abortion in the U.S. From the Pew Research Center in June 2022, a look at the most recent available data about abortion from sources other than public opinion surveys.

Latest News on Abortion from Google News

All of these resources are free for MJC students, faculty, & staff.

• Gale Databases This link opens in a new window Search over 35 databases simultaneously that cover almost any topic you need to research at MJC. Gale databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
• EBSCOhost Databases This link opens in a new window Search 22 databases simultaneously that cover almost any topic you need to research at MJC. EBSCO databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
• Facts on File Databases This link opens in a new window Facts on File databases include: Issues & Controversies , Issues & Controversies in History , Today's Science , and World News Digest .
• MEDLINE Complete This link opens in a new window This database provides access to top-tier biomedical and health journals, making it an essential resource for doctors, nurses, health professionals and researchers engaged in clinical care, public health, and health policy development.
• Access World News This link opens in a new window Search the full-text of editions of record for local, regional, and national U.S. newspapers as well as full-text content of key international sources. This is your source for The Modesto Bee from January 1989 to the present. Also includes in-depth special reports and hot topics from around the country. To access The Modesto Bee , limit your search to that publication. more... less... Watch this short video to learn how to find The Modesto Bee .

Browse Featured Web Sites:

• American Association of Pro-Life Obstetricians and Gynecologists Medical information and anti-abortion rights advocacy.
• American Congress of Obstetricians and Gynecologists Use the key term "abortion" in the search box on this site for links to reports and statistics.
• Guttmacher Institute Statistics and policy papers with a world-wide focus from a "research and policy organization committed to advancing sexual and reproductive health and rights worldwide."
• NARAL Pro-Choice America This group advocates for pro-abortion rights legislation. Current information abortion laws in the U.S.
• National Right to Life Committee This group advocates for anti-abortion rights legislation in the U.S.

Why Use Books:

Use books to read broad overviews and detailed discussions of your topic. You can also use books to find  primary sources , which are often published together in collections.  

Where Do I Find Books?

You'll use the library catalog to search for books, ebooks, articles, and more.  

What if MJC Doesn't Have What I Need?

If you need materials (books, articles, recordings, videos, etc.) that you cannot find in the library catalog , use our  interlibrary loan service .

Your instructor should tell you which citation style they want you to use. Click on the appropriate link below to learn how to format your paper and cite your sources according to a particular style.

• Chicago Style
• ASA & Other Citation Styles
• Last Updated: Apr 10, 2024 11:41 AM
• URL: https://libguides.mjc.edu/abortion

Except where otherwise noted, this work is licensed under CC BY-SA 4.0 and CC BY-NC 4.0 Licenses .

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Lippincott Open Access

Abortion as Essential Health Care and the Critical Role Your Practice Can Play in Protecting Abortion Access

Obstetrician–gynecologists have both the skills and the knowledge to incorporate abortion into their clinical practices, and our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care at this critical moment.

Few obstetrician–gynecologists (ob-gyns) provide abortion care, resulting in abortion being separated from other reproductive health care. This segregation of services disrupts the ob-gyn patient–clinician relationship, generates needless costs, delays access to abortion care, and contributes to stigma. General ob-gyns have both the skills and the knowledge to incorporate abortion into their clinical practices. In this way, they can actively contribute to the protection of abortion access now with the loss of federal protection for abortion under Roe v Wade . For those who live where abortion remains legal, now is the time to start providing abortions and enhancing your abortion-referral process. For all, regardless of state legislation, ob-gyns must be leaders in advocacy by facilitating abortion care—across state lines, using telehealth, or with self-managed abortion—and avoiding any contribution to the criminalization of those who seek or obtain essential abortion care. Our patients deserve a specialty-wide concerted effort to deliver comprehensive reproductive health care to the fullest extent.

On June 24, 2022, the Supreme Court overturned nearly 50 years of federal precedent protecting abortion access in its Dobbs v Jackson Women's Health opinion. 1 The American College of Obstetricians and Gynecologists (ACOG) has replied by messaging that, “Abortion is essential health care.” 2 A commanding 95% of obstetrician–gynecologists (ob-gyns) agree with ACOG and support provision of abortion care, reporting that they would provide or facilitate provision of care, even for indications that conflict with their own personal values. 3 , 4 However, abortion provision is not a routine part of most general ob-gyn practices; currently, only 14–24% of ob-gyns perform abortions. 5 , 6 Because few care for many, and are asked to do so primarily in independent clinics, abortion has long been legislatively vulnerable, practically speaking, through TRAP (Targeted Restrictions on Abortion Providers) laws and through more subtle harms created by distancing trainees and attendings from the lived realities of providing stigmatized care. Now, ob-gyns must recognize this vulnerability and consider how their practices could be used to strengthen the U.S. abortion-provision network.

In a field that values longitudinal relationships, it is problematic that our patients have to seek care in abortion-specific settings, unaffiliated with their usual ob-gyn practices. 7 The journey to find abortion care is complex and riddled with deliberate disinformation, discriminatory barriers, labyrinthine legislative hurdles, and the burdensome costs of out-of-pocket care, lodging, lost wages, travel, and childcare. 8 Even when ob-gyns are eager to guide their patients through this circuitous referral path, 53% of these well-intentioned physicians are unable to make effective referrals due to their own lack of knowledge regarding the abortion-referral process. 9 Resulting delays in accessing abortion appointments lead to greater patient cost, more complex logistics such as a multiday abortion procedures and fewer clinician options, and elevated risk of complications at advanced gestational ages. 10 – 12 Ultimately, delays may result in total denial of abortion care, which is associated with medical-, economic-, and safety-related harms. 13 , 14 These harms already accumulate disproportionately among racial and ethnic minority groups, particularly Black people who can become pregnant, a disparity that will be profoundly exacerbated now that Roe has been overturned. 15

Abortion is an essential part of health care, but our collective action as a specialty has not historically lived up to this principle. Now is the time for ob-gyns to actively participate in abortion care and to critically consider the needs of our patients, our personal conscience to act, and the responsibility to wield our professional skills. If we truly believe that abortion is standard health care, we should consider how we can directly contribute to equitable abortion care. We propose that all ob-gyns consider the most that they can do within the confines of their own practice environment from the following recommendations.

FOR THOSE WHO PRACTICE IN STATES WHERE ABORTION REMAINS LEGAL

Provide abortion care.

General ob-gyns have the required skillset both to perform procedural abortion with first-trimester uterine aspiration and the counseling required to guide patients through medication abortion. Consider how you may expand the use of those skills. For either procedural or medication abortion (detailed below), experts have developed clinical resources to refresh your patient-counseling points (Table ​ (Table1 1 ), 16 , 17 and patients can seek counseling and supportive care independently through organizations such as Reprocare, 18 All-Options, 19 and Exhale. 20

Options Counseling Considerations

Provide Medication Abortion

Medication abortion may offer the logistically easiest route toward integrating abortion care into clinical practice. 21 Early pregnancy loss and medication abortion require the same medications and office resources; counseling, evaluation, medications, potential complications, and follow-up are remarkably similar. Important differences that require investment before expansion of care include the development of appropriate consent forms as well as protocols for incorporating unique state mandates for abortion care (eg, counseling scripts, required information modules). Numerous resources, including ACOG and UpToDate, provide guidance on the provision of this care, summarized in Box 1 . 22 , 23 The coronavirus disease 2019 (COVID-19) pandemic prompted the growth of extraclinical pathways for medication abortion, including telehealth, postal mail distribution of mifepristone, and history-based care. 24 , 25 These practices are effective and safe and decrease barriers to care. 26 , 27 Many, but not a majority of, ob-gyns have established mifepristone as part of their practice for medication management of missed abortion given its superior efficacy to the regimen of misoprostol alone (Neill S, Goldberg A, Janiak E. Medication management of early pregnancy loss: the impact of the U.S. Food and Drug Administration risk evaluation and mitigation strategy [A289] [abstract]. Obstet Gynecol 2022;139:83S. doi:10.1097/01.AOG.0000825716.77939.40). 28 With the fall of Roe , the need to provide medication abortion services now should compel remaining ob-gyns to incorporate mifepristone into standard practice. This may involve education of other stakeholders, such as managers and administrators. A primary barrier to clinical use of mifepristone has been limited knowledge of mifepristone indications, safety, and provision logistics, primarily stemming from the Risk Evaluation and Mitigation Strategy (REMS) program (Neill et al. Obstet Gynecol 2022;139:83S; and Kaiser J, Kurtz T, Glasser A, Brintz B, Turok D, Sanders J. Current knowledge and use of mifepristone for miscarriage in Utah and the impact of an educational video on future use [A292] [abstract]. Obstet Gynecol 2022;139:84S. doi:10.1097/01.AOG.0000825728.94972.6d). 29 The American College of Obstetricians and Gynecologists’ position statement on improving access to mifepristone, which includes citations of important additional literature, offers an authoritative source to educate concerned staff. 30 Until the REMS program is dissolved, a change supported by robust safety data, a one-time prescriber agreement form must be filled out, often by just one person on behalf of the entire clinic. 31 , 32 The U.S. Food and Drug Administration has yet to release its certification process for pharmacy dispensation of mifepristone; once details are available, ob-gyns should encourage pharmacist colleagues to satisfy requirements.

Guide to Facilitating Medication Abortion

History: lmp, options counseling, rule out the following contraindications below:.

•  Pregnancy longer than 77 d
•  Suspected ectopic pregnancy (pain, bleeding)
•  Anemia (typically hemoglobin less than 9.0)
•  Anticoagulated, bleeding disorder
•  Long-term oral steroid use
•  Adrenal insufficiency, porphyria
•  IUD in place
•  Allergic to mifepristone

Examination: usually not indicated unless workup for pain, bleeding, or vaginal discharge

Laboratory results.

•  hCG (if needed for follow-up purposes or PUL workup)
•  CBC (if a history of anemia or heavy bleeding)
•  Type and screen (more than 56 d of gestation*; may be extended to 12 weeks)

Ultrasonographic indications

•  Unclear LMP (can be an informal ultrasonogram in the clinic for gestational dating)
•  Concern for ectopic pregnancy

Counsel and prescribe medications

•  Sign state † and institutional consents
•  Sign mifepristone patient agreement ‡
•  Provide mifepristone medication guide §
•   200 mg orally × 1
•   Patient may swallow pill in clinic or bring the pill home to take when it is convenient
•   No side effects typically
•   Dose 24–48 h after mifepristone
•   200 micrograms × 4 tablets buccally or vaginally; repeat 4 h later buccally if more than 63 d of gestation
•   Swallow pill remnants after 30 min in buccal mucosa
•   May premedicate for pain (ibuprofen 600 mg) or nausea before misoprostol
•   Expected effects within 2–6 h of misoprostol
•   Cramping, bleeding, passing clots normal
•   Flu-like symptoms normal
•  Provide desired contraception as indicated
•   Bleeding more than 2 pads/h for 2 h
•   Severe abdominal pain for longer than 24 h
•   Fever 100.4° F for longer than 4 h
•   Feeling sick more than 24 h after misoprostol

Follow-up to confirm complete abortion

•  Phone call for symptom check at 1 wk and negative home UPT at 4 wk, or
•  hCG level at 5–14 d with greater than 80% decline, or
•  Ultrasonogram at more than 48 h from misoprostol with no gestational sac

LMP, last menstrual period; IUD, intrauterine device; hCG, human chorionic gonadotropin; PUL, pregnancy of unknown location; CBC, complete blood count; UPT, urine pregnancy test.

*May be extended to 12 weeks.

† State counseling and waiting period laws: https://www.guttmacher.org/state-policy/explore/counseling-and-waiting-periods-abortion .

‡ U.S. Food and Drug Administration–mandated Patient Agreement Form—select and sign correct manufacturers' version: https://genbiopro.com/wp-content/uploads/2019/05/GenBioPro-Patient-Agreement.pdf ; http://www.earlyoptionpill.com/wp-content/uploads/2016/02/Patient-Agreement-Form-March2016-1.pdf .

§Patient Medication Guide—available in Spanish, Arabic, French, Chinese, Hindi, Vietnamese: https://genbiopro.com/wp-content/uploads/2019/05/GenBioPro-Medication-Guide.pdf ; http://www.earlyoptionpill.com/wp-content/uploads/2016/01/DAN_MedGuideEng_FINAL.pdf .

Provide Procedural Abortion

Because the procedural steps are the same for suction aspiration or dilation and curettage no matter the indication, ob-gyns already have the professional skills and expertise to provide procedural abortion in their medical practices. Seek to bolster your training as needed if you do not feel proficient at first-trimester surgical procedures or if you would like to start providing dilation and evacuation at later gestations. Although more than 90% of abortions are performed in the first trimester, induced abortion by suction aspiration through 15 weeks of gestation can be readily integrated into standard ob-gyn care as a single-day procedure with a curette size of 14–16 mm. 34 , 35 Individuals experiencing pregnancy loss or induced abortion benefit from an office or outpatient capacity to deliver manual vacuum aspiration and suction dilation and curettage under local or moderate sedation. 36 – 38 In-clinic procedures may be the most affordable option in these circumstances, and ob-gyns do many other in-clinic procedures that confer the same degree of risk as first-trimester uterine aspiration. The option for a procedure in a main operating room should be made available for individuals who need or desire procedural care under greater anesthesia support. Relationships with labor and delivery unit staff are central to existing care delivery under (at least) exigent circumstances, such as previable or periviable rupture of membranes, advanced cervical dilation, abruption or hemorrhage, and fetal anomalies. In practice settings that create significant barriers to procedural abortion care for most individuals, inroads may begin with institutional policies around the populations for whom there may be exceptions, such as the care of sexual assault survivors, incest survivors, minors, and pregnant people with life-threatening conditions. It is important to generate mutually agreed on, ideally expansively defined, diagnoses that jeopardize maternal health to avoid any delay confirming that care is in line with state and institutional policies at the time of patient presentation. Such conversations may require input from colleagues in subspecialties, namely complex family planning, maternal–fetal medicine, and pediatrics, as well as legal and ethics representatives. Identification of community allies may strengthen referrals and support outside of the institution (eg, child services, intimate partner or sexual violence support advocates) as well. Additionally, financial teams should generate a self-pay package to meet the needs of individuals who travel from states with restrictions on private and public insurance.

Improve Referral Pathways for Patients Who Need Abortion Care Beyond Your Expertise

Conscientious refusal to participate in any aspect of standard reproductive medicine is narrowly defined and always requires timely, nonjudgmental, accurate referral to care. 39 If you will not provide abortion care directly, learn the best way to facilitate care with a colleague who provides the care your patient needs (eg, what anticipatory workup, such as ultrasonograms, can your practice provide while the patient is waiting for an appointment?) Now is the time to solidify your relationships with and support for colleagues who provide complex abortions. Many current family planning clinicians, particularly in places such as Colorado, New Mexico, Illinois, and California that neighbor abortion-hostile states, are experiencing enormous increases in demand for care. Support of these colleagues, if not by providing first-trimester care yourself then by developing a streamlined referral process, will be essential in facilitating necessary patient care.

Become a Spokesperson Committed to Dismantling Abortion Stigma

Talk to your patients, your colleagues inside and outside of obstetrics and gynecology, and your community about accessible abortion care as a requirement for safe, autonomous reproductive health. Become a thoughtful and effective messenger by educating yourself on abortion speaking points supplied through reputable organizations such as ACOG, 40 Physicians for Reproductive Health, 41 and the American Civil Liberties Union. 42 Your complex family planning colleagues may not be available to contribute to this education while they provide direct clinical abortion care .

FOR THOSE WHO PRACTICE IN STATES WHERE ABORTION IS ILLEGAL OR SEVERELY RESTRICTED

Do not contribute to patient criminalization.

Since 2000, at least 21 people have been criminalized for abortions, many of whom were reported by health care professionals. 43 The World Health Organization, the American Medical Association, and ACOG denounce criminalization of abortion. 44 – 46 As of July 2022, no state mandates clinicians to report those who they suspect have undertaken self-managed abortion. 47 In fact, reporting counters current federal and state legal protections of health information. The Department of Health and Human Services affirmed this by releasing guidance on the Privacy Rule as it pertains to reproductive health, clearly stating that intention to seek a legal abortion is not a, “serious and imminent threat to the health or safety of a person or the public,” regardless of local state abortion policy. 48 There is a disgraceful and discriminatory history of collusion between medical professionals and the carceral system in regulating marginalized members of society (eg, biased prenatal substance use testing and reporting, court-ordered and physician-placed contraceptive implants among racial and ethnic minority groups, and forced sterilizations). 49 It is a moral and professional imperative to avoid participation in such discriminatory practices. This includes assuring patients of their right to privacy and limiting history-taking to what is clinically indicated as reports of physician interrogations arise. 50 Despite (poorly substantiated) concerns regarding the health risks of self-managed abortion, the greater risks facing some pregnant people with the fall of Roe are legal persecution and the carceral system; ob-gyns must not contribute to this risk.

Educate Those Inside or Outside of Your Professional Workplace Who May Encounter Patients Who Want or Need an Abortion

For colleagues in health care, such as emergency department clinicians, emphasize the clinician’s role in avoiding any contribution to criminalization as above. Confirm that there is no way and no need to determine a difference between induced abortion and miscarriage. Educate your medical colleagues to perform pregnancy-options counseling and timely abortion referrals when they cannot offer abortion services themselves.

For our medical and nonmedical acquaintances and communities, normalize abortion talk and speak up to correct misinformation and abortion myths. Share the reality that abortion, including self-managed abortion with misoprostol, is safe, especially when framed in direct contrast to the inevitable, dangerous effects of abortion restriction and forced continuation of pregnancy. 51 Review intentional vocabulary in speaking in a medically accurate, nonstigmatizing, and inclusive way about abortion. 40

Identify the Lowest Health-Risk and Legal-Risk Path for Patient Care

The lowest health-risk and legal-risk path for patient care may include self-managed abortion, as outlined by the World Health Organization and the Society of Family Planning. 46 , 52 Familiarize yourself with extraclinical resources and support, such as:

• Women Help Women, SASS – Self-Managed Abortion; Safe & Supported: comprehensive resource for medication abortions, available at https://abortionpillinfo.org/
• AidAccess: online consultation with physicians and mail service for medication abortion, available at https://aidaccess.org/
• Repro Legal Helpline: legal hotline to support those pursuing self-managed abortion, available at https://www.reprolegalhelpline.org/
• Miscarriage + Abortion Hotline: support hotline for any questions related to self-managed abortion or miscarriage, staffed by clinicians, available at https://www.mahotline.org/
• National Network of Abortion Funds: centralized source to support funding an abortion, including identification of local abortion funds, available at https://abortionfunds.org/

Assist Patients With Safely Accessing Periabortion and Postabortion Care if Needed

Consider providing supportive services, such as ultrasound reports or images, laboratory test results, and anticipatory guidance, for patients who can use that information for abortion by telehealth or by mail. 53 For the many patients who have not already independently connected with care and support, become a knowledgeable clinician who can facilitate warm referrals to online or out-of-state abortion care as well as to abortion funds. Empower your patients with the knowledge that clinicians cannot distinguish between miscarriage and induced abortion. Because the clinical presentation and any necessary clinical care is the same, patients can be reassured that they will receive appropriate treatment if they choose not to share with a health care team information regarding self-managed or induced abortion services they may have received.

Refresh Your Management of Complications of Abortion 54

Medication abortions (self-managed or clinically overseen) are expected to increase in volume, so the absolute number of rare complications, such as infection or clinically relevant bleeding, may as well. Importantly, those who take mifepristone and misoprostol or misoprostol alone to manage first-trimester pregnancy terminations will have extremely low rates of complications, with or without clinician involvement. 55 It remains to be seen how readily these medications will be obtained by pregnant people. If self-administration of the U.S. Food and Drug Administration–approved regimen for medication abortion is not an option in one state, some may be able to seek care in other states. For the majority of individuals seeking abortion with existing financial, logistic, and societal barriers to care, access will likely become (or already had become) impossible. Therefore, alternative measures may be sought, some familiar to those who practiced in the era before Roe . Concerns related to ingestion of substances unfamiliar to clinicians can be reviewed for free and confidentially 24-hours a day through the national toxicology hotline (800-222-1222); callers will be routed to toxicology-trained pharmacists or physicians.

Intensify Abortion Training for Clinical Staff

Regardless of state legislation, all those involved in patient care should continue to receive education in referral and options-counseling training, 56 , 57 use of hospital simulation spaces, 58 and recruitment (and payment) of family planning clinicians for grand rounds, resident training sessions, clinical shadowing, and apprenticeships. These learning opportunities also establish institutional norms around abortion care and allow for those who desire more involvement in abortion care to have their interests recognized.

FOR THOSE WHO PRACTICE ANYWHERE IN THE UNITED STATES

The task of professional and practice transformation may seem great, but it is long overdue. As you personally, and as a practice, work to improve abortion provision, complementary exercises in advocacy include the following.

Know Your State Laws

The Guttmacher Institute provides an excellent overview of state laws, updated monthly. 59 However, legal counsel may provide more nuance and address specific questions (eg, initiating mailing of mifepristone, caring for people from out of state), particularly in what is anticipated to be a rapidly changing landscape.

Leverage Your Professional Position

Physicians and other clinicians have both medical expertise and public trust. 60 By developing relationships around your work and personal communities (eg, with the department chair, hospital committees, state and district professional societies, and community organizations), efforts in destigmatization, buy-in from stakeholders, and pathways for policy change may be easier.

Identify Your Geographically or Professionally Close Complex Family Planning Specialists

Depending on state politics, these individuals may be eager to share with you means of complementing their work, relief of what will be a potentially enormous care burden, and pathways for local advocacy. In other settings, these individuals may have the capacity to support professional development by refreshing your counseling and procedural training or to facilitate practice changes by sharing protocols or relevant troubleshooting efforts.

Support Each Other in a Rapidly Changing Legal Landscape That Puts Good Medical Practice and Legal Practice at Odds

The language of anti-abortion state laws is intentionally threatening and, if upheld, holds new legal precedence within and across state lines. Thus, clinicians and our patients have legitimate concerns regarding the risk of criminalization. The relationship between clinicians in states where abortion is illegal and those in states where it is legal may become one of critical support, trust, and empathy as cross-state transfers potentially increase to care for those with gray-area diagnoses (a term we are using here for individuals who have detectable fetal cardiac activity in the setting of a pregnancy complication that is life-threatening but may not yet be imminently life-threatening). Clinicians will be expected to accept, deny, or transfer care based on what is legally less risky instead of what is best clinical care for the patient, an impossible task for our colleagues in restrictive states that warrants special compassion. For those residing in states with and without legal abortion, ACOG has a toolkit to guide institutional discussions regarding transfer policy, capacity building, and expected legal support for clinicians in an era in which legislation will do irreparable harm to the medical community and those we serve. 61

Center Equity in Abortion Advocacy

In the wake of a number of professional organizations and educational bodies publicly committing to anti-racism and the dismantling of white supremacy over the past 2 years, we must realize that abortion protection is a key part of that work. 62 More than half of abortion need is among people who identify as Black or Latina, a disparity generated by racism, similar to many other aspects of medical care. 63 Further, other intersecting sources of oppression, such as classism, ableism, and the rural–urban divide, have and will continue to generate inequities in reproductive care. Abortion access is a critical tenet in Reproductive Justice, alongside other essential rights of bodily autonomy and having and parenting children in safe and sustainable communities. 64 Uplift the voices and organizations that operate from a Reproductive Justice framework, such as SisterSong, the National Latina Institute for Reproductive Justice, and the Black Women's Health Imperative. 64 – 66 For our White colleagues and masculine-identifying colleagues, commitment to equity may take the form of self-education, community organizing, and advocacy that demands your efforts while creating and preserving space for marginalized members of the abortion advocacy movement to be the vocal, public-facing authorities that this moment demands.

The time for a minority of ob-gyns to provide the nation's abortion care is over. In an era of breathtaking restrictions to access, this division of clinician labor simply cannot be sustained. Our patients deserve continuity of timely, compassionate care from their clinicians. Moreover, most of us are already skilled to perform most abortions. By continuing the status quo within the ob-gyn community—as protections for this clinical care crumble around us—supportive but abstaining ob-gyns contribute to stratified reproduction.

This is a fight for the autonomy, the dignity, the equity, and the lives of our patients and our own loved ones. In our personal lives or through our professional duties, we are all abortion beneficiaries. Obstetrician–gynecologists are qualified to provide this care already; more ob-gyns providing this care not only supports a human right, but also elevates patient experience, trainee education, and parallel services such as pregnancy-loss management. We have contributed to the vulnerability of abortion care, but it is within our power to correct our wrong. Now is the time to act on our principles: abortion is essential health care.

Kathryn Fay receives support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD103096). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The content in this commentary should not be considered legal advice. The opinions herein are our own. Furthermore, the content reflects the best of what we can offer at this critical moment for reproductive health in the United States; we hope the essential principles remain relevant and anticipate that specific resources, needs, and the best paths forward for clinicians and patients will alter as the medical community adapts to this seismic shift. Open Access is made possible by the Division of General Obstetrics and Gynecology Specialists at the Brigham and Women’s Hospital.

Financial Disclosure Deborah Bartz receives royalties from UpToDate related to medication abortion. She also indicated that, although the article describes the U.S. Food and Drug Administration–approved regimen for medication abortion with mifepristone and misoprostol, it also includes text on self-sourcing these prescription medications. The other authors did not report any potential conflicts of interest.

The authors thank Dr. Mindy Sobata for her prior work that contributed to the development of Box 1 .

Each author has confirmed compliance with the journal's requirements for authorship.

Published online ahead-of-print August 10, 2022.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/C846 .

PUBLISHED Apr. 8, 2024, at 11:30 AM

Can you guess where Americans stand on abortion?

Test your knowledge of public sentiment on abortion, ivf and more..

By Katie Marriner , Kaleigh Rogers and Holly Fuong

For decades, many Americans considered abortion a settled debate. From 1992 to 2020, anywhere from 23 to 39 percent of adults didn’t consider it a major voting issue, according to regular polling from Gallup . But in June 2022, when the Supreme Court overturned the constitutional right to abortion in its ruling on Dobbs v. Jackson Women's Health Organization, that all changed. As states introduced abortion bans and lawsuits ping-ponged through the court system , the issue took on new pertinence for many voters. During the 2022 midterm elections, abortion proved to be a defining issue , and many Democrats are banking on it remaining one in the 2024 election. But where exactly do Americans stand on this divisive issue now, and how might it impact their vote come November? Test your instincts to see if you can guess what recent polls found.

Let’s start with how Americans' views on abortion have changed over time. How big of a shift do you think has occurred over the past decade, and in which direction?

58 percent of Americans in June 2015 and 71 percent of registered voters in February 2024 said abortion should be legal in all or most cases, a difference of 13 percentage points .

Source: KFF , The Washington Post (May 21-June 17, 2015, and Feb. 20-28, 2024)

That’s a pretty significant increase, and it demonstrates how out of line the Dobbs decision was with the general public’s views. Anti-abortion activists and lawmakers spent years trying to overturn Roe v. Wade, but when they achieved their goal, the public was suddenly faced with the reality of what that meant — and they didn’t like it. Consider the current breakdown between voters who favored the Dobbs decision and those who opposed it:

Just 36 percent of registered voters favored overturning Roe v. Wade , while 64 percent said they somewhat or strongly opposed it.

Source: Marquette University Law School (Feb. 5-15, 2024)

It’s clear the country is pretty staunchly opposed to Dobbs. But simply having an opinion on a particular issue doesn’t necessarily mean it’ll change how people vote. There are a lot of issues that Americans rank as more important than abortion, such as the economy and immigration. How do you think voters' views on abortion will or won’t affect their vote for president this year?

51 percent of registered voters said abortion would be a major factor in their vote for president. 32 percent of voters said abortion would be a minor factor for them, while 17 percent said it wouldn’t be a factor.

Source: YouGov/CBS News (Feb. 28-March 1, 2024)

So the vast majority of voters are at least taking abortion into consideration when deciding whom to support for president. But abortion isn’t the only reproductive-health issue being debated lately. Anti-abortion activists have now set their sights on banning or limiting fertility treatments , which help people who struggle to have children get pregnant. The Alabama Supreme Court recently ruled that frozen embryos are children , leading many fertility clinics to pause services and prompting the state to pass a law to protect patients and providers. The decision thrust this new debate into the election-year conversation.

67 percent of Americans said IVF should be legal . Just 8 percent said IVF should be illegal, while 24 percent said they were not sure.

Source: YouGov/The Economist (Feb. 25-27, 2024)

The Supreme Court is continuing to hear abortion-related cases, including a challenge to access to mifepristone , a medication that induces abortion and is used in early-pregnancy abortions as well as some miscarriages. How do you think Americans feel about how easy it should be to access mifepristone?

72 percent of adults said they supported women obtaining the pills needed for a medication abortion from their doctor or a clinic, while 26 percent were opposed to it.

Source: Ipsos/Axios (March 26-27, 2024)

Polling reveals Americans’ views on abortion are a lot more liberal than some hardline anti-abortion politicians may like, and the legal turmoil around abortion has only made it more top-of-mind for many voters. This has been a major weakness for Republicans and, if it continues to be a dominant issue through 2024, would likely hurt the GOP again. The biggest question is where access to abortion will land on the long list of issues voters are considering as they head to the polls.

Edited by Cooper Burton and Nathaniel Rakich .

Related Stories

Comments .

Survey: More than 8 in 10 Texas women have inaccurate knowledge of abortion ban exceptions

T exas women of reproductive age have significant gaps in knowledge regarding the state's near-total abortion ban — which prohibits terminating pregnancies unless the life of the mother is in danger — with more than 8 in 10 lacking an accurate understanding of what medical exceptions are allowed under the law, according to recently released results of a survey by Austin-based collaborative Resound Research for Reproductive Health.

One-third of the 763 respondents in the poll, or 32%, incorrectly believed that victims of rape and incest can legally get an abortion in Texas. Nearly 25% falsely believed that the abortion ban does not apply to pregnant patients facing fatal fetal diagnoses.

Furthermore, 73% of the survey respondents were unaware that clinics in the state cannot terminate pregnancies, according to the survey results released March 21. And a minority of respondents, or 43%, said they knew it was legal in Texas for pregnant people to get an abortion if they have a life-threatening medical condition.

What is the Texas Medical Board? How will it consider abortion ban guidelines?

“Our research shows that many Texans think abortion care is still legally available under a broader set of circumstances than it currently is,” Dr. Samuel Dickman, a researcher at the City University of New York’s Research Foundation and the chief medical officer at Planned Parenthood of Montana, said in a news release.

Resound, which studies the effects of policy related to contraception, abortion and pregnancy, administered the poll in English and Spanish between May and June 2023 through the Ipsos KnowledgePanel . The survey included only Texas residents between the ages of 18 and 49 who were assigned female at birth.

Since August 2022, when the state's "trigger law" went into effect after the U.S. Supreme Court reversed the constitutional right to an abortion, the procedure has been prohibited in Texas except in cases in which a pregnancy puts a woman at risk of death or "poses a serious risk of substantial impairment of a major bodily function." Physicians who violate the law could face penalties of up to 99 years in prison and fines of more than $100,000 and could lose their medical license.

Beginning in September 2021, one of the country's most restrictive abortion bans went into effect in Texas, banning the procedure after fetal cardiac activity could be detected, or about six week of pregnancy. This law, like the state's "trigger law," makes no exceptions for rape, incest or fatal fetal diagnoses. Both were passed by the majority-Republican Legislature and signed into law by Republican Gov. Greg Abbott in 2021.

When Resound conducted its survey in Texas, a near-total abortion ban had been in effect for more than a year. Forty percent of respondents, however, said they had not heard about Texas passing abortion laws in the two years prior.

Texas abortion bans: New poll shows broad support for rape, fetal anomaly exceptions

In addition, 24% of survey respondents incorrectly believed that Texas had prohibited travel outside of Texas to obtain an abortion. (Some localities such as Lubbock County and Odessa have passed ordinances to this effect, but legal experts doubt they will hold up in court, and there is no statewide ban on out-of-state travel for abortions, the Houston Chronicle has reported ).

The survey adds context to a February 2024 University of Texas poll that found the overwhelming majority of Texas voters support legal abortion access for pregnant women in cases of rape, incest or serious risk of birth defects, said Resound Research Director Kari White , an associate professor of social work at UT. 

"Disseminating clear information about the specific restrictions imposed by Texas’ abortion laws and their impacts may make Texans even less supportive of policies that restrict abortion access," White said.

This article originally appeared on Austin American-Statesman: Survey: More than 8 in 10 Texas women have inaccurate knowledge of abortion ban exceptions

Abortion Rights: Advantage Left

Even in states where abortion is legal, the issue could drive turnout and make a difference in close Senate and House races as well as key state legislative races.

Abortion Rights: Advantage Left

Jose Luis Magana

Anti-abortion and abortion rights activists, rally outside the Supreme Court, Tuesday, March 26, 2024, in Washington. The Supreme Court is hearing arguments in its first abortion case since conservative justices overturned the constitutional right to an abortion two years ago. At stake in Tuesday's arguments is the ease of access to a medication used last year in nearly two-thirds of U.S. abortions. (AP Photo/Jose Luis Magana)

Americans have made it clear that they're not too excited about another matchup this fall between President Joe Biden and former President Donald Trump. But they do care about abortion laws – and that issue may end up deciding not only the presidential race but campaigns for Congress as well, experts say.

Florida this week became the third state where an abortion-related referendum will be on the ballot. Not only could a vote in favor of the ballot initiative reverse the Sunshine State's recently affirmed six-week abortion ban, but it could spur otherwise disaffected voters to get to the polls. And that, Biden-Harris operatives believe, takes the delegate-rich state of Florida from a Democratic fantasy to a genuine – if still Republican-friendly – battleground for both the presidential race and the seat now held by GOP Sen. Rick Scott.

Even in states where abortion is now legal, the issue could get voters to the polls, possibly making a difference in close Senate and House races as well as key state legislative races. Abortion was the No. 1 issue in political ad spending in 2022 and 2023, after the Supreme Court ruling undoing guaranteed abortion rights, according to data by AdImpact, and campaigns for seats up and down the ballot are already making reproductive rights a central issue.

"Anything that increases the salience of abortion rights in this cycle is meaningful," says Jill Habig, founder and president of the nonprofit civil rights group Public Rights Project and a former adviser to then-California Attorney General Kamala Harris. "We have learned two election cycles in a row, and in every special election so far, that every time abortion has been on the ballot, people have voted for abortion rights."

Abortion foes have been on defense, especially after in-vitro fertilization was imperiled in Alabama because of a court interpretation of the state's "personhood" law. They are casting Democrats as the extremists on the issue, saying the party wants to allow abortion under any circumstances.

The Best Political Cartoons on Joe Biden

"They will spend millions to fear-monger and lie about the Republican position, denouncing any limits whatsoever on abortion as a ‘national ban,’ even while they refuse to tell the truth about their own radical stance," Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a recent memo.

But after their earth-shattering Supreme Court victory in 2022, anti-abortion forces have not had a good track record with voters. They lost seven state ballot measures on the issue in 2022-23, with voters in Kansas, Kentucky and Montana rejecting measures to restrict abortion rights, and approving referendums in Ohio, California, Michigan and Vermont to ensure abortion access.

This fall, voters in Florida , New York and Maryland will have abortion-related measures on the ballot. Proponents of an abortion-rights measure in Arizona say they have collected enough signatures to put it on the ballot there, and other measures are in the works in Arkansas, Colorado, Maine, Missouri, Montana, Nebraska, Nevada, Pennsylvania and South Dakota.

The outcomes of the state ballot measures may not matter much – especially in blue states, where abortion rights are already protected under state law. But the threat of a national ban, along with worries about access to IVF treatment and birth control, have escalated worries about the reach of the 2022 Dobbs decision that undid Roe v. Wade.

Just this week, for example, the Alabama hospital at the center of a state court ruling establishing fertilized embryos as children said it would stop providing IVF services after this year, out of fear of legal reprisals. That was in spite of a hastily passed state law sparing IVF patients and clinics from prosecution or civil liability.

Alabama is virtually certain to go for Trump this fall, and there are no congressional seats in play because of abortion (a newly drawn district with a majority of Black voters may well flip to Democrats, but the shift is because of its demographic makeup). But many races in other states may be affected by the focus on abortion.

In Maryland, for example, where abortion is now legal, former GOP Gov. Larry Hogan is well-positioned on paper to flip an open Senate seat. Hogan, a popular governor who maintains a high approval rating – even among Democrats – was a rare Republican to close the gender gap when he was running, says Mileah Kromer, director of the Sarah T. Hughes Center for Politics at Goucher College.

But while Hogan is not "a pro-life warrior," he's hobbled by his party ID, Kromer says, pointing to an April poll Goucher conducted with the Baltimore Banner that found 60% of Marylanders – and 70% of Democrats – say abortion is a "major issue" for them in the race.

Democrats, who are the strong majority of Maryland voters, don't want Republicans to control the Senate (75% of Democrats say it's a "major issue").

"It is the true nationalization of the issue" that could keep Republicans from picking up a seat in blue Maryland, Kromer says.

In New York, an abortion-related referendum on the ballot this fall (it prohibits the denial of rights to individuals based on pregnancy or pregnancy outcomes) won't have an impact on overall abortion rights in New York. But it might get more Democrats out to vote, analysts say, helping the party take back several congressional seats it lost in 2022 .

Montana is a sure bet for Trump in the fall. But if an abortion-related referendum makes it on the ballot there, it could help Democrats get the vote out for Sen. Jon Tester, who faces a tough race for reelection in November. A February survey by Middle Fork Strategies found that 6 in 10 Montanans believe abortion should be legal in all or many circumstances.

Arizona, Nevada and Pennsylvania are all presidential battlegrounds and home to Senate races that could well determine which party controls the chamber next year. Turnout matters, and a referendum on a hot-button issue like abortion could make the difference.

A 2005 study in Sage Journals found that ballot initiatives increased turnout by 1.7% in midterm elections and 0.7% in presidential elections. While that sounds minimal, "Given the closeness of the Electoral College contests, it is possible that the mobilizing effects of statewide ballot questions could be the determining factor in future presidential elections," the study said.

Arizona is in that category: Biden beat Trump by an excruciatingly close 0.3% in 2020. While collecting signatures for the ballot initiative, voters seem energized by the issue, says political strategist Dawn Penich, who has been working on the Arizona effort.

"People tell us, 'I've been pretty checked out, maybe I vote now and then, but on this issue, I cannot sit back and stay home.' We're seeing people galvanized," Penich says.

Florida remains a reach for Democrats, who are outnumbered by Republicans by nearly 900,000 voters. But having lost the state by a relatively small margin – 3.3% – in 2020, Democrats believe they can compete there if they continue to hammer Trump and down-ticket candidates on abortion. And just putting the state in play forces the GOP to spend money in Florida, diverting needed cash from more competitive races.

Trump – while bragging that he is responsible for the overturning of abortion rights – has been quiet on the recent rulings in Florida on the issue, saying he will make a statement in the coming weeks.

"We know folks are fired up," says Nourbese Flint, president of the pro-abortion rights group All* In Action Fund. "We know it's a driving factor."

And it's one that may well decide who controls the White House and Congress next year.

Tags: Senate , abortion

Subscribe to The Report

Sign in to manage your newsletters »

Sign up to receive the latest updates from U.S. News & World Report and our trusted partners and sponsors. By clicking submit, you are agreeing to our Terms and Conditions & Privacy Policy .

America 2024

You May Also Like

The women of the 116th congress.

Claire Hansen Nov. 13, 2018

Cartoons on President Donald Trump

Feb. 1, 2017, at 1:24 p.m.

The 10 Worst Presidents

U.S. News Staff Feb. 23, 2024

The Key to the White House: Math

Susan Milligan March 29, 2024

When Three’s a Crowd

Susan Milligan March 22, 2024

A Timeline of Supreme Importance

Lauren Camera March 1, 2024

Trailing in Polls, Winning at Polls

Susan Milligan Feb. 16, 2024

Trump Just Can't Quit Obama

Susan Milligan Nov. 24, 2023

Congress Fiddles, the Debt Crisis Burns

Tim Smart Oct. 20, 2023

Campaigning From the Courthouse

Lauren Camera Oct. 6, 2023

• Skip to main content
• Keyboard shortcuts for audio player

How the issue of abortion could affect some key races in November

Sarah McCammon

Abortion will be on the ballot in Florida this fall and maybe in a dozen or so other states. That could have big implications for abortion access, voter turnout and for key races in December.

MARY LOUISE KELLY, HOST:

Abortion will be on the ballot in Florida this fall and maybe in a dozen or so other states as well. That could have big implications, not only for abortion access but also voter turnout and for key races in November. NPR political correspondent Sarah McCammon covers the intersection of politics and abortion, and she is with us now for a preview of what's ahead. Hey, Sarah.

SARAH MCCAMMON, BYLINE: Hey, Mary Louise.

KELLY: Start with Florida. I want you to tell us more about what the state Supreme Court ruled yesterday.

MCCAMMON: So it's interesting because it was really a mixed decision. On the one hand, the court is allowing a measure to go before voters in November which would offer significant protections for abortion access. That's after supporters gathered more than a million signatures toward that end. And at the same time, Florida's Supreme Court also issued a decision upholding the state's 15-week abortion ban.

And because of the way that Republican state lawmakers wrote another anti-abortion law, a much more restrictive law banning most abortions after about six weeks that was passed last year, that'll be able to take effect in just under a month. And this means that Florida will, at least for now, become a state with limited abortion access. It had been sort of an outlier in the South for access since the Supreme Court's Dobbs decision in 2022, which led to new abortion restrictions in a huge part of the region. And so this sets up an interesting fight in November.

KELLY: Well, and let's talk about that fight and broaden beyond Florida. How does what is happening in Florida fit into the larger national battle over abortion rates?

MCCAMMON: So in the last couple of years since the Dobbs decision, voters have uniformly signaled support for abortion rights when the issue has been put directly before them. Polling has shown that a majority of voters opposed overturning Roe v. Wade. And, you know, even in red states, they've pushed back as laws have taken effect which have shut down virtually all abortion access in some states.

Voters are seeing reports of rape victims or women facing medical crises related to their pregnancies being turned away for abortions in some of these states. So ballot measures have become an important strategy for abortion rights supporters in states that have enacted restrictions that may be out of step with what voters want. I talked earlier with Sarah Standiford, national campaigns director with Planned Parenthood Action Fund.

SARAH STANDIFORD: It is an important, galvanizing moment because voters have both experienced and will experience more the harm that comes when politicians try to make decisions that are personal, private and should belong between women and their doctors.

KELLY: A galvanizing moment, she's calling it. So you have abortion rights advocates like her banking on these measures, that they're going to boost turnout among voters. But what are you hearing from groups on the other side, groups that oppose abortion rights?

MCCAMMON: Right. Well, they point to the fact that several anti-abortion Republican governors, like Florida Governor Ron DeSantis and Georgia's Brian Kemp, held on to their jobs in the past couple of years. They point to that with some hope. But they're also looking at these results of ballot initiatives in red states, places like Ohio last fall, Kentucky and Kansas in 2022. And they're concerned. Katie Daniel is state policy director with SBA Pro-Life America, and she says they're going to be working hard to defeat these ballot measures and to support candidates who oppose abortion rights.

KATIE DANIEL: It's incredibly important that we take back the Senate and we hold the House and, of course, win the presidency so that we can enact our vision of a pro-life America.

MCCAMMON: So while they're hopeful about continuing to limit abortion in this post-Dobbs environment, Republicans are also aware that they are struggling with messaging around the issue with voters. We saw that recently, for example, in the debate over the fertility treatment known as IVF, after that controversial Alabama Supreme Court decision.

KELLY: And just to focus on the politics in what is, of course, an election year, what could having these abortion questions on ballots, some ballots, what could that mean for the outcome of key races?

MCCAMMON: So Planned Parenthood officials tell me they're paying attention to about 11 states where ballot measure efforts are underway, similar to this one in Florida. Those include some key presidential states, like Arizona, where advocates say they now have enough signatures to put that question on the ballot. In Florida, though, abortion rights advocates may have a tough fight on their hands. Constitutional amendments there require the approval of 60% of voters to pass.

But regardless of the outcome, the campaign around this issue could drive voters to the polls. That could have implications for down-ballot races. And the Biden campaign says they think the issue could put Florida in play in the presidential race. So they've rolled out a new ad running in several battleground states that's pointing out that former President Trump is responsible for overturning Roe v. Wade, which, you know, just underscores how central the abortion issue will be for this campaign.

KELLY: Thank you, Sarah.

MCCAMMON: Thank you.

KELLY: NPR's Sarah McCammon.

Copyright © 2024 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Majority of women in states with abortion bans believe access should be legal

More than 20 percent of women ages 18 to 49 in those states also said they or someone they know struggled to access abortion after roe’s overturn, a first-of-its-kind kff survey shows..

(Trent Nelson | The Salt Lake Tribune) People march around the State Capitol in Salt Lake City in support of abortion rights on Saturday, Oct. 8, 2022.

Nearly two years after the Supreme Court ended the federal right to abortion, more than a fifth of reproductive-age adult women in states with abortion bans have struggled to access abortion care themselves or know someone who has, according to first-of-its-kind polling released Friday by the nonprofit, nonpartisan health policy research group KFF.

A majority of these women — 67 percent — believe that abortion should be legal in all or most cases, according to the survey taken February 20-28, 2024.

KFF categorized 14 states as having “banned” abortion: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Missouri, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. Eleven states were categorized as having “limited” abortion: Arizona, Florida, Georgia, Iowa, Kansas, North Carolina, Nebraska, Ohio, South Carolina, Utah and Wisconsin. The survey was of women aged 18 to 49, but did not break down results within state categories by race, ethnicity or socioeconomic status.

In states where abortion is banned, 21 percent of women said they or someone they know has had difficulty accessing abortion care, compared to 9 percent in states with abortion limits and 12 percent in states where it is fully legal.

In response to another poll question, 74 percent of U.S. women said that abortion should be legal in “all or most cases.” In states with bans, 67 percent agreed. In states with limits, 71 percent did.

Nationally, 88 percent of women — in states with abortion bans, that number is 85 percent — supported “protecting access to abortions for patients who are experiencing miscarriage or other pregnancy-related emergencies.” Eighty percent — 70 percent in states with bans — supported “protecting a patient’s right to travel for medical care, including getting an abortion.” And 70 percent of U.S. women — 66 percent in states with bans — supported “guaranteeing a federal right to abortion,” the KFF survey showed.

It is unclear to what extent voters’ personal difficulties securing an abortion might affect the November elections, but KFF noted that strong support for abortion access from women in states with bans and restrictions “suggest[s] a disconnect between what women in these states support and the policies their state lawmakers have enacted.”

President Joe Biden and his fellow Democrats are making the case that they are the party that will protect reproductive rights and stymie Republicans’ attempts to further restrict abortion access. Their pitch paid off in the 2022 midterm elections — the first held after the Supreme Court’s Dobbs decision overturning Roe v. Wade — when Democratic candidates suffered fewer losses at the federal level than in past midterm elections for the party in the White House.

Republicans, meanwhile, are grappling with the unpopularity of their anti-abortion policies among swing voters as they try to appease the fervently anti-abortion component of their base. Former President Donald Trump, the de facto GOP White House nominee, made three nominations to the Supreme Court that cemented its conservative majority and allowed it to overturn Roe. After the high court in Trump’s home state of Florida earlier this week allowed a 6-week abortion ban to stand , he teased an announcement on abortion to come next week. Trump’s position has been hard to nail down, but he has previously suggested that he supports a 15-week cutoff.

Immediately after the Florida Supreme Court ruling, Biden’s campaign manager said that they saw an “opening in Florida” — a state he lost to Trump by about 3.5 points in 2020. But, in a separate decision, the court also ruled that a measure to amend the state constitution to protect abortion rights will be on November ballots. Florida ballot measures have to clear a 60-percent support threshold, so it will need votes from Republicans to pass. Advocates of the abortion-rights measure are wary that if Biden’s campaign gets too involved in their effort, and make it seem like a partisan campaign, it could make their job more difficult.

In addition to the presidential race, about a third of U.S. Senate seats — 34, in total — will be on November ballots, along with all 435 in the House of Representatives. Eleven states are holding gubernatorial contests, 44 have state legislative elections, 33 will vote for judges to their states’ highest courts and 10 will elect state attorneys general.

“Support for abortion protections including a federal guarantee to the right to abortion is robust among women, regardless of where they reside,” the KFF analysts concluded. “While substantial minorities of women in states with abortion bans support some restrictions on abortion access, two-thirds of women living in these states think abortion should be legal in all or most cases.”

Originally published by The 19th.

Donate to the newsroom now. The Salt Lake Tribune, Inc. is a 501(c)(3) public charity and contributions are tax deductible

BYU coach Mark Pope closing in on a deal with Kentucky, one of college basketball’s biggest jobs

Salt lake city driver charged in pedestrian attacks linked to 2 more hit-and-runs, gordon monson: byu’s mark pope to kentucky reports say he’s all but gone., map: utah has more than 200 ‘high hazard’ dams. here’s where they are and what that means., bagley cartoon: legislative lunchables, panguitch dam danger significantly reduced, officials say, featured local savings.