The US Supreme Court on Friday, the 1973 ruling that made access to abortion a constitutional right. That means it's up to each state to decide on laws that govern abortion access, and many of them are prepared to .
Legality aside, safe abortion access is considered a health care right within many of our medical communities that issue guidance and safety practices for patients and their physicians, including doctors that care for pregnant patients and children. Following the ruling by the country's highest court, the president of the American College of Obstetricians and Gynecologists, Dr. Iffath Abbasi Hoskins, called the decision a "direct blow to bodily autonomy, reproductive health, patient safety and health equity in the United States."
The American Academy of Pediatrics, a college of pediatricians, on Friday reaffirmed its stance for "support for adolescents to receive comprehensive, evidence-based reproductive healthcare services, including abortion." Abortion restrictions impact children and teenagers who get pregnant, too.
The American Academy of Family Physicians also expressed its disapproval of the court's decision, saying the ruling "negatively impacts our practices and our patients by undermining the patient-physician relationship and potentially criminalizing evidence-based medical care."
According to the World Health Organization, a global health care agency of the United Nations, abortion is "a simple and common health care procedure" that occurs in roughly three out of 10 pregnancies worldwide. In the US, roughly one in four women will have an abortion before their 45th birthday, according to 2014 data.
Barriers to abortion access often turn patients to unsafe abortion, the WHO says, which currently account for about 45% of abortions worldwide. "Unsafe abortion" may refer to self-administered procedures or attempted abortions in unsterile environments or by people who aren't qualified health care providers. Roughly 5% to 13% of maternal deaths can be attributed to unsafe abortion, according to the WHO.
Here's what to know about abortion as a health care issue, and the reasons health care providers give for proclaiming it as such.
Abortion as a personal medical decision
Such bans have turned up the volume on conversations about abortion, including abortion as a life-saving medical procedure as opposed to a right. Medically necessary cases include such life-threatening conditions as ectopic pregnancies, when the embryo implants outside the uterus and can't grow to term.
Dr. Jennifer Lincoln is a board-certified OB-GYN with an extensive social media following for her coverage of reproductive and pregnancy topics. Though there are medically necessary abortions, someone's reason for getting an abortion is beside the point, according to Lincoln.
"As an OB-GYN I could rattle off a list of medical conditions where a pregnancy could have killed a patient and an abortion was essential, but it is important to note that all abortions are essential," she said in an email.
"When we start to put qualifications on what abortions are 'OK' then we are on a slippery slope," Lincoln added.
There are some doctors who disagree that access to abortion is a health care issue. The American Association of Pro-Life Gynecologists and Obstetricians says in its mission statement that members believe life begins at fertilization, before a pregnancy officially begins. But that group, too, supports terminating a pregnancy in some cases, specifically when it's necessary to save someone's life.
The American College of Obstetricians and Gynecologists' position on abortion is that it should be legal and available to patients with healthy pregnancies up to fetal viability (when the fetus has a chance of surviving outside of the uterus). While it's generally understood to occur around 23 weeks, fetal viability is ultimately a "medical determination," according to the ACOG, and it may vary pregnancy to pregnancy.
But a health organization or agency maintaining patients' access to safe abortion doesn't require physicians to perform them. A 2019 study published in Obstetrics & Gynecology and reported by the Los Angeles Times found that fewer than one in four OB-GYNs were willing or able to perform abortions themselves. Reasons ranged from the personal to the practical, including restrictions where they practice. That means many patients were referred elsewhere.
Lincoln says she fully supports someone's decision to dislike or never have an abortion themselves. But abortion bans harm the health care system and erode trust in the patient-doctor relationship when that personal and professional line is blurred, according to Lincoln.
"We live in a world where you are not forced to donate your blood or your organs -- even if we know this could save a life before us," she said. "So why is it that we think it's OK to tell someone what to do with their pregnancy?"
Reducing abortion access will increase existing gaps in health care
About half of US states, including many in the Midwest and the South, will move to ban or restrict abortion, according to the Guttmacher Institute, an organization that endorses abortion access. already in place awaiting the overturn of Roe, which means bans will soon go into effect. Tennessee's law, for example, will outlaw abortion 30 days from now unless ending the pregnancy is "necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman."
Pregnant people living in these states will be the most affected by a ban or further restrictions on abortion access -- specifically, people with lower incomes and those with less access to other health care services. About 75% of abortion patients were low-income in 2014, and nearly half lived below the federal poverty level.
Disproportionately, people of color living in Republican-led states, like Mississippi and Texas, will be affected by heavily restricted or banned abortion access. The US has the highest maternal mortality rate of all industrialized countries, according to the Commonwealth Fund, and Black women are more than twice as likely to die during pregnancy or childbirth than their white counterparts. Black infants in Texas, also, were twice as likely to die before their first birthday compared with white infants, the Commonwealth found. (This was before Texas SB 8 went into effect.)
Some states will continue to have relatively broad abortion access. Colorado and Rhode Island have reproductive rights codified into state law, for example, and some patients living in restricted states will be able to travel to states where abortion is legal for a procedure. However, this option is available only for people who have the time and resources to make the trip.
"Those who can afford to travel and pay for an abortion in a state like California will do so, while low-income, disabled and young people who can't travel outside their state may not be able to obtain a safe abortion," Paula Tavrow, director of the Bixby Program in Population and Reproductive Health at the University of California, Los Angeles, said in an email.
Under current laws, people are already traveling for abortions. Those living in states that have already heavily restricted abortion access, mostly concentrated in the Midwest and in the South, have been forced to travel long distances to get the procedure. In Missouri and South Dakota, for example, there's one abortion clinic in each state. State imposed "waiting periods" to make sure someone is certain about their decision to have an abortion often require people to make two long trips.
The need to travel can be a barrier for ending a pregnancy. In addition to having less money, most people in the US who have abortions already have children. Making one or more trips for an abortion procedure requires them to take time off work, miss out on wages and arrange child care, which can be impossible for many.
These second appointments and trips are part of laws in some areas even in the case of medication abortions -- two pills that induce a miscarriage, are taken at home and are safe and effective up to 10 weeks of pregnancy, according to the ACOG. The vast majority of abortions -- just under 93% -- take place in the at 13 weeks or earlier, according to the US Centers for Disease Control and Prevention.
The US Food and Drug Administration in December loosened the restrictions on medication abortion, making pills available by mail and telemedicine to patients. However, they're still not accessible for everyone. Some states have prohibited the use of telemedicine for patients seeking medication abortion pills. Demand for medication pills at overseas pharmacies is expected to go up as abortion restrictions increase. This is one reason that -- despite Texas' near-total abortion ban becoming effective in September -- abortion rates fell only 10%, The New York Times Reports.
Outlawing abortion won't stop it
"Access to safe abortion is a public health issue, because when people decide that they must abort they will find a way to do so," Tavrow said.
In countries where abortion is restricted, more abortions occur without a medically approved method or performed by someone who doesn't have proper training. These abortions account for about 4% to 13% of maternal deaths worldwide.
Tavrow, a researcher in population and reproductive health, has conducted research in Kenya, where abortion is illegal except in cases where the pregnant person's life is at risk. At one boarding school for girls she visited in Western Kenya, she said, it was estimated that 1% of its student population died from complications of illegal abortion.
"It is vital for everyone to realize that restricting abortion doesn't make it go away," Tavrow said.
Before Roe v. Wade, some women in the US got illegal abortions from physicians who agreed to break the law by providing the procedure. But many women in the US went to someone unlicensed who inserted instruments to try to induce a miscarriage, Tavrow said. These unsafe practices led to infection, hemorrhage or death in some cases. Other people would drink household chemicals that hadn't been proved to be effective for ending a pregnancy and could make a person seriously ill. Some herbs have traditionally worked as an abortifacient in some cases, Tavrow says, but they're "harmful if taken in large quantities."
Trying to determine how many people will die or develop complications from unsafe abortions in the US now that Roe v. Wade has been overturned is complicated. People who have illegal abortions have historically been less likely to seek treatment for complications.
"In my opinion, if Roe v. Wade were overturned, women would turn to relatively safe medications that can be purchased over the internet," Stanley Henshaw, a researcher for the Guttmacher Institute, told The Washington Post in a 2019 fact-check article. "There would be some deaths but probably not as many as there were in the 1960s."
The Turnaway Study by the University of California, San Francisco, looked at what happens when people carry unwanted pregnancies to term. In addition to effects on children born to people denied abortions, like poverty, one of the medical findings of the study concluded that people denied abortion were more likely to experience complications, including preeclampsia and death. One contributing factor is a lack of prenatal care.
According to the most recent CDC report on abortion data, two deaths were reported from (legal) abortion complications in 2018 -- a 0.41 death rate per 100,000 abortions from 2013 to 2018. By contrast, 658 maternal deaths were reported in 2018 -- a rate of 17.4 deaths per 100,000 live births, according to the CDC. These include deaths during pregnancy, birth and the postpartum period.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.