Despite abortion being a highly controversial and divisive public policy issue, medical abortion is a highly feasible and healthy alternative to other, illicit abortion procedures and the availability of medical abortion should, consequently, be maximized rather than restricted. The reality is that for most women who are seeking ways to end their pregnancy a legal and safe medical abortion is just one of several options that such women are willing to go through. Without a viable and safe option for women seeking ways to end their pregnancy, many more women will engage in risky pregnancy ending behaviors, such as self-induced, non-medical, and illegal abortions. Minimizing the access to abortion services has been a policy goal of conservatives for some time, while the left has sought to increase access to medical abortion services. This debate is framed by several Supreme Court rulings, most notably the Casey v. Carhart case which affirmed women’s right to abortion, limiting the restrictions that states can put on abortion clinics but leaving ambiguous exactly what restrictions are allowed.
While states and local municipalities are not allowed to outlaw abortion clinics, they still enact and enforce severe restrictions on abortion clinics and abortion services. This creates a de facto ban on abortion in many states, particularly red states. The problem addressed in this project is the potential for severe costs of severely limiting the availability of and access to abortion services for mother seeking to end their pregnancies. Relying heavily on recent empirical studies on the health outcomes of mothers after abortions, this project begins by examining the safety, both physical and psychological, of abortions for mothers. Next, this project examines the legal issues that frame the public policy abortion debate, with a particular focus on the Casey v. Carhart case. Finally, this project presents recent findings from various organizations on the prevalence of abortions around the world and, in particular, the United States.
The most important finding presented here is that abortion rates tend to remain steady regardless of whether there are several restrictions on abortions, which suggests that women who seek abortions are willing to engage in illegal and unsafe abortion procedures when no legal options are available. Because of this fact and other findings presented below, legal abortion services should be made widely available to populations across the United States. While most public policy debates on abortion focus on the distinction between persons and non-persons, as well as the point in which a fetus is considered a person, there is considerable debate over the health outcomes of women who go through abortions. Much of the research relevant to the abortion issue focuses on the physical health outcomes of women. Creinin and Danielsson investigate recent evidence on the physical health outcomes in women after they go through abortions.
This article discusses many studies concerning medically induced abortion that occur very early in pregnancies. The researchers draw conclusions about trends found in the studies and the empirical data produced by such studies. The researchers here find that medical abortions are becoming safer (121). That is, while at one point medical abortions were potential quite dangerous for women, today, evidence suggests that they are quite safe for the physical health of the women. In fact, the rate of incident is lower than most invasive procedures, the research suggests, which supports the notion that legal medical abortions are substantially safer than other ways that women seek to end their pregnancies. Only studies on legal abortions were featured in this review. While there is no empirical evidence on the safety of illegal abortions performed on women, it would seem that they are unlikely to be nearly as safe as legal medical abortions.
The physical health of a woman after receiving an abortion is, of course, a very important factor in determining whether medical abortion practices area safe. However, with much more attention being paid to mental health of individuals and the importance of mental health in living a healthy and meaningful life, it is important to examine research findings on the specific mental health effects of abortion on women. In a systematic review of literature on the long-term mental health outcomes of women Charles et al. analyzes, compares, and discovers tends in the data from more than twenty studies on the long-term mental health outcomes of women who have medical and legal abortions (442). This literature review focuses very heavily on the long-term psychological health of such women and assesses the quality of the findings from each study, on a scale that extends from very poor to excellent in quality. Charles et al. effectively scan the relevant literature from 2000 to 2008 on the mental health outcomes of women after medical abortions to find the most relevant findings.
This literature review finds that most higher quality studies found almost no significant differences in the mental health outcomes of women who have had abortions performed and those who have not. Additionally, while the studies that were much poorer in quality than the aforementioned studies more than half of the time produced findings that suggested that women who have had an abortion in their life times have significantly worse mental health outcomes. Thus, there may be two sorts of data being presented in public policy debate on abortion: data that suggests that women do not suffer negative long-term mental health consequences of abortion and data that suggests otherwise. The objective Charles et al. literature review, however, strongly supports the latter findings, suggesting that, in fact, there is support against the notion that medical abortions lead to long-term negative mental health outcomes in women.
While the systematic literature review of the available data on the psychological health of women after abortions is highly useful in any attempts to determine the risks associated with legal abortions, there is a need for the presentation of much more recent research findings on this issue. Munk-Olsen et al. report the results of a study on the risks of mental disorders and threats to psychological health in women who have gone through induced abortions during their first trimesters. The results of this study are very recent and help to shed light on exactly how safe medical abortions have become. Also, the findings presented in this study have been compared to the results of other studies performed at a similar time to this study, making for more meaningful and significant results. The results of this study indicate that there is no significant difference between the prevalence of mental disorders in women who have had at least one abortion and those who have not (336).
Additionally, the results of this study showed that the participants who had gone through abortions were not in significantly different mental health conditions than the participants who had not gone through abortions (336). The findings form this study lend strong support for the notion that access to abortion clinics should be maximized. One notable problem in public policy debates it the availability of data on the frequency of abortions, both legal and illegal, performed in the United States. Jones et al. presents findings about the frequency of abortions in the United States, as well as the availability of abortion services across the United States. The researchers found that in general access to legal abortion services was quite low, despite the Supreme Court ruling that women have a constitutional right to an abortion (11).
However, the authors note that all of the available data for the report did not include any data on unreported abortions, which, presumably, mostly includes illegal abortions. There is a problem emerging in regard to the availability of data on legal abortions and illegal abortions. The problem is that there is a wealth of data available on the prevalence and health outcomes of legal abortions, while there is virtually no meaningful data on illegal abortions. This is, of course, due to the fact of the illegality of such abortions. Nevertheless, it can be difficult to measure the potential harms committed in illegal abortions when not enough data is available. Additionally, comparing legal to illegal abortions and their respective maternal health outcomes is quite challenging given the differences in the availability of data. Even so, there are several assumptions that can help draw sound conclusions based on these research findings.
One assumption is that legal abortion procedures tend to be safer than illegal abortion procedures. The rationale behind this assumption is that there is a greater likelihood that legal abortion procedures are performed by trained medical professionals who are qualified for such procedures. For illegal abortion procedures, neither the proper training nor the proper credentials are required. Additionally, illegal abortion procedures include self-initiated abort procedures, which are, of course, not performed by medical professionals. Another sound assumption is that as the availability of and access to legal medical abortion procedures decreases, the number of illegal and unsafe abortion procedures increases. This is because many women choose to have abortions whether legal or illegal. Easy access to a safe and legal abortion clinic is likely more preferable for most women seeking abortions. Thus, when such women do not have access to a safe and legal abortion clinic, many will still choose to have an abortion, but under much less safe conditions. Pazol et al. present a report on the prevalence of abortions in the United States.
This report features a number of surveillance summaries on abortions performed. The data used to construct such summaries is provided by the Center for Disease Control. The data is compiled and then analyzed, leading to a number of summative statistics concerning the rates of abortion in the United States. The number of reported abortions is among the leading statistic in this report, as is the abortion rate by age groups and several historical data trends. This report indicates that the number of performed abortions in the United States increased from the mid-1990s to the late 2000s (Pazol et al. 27). However, more recently, the data suggest that reported abortion numbers have fallen, as have abortion rates in the United States. The report finds that access to abortion in many parts of the country has decreased, which may help to explain why the number of reported abortions has decreased (Pazol et al. 29). The findings from this study do not include findings of unreported or illegal abortions. Nevertheless, the findings from this study are consistent with previous findings and follow the path that the legal framework for abortion and abortion restriction policies appears to have taken with recent Supreme Court rulings.
Once of the most important Supreme Court cases concerning state restrictions on abortion is the Casey v. Carhart case. The law professor Reva Siegel wrote a law review article on the Casey v. Carhart case. The ruling by the Supreme Court in this case is that states are not allowed to severely restrict women’s access to abortion services (Siegel 1724). Doing so is a violation of women’s right to an abortion, according to the Court. This ruling affirms prior rulings that have stated that states may not prohibit abortion and may not make it so difficult for a woman to get an abortion that the states have de facto banned abortion (Siegel 1729). Despite this very important ruling from the Supreme Court, states are, in many ways, still allowed to severely restrict access to abortion clinics to the point where most women seeking abortion in a state will be more likely to choose to either not have an abortion or have an illegal abortion. This is because the Supreme Court ruled that states, themselves, must be challenged on a case-by-case basis before the exact laws that restrict abortion can be deemed unconstitutional (Siegel 1736).
In other words, though the Supreme Court struck down state legislation that put severe limitations on legal abortion clinics, states still have so many other limitations that have not been explicitly stricken down and, thus, can still be used by the states to effectively ban abortion. Even though the Court has stricken down several specific forms of limitations for legal abortion clinics, states have still continued to come up with new ways to limit abortion clinic practices that the Court has yet to strike down (Siegel 1732). The current state of the law concerning abortion and state policy abortion restrictions is such that states are allowed to substantially restrict access to safe and legal abortion procedures. Another legal scholar, Mary Anne Warren, agrees that the current legal status of abortion is such that states are largely free to severely limit access to safe and legal abortion procedures, despite Supreme Court rulings that would seem to suggest otherwise (142).
Warren argues that not only is the current legal status of abortion in the United States an uncertain one and one that need further clarification from the Supreme Court, but also that the Court has expressed the strong moral obligation to allow women to have abortions, yet has not done nearly enough to make this assertion hold among the states (145). Warren presents findings from several different studies and literature on the various effects of abortion, the established rates of reported abortion, and the availability of abortion clinics. The findings presented by Warren show that there is a strong contradiction in what the Supreme Court claims is the established rights of women to have an abortion and the actual state of affairs. One of the biggest issues, Warren states, with the current state of affairs for abortion is that the access to abortion differs radically by state.
In some states, abortion clinics are easy to find, while in others, they are virtually non-existent due to severe limitations and restrictions imposed by the state (141). Although it is typical for states to differ substantially on many public policy issues, for several Supreme Court decisions to come down and expressly prohibit states from imposing such abortion limitations, it is a clear contradiction by the Court. From many perspectives, then, the current legal situation of abortion and abortion restrictions by the states in the United States in one that allows the states far too much leeway in how far they can restrict access to abortion.
Research from 2013 suggests that more than twenty million unsafe abortions happen every year worldwide annually. However, less than two percent of these abortions occur in developed countries. Additionally, far fewer occur in the United States (Sedgh et al. 27). This finding would appear to suggest that the number of unsafe abortions is relatively low in the United States compared to the rest of the world. However, the United States has a low tolerance for abortions, compared to many of the other states included in these research findings. Moreover, the United States has a rate of maternal fatalities for legal abortions that is less than 1 out of 10,000, with almost all of such fatalities occurring past 16 weeks after conception (World Health Organization 16). Recent research findings have confirmed the assumptions that certain clinical practices and mandates for abortion procedures lead to very safe abortions (World Health Organization 30).
This finding provides substantial support in favor of keeping the availability of legal and safe abortion options available to women who are determined to get an abortion. Research findings from 2013 also suggest that “where legislation allows abortion under broad indications, the incidence of and complications from unsafe abortion are typically lower where abortion is legally more restricted” (World Health Organization 17). Furthermore, the World Health Organization reports that “where abortion is legally more restricted or available on request, a woman’s likelihood of having an unintended pregnancy and seeking induced abortion is about the same” (17). Additionally, research findings from World Health Organization reports indicate that illegal abortion practices tend to be much less safe than legal abortion practices (23). The World Health Organization findings strongly suggest that women who seek abortion services are likely to engage in some form of abortion services even when such services are unsafe or illegal. These findings are not only applicable to the world, in general, but also apply to the United States specifically.
The report by the World Health Organization on the rates of abortion in countries that impose strict abortion laws and those that have not shows that when countries tighten their restrictions on abortion the actual rates of abortion tend not to decrease substantially, meaning that women who seek abortions are still having abortions performed, even when such abortions are illegal and unsafe (22). These findings support the notion that the levels of restrictions on abortions in the United States should be decreased and the availability of and access to abortion services for women should be maximized, not minimized. The evidence presented here strongly suggests that women will be better off if abortion services are made widely available. Current restrictions on abortion services, particularly through state legislative actions, are making it much more difficult for women to find abortion clinics. Many abortion clinics have closed in many states, particularly red states.
The political divide on this issue is leading to states polarizing, with many states having a very high level of abortion clinic availability and many other states having a very low level of abortion clinic availability and access. However, the Supreme Court has already ruled on this issue. It is unconstitutional for any state to outright ban abortion or make it so difficult for a woman to receive an abortion that abortion is de facto banned, meaning that for all intends and purposes abortion is banned by the state. The states that are severely limiting women’s access to safe and legal abortion procedures are not only violating the Constitutional as interpreted by the Supreme Court, but are also harming women. The fact that women will continue to seek abortion procedures, even when no safe and legal abortion procedures are available means that women are willing to cause significant bodily risk to themselves to have an abortion. With this in mind, restricting access to abortion is creating many more risky situations than was ever intended. It should be realized that further restricting safe and legal abortion procedures in any particular state is simply hurting the women who may be seeking abortions at some point in those states.
Evidence presented earlier showed that legal abortion procedures are very safe now, which means that women who seek abortions can have access to safe abortion procedures, but only if the abortion procedures in the given state are low. In states with high abortion restrictions, many women will be denied access to safe abortion procedures, despite such procedures being protected by the Constitution. By not acting to bring down the restrictions on abortions that are harming women by putting them in risky situations and continuing to tighten such restrictions, policy makers are acting irresponsibility. The topic of abortion in public policy debates is typically highly controversial and divisive. Even so, the findings presented here show that because medical abortion is a highly feasible and healthy alternative to illegal and unhealthy abortion procedures. Thus, the availability of and access to legal medical abortion procedures should be increased.
As shown above, research suggests that most women who seek means end their pregnancies tend to find ways to have abortions, legal otherwise. After all, a legal and safe medical abortion is just one of several options, many of which are unsafe. Without a viable and safe option for women seeking ways to end their pregnancy, many more women will engage in risky pregnancy ending behaviors, such as self-induced, non-medical, and illegal abortions. Minimizing the access to abortion services has been a policy goal of the right, while the left seeks to increase access to medical abortion services. The ensuing public policy debate is framed by the Casey v. Carhart case which affirmed women’s right to abortion, limiting the restrictions that states can put on abortion clinics but leaving ambiguous exactly what restrictions are allowed. While states and local municipalities are not allowed to outlaw abortion clinics, they still enact and enforce severe restrictions on abortion clinics and abortion services.
This creates a de facto ban on abortion in many states, particularly red states. This project has addressed the problem of the possibility of extreme unsafe risks to women seeking abortion services when access has been severely limited by state and local policies. This project presents recent empirical studies on the health outcomes of mothers after abortions, examining the safety, both physical and psychological, of abortions for mothers. It also presented the legal issues that frame the public policy abortion debate, with a particular focus on the Casey v. Carhart case, before turning to recent findings the prevalence of abortions in the United States. Abortion rates tend to remain steady regardless of whether there are several restrictions on abortions, which suggests that women who seek abortions are willing to engage in illegal and unsafe abortion procedures when no legal options are available. This crucial finding is well supported in by research and strongly supports the conclusion of this project: legal abortion services should be made widely available to populations across the United States.
Charles, Vignetta E., et al. “Abortion and long-term mental health outcomes: a systematic review of the evidence.” Contraception 78.6 (2008): 436-450. Creinin, Mitchell D., and Kristina Gemzell Danielsson. “Medical abortion in early pregnancy.” Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (2009): 111-134. Githens, Marianne, and Dorothy McBride Stetson, eds. Abortion politics: public policy in cross-cultural perspective. Routledge, 2013. Jones, Rachel K., et al. “Abortion in the United States: incidence and access to services, 2005.” Perspectives on Sexual and Reproductive Health 40.1 (2008): 6-16. Munk-Olsen, Trine, et al. “Induced first-trimester abortion and risk of mental disorder.” New England Journal of Medicine 364.4 (2011): 332-339. Pazol, Karen, et al. “Abortion
surveillance–United States, 2009.” MMWR Surveillance Summit 61.8 (2012): 1-44. Rohlinger, Deana A. Abortion Politics, Mass Media, and Social Movements in America. Cambridge University Press, 2014. Sedgh, Gilda, et al. “Induced abortion: estimated rates and trends worldwide.” The Lancet 37.5 (2007): 1338-1345. Siegel, Reva. “Dignity and the politics of protection: abortion restrictions under Casey/Carhart.” Yale Law Journal 117 (2008): 1694-1802. Warren, Mary Anne. “On the moral and legal status of abortion.” (2009). World Health Organization. “Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008.” (2011).
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