research paper on morality of abortion

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

Affiliation.

• 1 Faculty of Social Sciences, University of Craiova, Romania; [email protected], [email protected], [email protected].
• PMID: 32747924
• PMCID: PMC7728127
• DOI: 10.47162/RJME.61.1.35

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

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• Case Reports
• Abortion, Induced / ethics*
• Ethics, Medical*

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• Volume 27, Issue suppl 2
• Reproductive autonomy and the ethics of abortion
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• Barbara Hewson
• Littman Chambers, London

Abortion is one of the most controversial issues in today's world. People tend to turn to the law when trying to decide what is the best possible solution to an unwanted pregnancy. Here the author's views on abortion are discussed from a lawyer's and a woman's point of view. By taking into consideration the rights of the fetus an “antagonistic relationship” between the woman and her unborn child may occur. Therefore, women should have more autonomy in the issue. The article concludes with examples of cases in the United States and Ireland where the rights of the fetus are considered more important than those of the mother because of existing laws. This article suggests that a more inclusive ethics of abortion is required rather than a new ethics of abortion when “translating fetal life into law”.

• 1967 Abortion Act

https://doi.org/10.1136/jme.27.suppl_2.ii10

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Practising lawyers generally have little time to reflect on matters of ethics. The law is a blunt instrument. Lawyers are often instructed to act for clients wishing to do things that would strike many people as immoral, but which the law entitles them to do. Evicting homeless people from one's property is an example. Lawyers are not expected or invited to pass moral judgments on their client. If they did, the client would probably go elsewhere! The Bar has a rule of conduct called the “cab-rank” rule. This obliges barristers to accept instructions regardless of the identity of the client, or the nature of the cause, or the barrister's own opinions about the client's conduct. Judges, likewise, must decide disputes according to law; their function is not to pass moral judgments on litigants. The reflections that follow, therefore, do not pretend to constitute some systematic overview but rather, some personal thoughts and ideas which may prompt further discussion.

So what can a barrister say on the ethics of abortion? Is a new ethics developing? Should there be one? These are interesting and important questions. As a lawyer with a commitment to autonomy, I see abortion as an issue that overwhelmingly concerns the autonomy and dignity of the pregnant woman herself. “Autonomy” derives from the Greek and means, literally, “self rule”. If a woman who is pregnant wishes to stop being pregnant, why should we prevent her? If we regard her pregnancy as a morally neutral state, there ought to be no satisfactory reason to prevent her. The way that humans reproduce, in common with other mammals, is simply a product of evolution. Biologically, the developing fetus is somewhat like an invading organism; if it were not for a complex system of compensating mechanisms, the woman's body would reject it in the same way as the body rejects a transplanted organ.

Attitudes to pregnancy are, however, inextricably bound up with how society views sex, women, and the fertile woman in particular. Pregnancy and birth are not minor inconveniences, such as having a cold. They constitute a major life event, which even when welcome causes immense discomfort and disruption to many women. Only recently Mrs Blair confessed that she had forgotten what an ordeal the last few hours of labour are. I have a dear friend who spent much of her two (planned) pregnancies being ill and unable to work. There exists a raft of laws to protect pregnant employees from unfair treatment because they are pregnant. Nevertheless, lawyers in the employment field still encounter cases where employers try to rid themselves of their pregnant employees. When a high-profile court case involving maternity rights is decided, leaders of industry often complain that this will have a chilling effect on employers' readiness to employ women of child-bearing age. I mention these factors simply to contextualise some of the difficulties that child-bearing women face.

If one is adamantly opposed to abortion, one is committed to some set of values which requires that women who become pregnant (whether intentionally or unintentionally) must endure the process of pregnancy and birth, no matter how distressing, painful and risky it is for them. The justification given for this is usually based on an abstract notion of the value of “fetal life”, rather than on the ground that suffering is morally improving for the women concerned. Extreme opponents of abortion argue that abortion is equivalent to murder and that, no matter how much women may suffer, they cannot be allowed to “kill their children”. But opposition to abortion entails a demand that women suffer, regardless of the circumstances in which they came to be pregnant, and despite the opportunities for ending pregnancy that exist. For those who believe that fetuses are full human beings, the justification is presumably that the woman's suffering is a lesser evil than terminating fetal life. This raises the question whether they tolerate the taking of “innocent” human life in other circumstances, for example. NATO's attack on Kosovo, or careless driving. Since an unwanted fetus is analogous to an invading organism, even if it is viewed as a human being, an argument can be made that the woman is entitled to refuse to act as a life-support system for it, and to abort in self defence. What about those who do not believe that fetuses are full human beings, but believe that abortion following consensual sexual activity is “wrong”? As the philosopher Janet Radcliffe Richards 1 has pointed out, the only time when we insist that a particular consequence must follow a particular activity, and do not allow people to escape the consequence, is when the consequence is intended as a punishment. 2 Apart from this punitive aspect of anti-abortion belief, it is also objectionable in ethical terms because it treats the pregnant woman as a means to an end: that of producing a baby.

Of course, many women will not accept the suffering which continuing with pregnancy would cause them (or their families), and take steps accordingly. In countries where safe abortion is illegal or unavailable, this results in self-imposed or “back-street” abortions and all the ills that flow from that: injury, infection, infertility, and even death. It is striking that complications from unsafe abortion are estimated to result in 13 per cent of maternal deaths worldwide. 3 It is hard to see how such wastage of female life could be condoned in ethical terms. As Ann Furedi has said: “The issue is not so much whether or when the embryo/fetus is deserving of respect per se, but how much respect and value we accord to a life (that does not even know it is alive) relative to the respect and value we have for the life of the woman who carries it.” 4

If we start from the premise that the promotion of freedom and the prevention of suffering are fundamental goals which society ought to support, then the prospect of women forced into suffering even—death—ought to worry us. Kant says that “a man is not a thing, that is to say, something which can be used merely as a means, but must in all his actions be always considered as an end in himself”. 5 Denying women abortion is, on this analysis, unethical because it subordinates women to a reproductive end.

The present tendency to characterise questions about abortion ethics in terms of concerns about fetuses, or even fetal “rights”, tends to sideline women and the realities of women's lives. Such sidelining of women is not entirely accidental; it is trite that many “fetal rights” proponents are opposed to the present increase in women's freedoms, and want to roll them back. Others who speak of fetuses as having “rights” assume that fetuses either have, or should have, rights, without necessarily explaining why this should be so, or why it should result in another person's loss of autonomy.

To put women back centre-stage, we should ask: why do women want abortions? Research has shown that the most commonly reported reason worldwide is that women wish to postpone, or stop, childbearing. 6 Abortion is a form of family planning, though it may not be “politically correct” to say so. What other reasons do women give for wanting abortions, worldwide? They include:

disruption of education or employment;

lack of support from father;

desire to provide for existing children;

poverty, unemployment or inability to afford sadditional children;

relationship problems with husband or partner, and

a woman's perception that she is too young to have a child.

To compel such women to bear unwanted children is in my view a form of ethical despotism: in Mill's words: “compelling each to live as seems good to the rest”. 7 If people are to be free, that freedom must include freedom to make these difficult and extremely personal choices.

Is the law informed by a consistent set of ethical principles? In England, Scotland, and Wales, abortion is permitted by the 1967 Abortion Act (amended by the Human Fertilisation and Embryology Act 1990), when two medical practitioners decide, in good faith, that one of the following grounds applies:

That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.

That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.

That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated.

That there is a substantial risk that if the child were born it would suffer from such mental or physical abnormalities as to be seriously handicapped.

Grounds 1 and 3 call for balancing exercises. Ground 2, which is based on necessity, does not. Ground 4 calls for an assessment of the likely severity of fetal handicap.

Doctors may take into account the pregnant woman's actual or reasonably foreseeable environment, in assessing the risk of injury to her health. The World Health Organization (WHO) defines health as a “state of complete physical, mental and social wellbeing that does not consist only in the absence of infirmity”. According to evidence-based guideline no 7, issued in March 2000 by the Royal College of Obstetricians and Gynaecologists (RCOG), The Care of Women Requesting Induced Abortion , 8 most doctors apply the WHO definition of “health” in interpreting the Abortion Act. 9 The RCOG's guideline development group views induced abortion as a health care need. 10 It also states that, among information on other topics which should be available to women, “abortion is safer than continuing a pregnancy to term and complications are rare”. 11

Janet Radcliffe Richards criticises the existing law:

“ …as things stand at the moment there is no real concern to estimate the value of the unborn child, or for the degree of suffering which would justify an abortion. All the law does, in effect, is make sure that a woman may not decide for herself whether to have an abortion, and send her to someone else in the position of a suppliant for favours, or even a culprit. It does nothing else ... as the law now stands there is no reason whatever for stopping where we are, and not going forward to a state where all women who want abortions can have them.” 12

If having an abortion is safer than carrying a pregnancy to term, then all pregnant women who wanted a termination below 24 weeks should qualify under ground 1 above. So perhaps the law is not so bad, after all.

In Northern Ireland, however, the 1967 Abortion Act does not apply. Doctors there do perform abortions on the ground of fetal abnormality. They can also perform abortions in cases where the woman's mental or physical health or wellbeing, or her life, are at real and serious risk. In this context, “real and serious” mean, simply, “genuine” and “not minor or trivial”. Thus, a woman does not have to show a life-threatening risk to her health, or even a “very serious” risk, to qualify for a legal abortion. Ironically, in the absence of any prescribed statutory formalities for abortion, Northern Ireland has on the face of it a more liberal abortion regime than the rest of the United Kingdom. In practice, though, the reluctance of the medical profession to perform abortions has a chilling effect. Most women seeking terminations have to travel to England or Scotland, at their own expense.

There are irreconcilable conflicts between what might be called the fundamentalist approach to the issue of abortion, which sees life as starting at conception, and what might be called the sceptical view, by which life begins when we attribute enough value to it to warrant its protection. Under English law, a fetus is not a “person”. Furthermore, a woman may decline medical intervention that would preserve the life of her fetus, and is free to let nature take its course, even where this may cause the death of her fetus. The justification for this is, firstly, that the common law respects the pregnant woman's autonomy; and secondly, that the common law does not coerce people into being “Good Samaritans” and saving others (assuming, for argument's sake, that the fetus is an “other”). The common law tradition is essentially liberal. The vice-chancellor, Sir Robert Megarry, put it like this in 1979: “[England] is a country where everything is permitted except what is expressly forbidden”. 13 If everyone could be compelled by law to do what others considered “right”, we should have no freedom, only moral dictatorship.

The case of St George's Healthcare NHS Trust v S , 14 decided in 1998, was a landmark case involving reproductive autonomy in another context: that of the pregnant woman's freedom to decline invasive treatment. The Court of Appeal upheld the common law rule that competent adults can refuse medical advice and intervention, despite being pregnant. Ms S was compulsorily detained under the Mental Health Act 1983 because she was refusing hospitalisation for pre-eclampsia. She was then forced into an unwanted caesarean, purporting to be authorised by a court order, which was made without any notice to her. She later recovered very substantial damages for trespass. The Court of Appeal stressed the importance of protecting individual autonomy, regardless of sex:

“while pregnancy increases the personal responsibilities of a woman it does not diminish her entitlement to decide whether or not to undergo medical treatment…. Her right is not reduced or diminished merely because her decision to exercise it may appear morally repugnant . . .the autonomy of each individual requires continuing protection even, perhaps particularly, when the motive for interfering with it is readily understandable, and indeed to many would appear commendable ... if it has not already done so, medical science will no doubt advance to the stage where a very minor procedure undergone by an adult would save the life of his or her child, or perhaps the child of a complete stranger . . .if however the adult were compelled to agree, or rendered helpless to resist, the principle of autonomy would be extinguished.”[italics added]

St George's wanted to appeal to the House of Lords to ventilate the arguments (among others) that a fetus was a “person” and that a pregnant woman could be deprived of her autonomy at the stage of fetal viability. These were interesting arguments for a National Health (NHS) trust, which presumably carries out abortions for fetal abnormality and other reasons, to pursue. If such arguments had been upheld on appeal, they would have had momentous implications for abortion law. St George's was refused leave to appeal by the Court of Appeal, and initially began proceedings for leave to appeal in the House of Lords. These were abandoned before the House of Lords had made a final decision on whether to grant leave.

Another interesting feature of the case is that Ms S's detention and forced treatment were prompted by concerns that she was refusing treatment for a disorder of pregnancy, pre-eclampsia. This could have killed her and her fetus, had it deteriorated into full-blown eclampsia. The irony is that Ms S could have sought a late abortion, on the ground that the continuation of her pregnancy posed the risk of grave and irreparable injury to her health and a serious risk to her life (grounds 2 and 3, referred to above). She was not seeking a late termination, but if she had, her situation would have been covered by the Abortion Act. That she wanted to let nature take its course was certainly eccentric, but ethically less troubling (if you dislike the idea of late termination) than if she had sought a late abortion.

Many people attribute a higher value to fetal life when fetuses reach viability. Thus, some people are troubled at the idea of, or opposed to, late terminations, whilst regarding early terminations as unproblematic or at any rate less problematic. But as Justice Ginsberg of the United State Supreme Court has recently pointed out: “the most common method of performing previability second trimester abortions is no less distressing or susceptible to gruesome description”. 15 In practice, late terminations are rare. The majority are done for fetal abnormality in what were otherwise wanted pregnancies; a minority are done to save the woman's life, or to prevent grave permanent damage to her health.

The question is, again, how to assess when life begins, in an ethical sense. Legally, as I have said, the fetus is not a “person”, and does not become a rights-bearing entity until it is born. But attempts to pin down “viability” as a criterion for abortion run into the problem that viability depends partly on where the fetus happens to be; if it is in an area with excellent facilities for the care of very premature babies, then it may be considered “viable” at an earlier gestational age, than if it were somewhere else. On any view, this is arbitrary.

In the United States' constitutional jurisprudence, access to abortion is a constitutionally protected right. Subsequent to fetal viability, the state may regulate and even prohibit abortion as a means of promoting its interest in the potentiality of human life. However, a woman remains constitutionally entitled to an abortion post-viability, where this is necessary to preserve her life or her health. 16 Her interests in preserving her own life and health will “trump” the state's interest. It is also worth noting that fetuses are not recognised as “persons” under the US constitution; if they were, it would be difficult, if not impossible, to derive any right to abortion under the constitution. Even if a pregnant woman's life were at stake, it would be more difficult to argue that this should justify killing fetal “persons”: our response to people who are dangerously ill is not to kill other people. (Otherwise, every time someone needed a life-saving transplant, we could justify killing someone else to provide the needed organ). Some form of “self-defence” argument would have to be invoked.

Some people argue that it is arbitrary not to bestow “personhood” on a fetus until it is born. They ask rhetorically: What is it about the passage through the vagina that makes such a difference? Of course, if you can only envisage a vagina instead of a woman giving birth, you may have difficulty acknowledging the critical role that a woman plays in giving birth, and why (in turn) society views birth as the critical moment. This is, as much as anything, a mark of respect for women's role in giving birth.

Some obstetricians regard pregnant women as “two patients” in the maternity care context. To a blunt lawyer, this is incongruous in the extreme. One wonders, is the fetal “patient” a “person”? Presumably so, because the idea of a patient who is not a person is bizarre. But in legal terms, as I have said earlier, the pregnant woman is only one person. Whom do doctors advise? Who takes the treatment decisions? The woman. Generally, midwives and obstetricians talk about “babies” rather than fetuses, presumably because that is how the women whom they attend regard their fetuses. But is the fetus really a second patient? If it were such, one might expect doctors would have to open up a separate file for the fetus, which is not customary (as far as I know) in maternity hospitals. Perhaps having “two” patients makes an obstetrician a “super-doctor”, which is why the idea has gained ground!

There are conceptual difficulties to do with attributing personhood to an entity which is invisible, inaccessible, physically contained in and attached to the woman, which entirely lacks capacity, and which cannot interact with others at all, prior to birth. In everyday life, such an idea, if given legal effect, would lead to some strange outcomes. Pregnant women might have to purchase two tickets every time they used public transport to avoid being prosecuted for fetal “fare-dodging”. More seriously, if fetuses were “persons”, this would open the way to lawsuits for alleged wrongdoing by pregnant women whose conduct allegedly compromised fetal wellbeing in some way. In the words of a 1993 Canadian Royal Commission on New Reproductive Technologies (cited in the St George's judgment): “each choice made by the woman in relation to her body will affect the fetus and potentially attract tort liability”. 14

One can make a case for saying that a pregnant woman is entitled to be regarded as two persons, not as a means of subordinating her interests and autonomy, but rather to enhance it. (I have problems with this argument, however, and it doesn't work in terms of abortion). Quite simply, one could say that, given the increased needs which pregnancy brings, the pregnant woman is entitled to call for special care and treatment for herself and for her fetus. In theory, the pregnant woman could act as the fetus's proxy, with sole authority to advocate on its behalf, and to determine what happens to it. The problem with translating the idea of “two patients” into legal terms, however, is that “fetal rights” proponents have deployed this concept not as a means of improving care for pregnant women, but as a pretext for coercion: state intervention which forces pregnant woman into an antagonistic relationship with their fetuses. In other words, state control of pregnant women.

An illustration of the coercion to which this can give rise, is provided by certain US states. In South Carolina and California, drug-addicted pregnant women attending antenatal clinics have been arrested and charged with criminal offences, after they tested positive for drugs whilst pregnant. The MSUC hospital in Charleston, South Carolina pursued a particularly punitive policy against addicted African-American women in the 1980s and early 1990s. Pregnant women attending for antenatal care were tested for drugs without their knowledge and, if the tests were positive, the women were arrested and taken into custody by the police. An appeal to the US Supreme Court, in a case called Ferguson v City of Charleston , recently succeeded: the Supreme Court decided in March 2001 that covert drug-testing was unconstitutional. 18

The South Carolina Supreme Court gave a ruling in 1997, in a case concerning another drug-addicted pregnant woman, Whitner v State . 19 She was convicted of criminal child neglect for (in the words of prosecutors) failing to provide proper medical care for her unborn child, and jailed for eight years. He was born healthy, but a test showed prenatal exposure to cocaine. The ruling is that a viable fetus is a “person”, and that acts which endanger fetal health—including drinking and smoking—can be prosecuted under child abuse laws. After this ruling, the Attorney-General's office in South Carolina announced that anyone who had, or who took part in, a post-viability abortion could be prosecuted for murder and receive the death penalty. 20 Here are some examples of how the decision has been applied:

“ Whitner has not been limited to women who use illegal drugs. Following the decision a pregnant woman in South Carolina was arrested because she was pregnant and used alcohol. When a thirteen-year-old girl experienced a stillbirth her parents were arrested: one charge was for unlawful conduct to a child because the girl's parents had allegedly ‘failed to get proper care for the fetus’. A woman who suffered a miscarriage was arrested and charged with homicide by child abuse. The prosecutor admitted there was no evidence of drug use but nevertheless insisted that the miscarriage was a ‘crime’ for which the woman had to take responsibility.” (L M Paltrow, personal communication, 4 May 2000)

Another example of state control is provided by the Republic of Ireland, where the constitution gives the “unborn” a right to life equal to that of the “mother”. Even rape is not recognised as a legal basis for abortion, though this could be the subject of a challenge before the European Court of Human Rights in Strasbourg. In two dramatic cases involving child victims of sexual assault, the X and C cases, 21 , 22 Irish courts have become involved in the question whether such victims are free to travel to England for lawful abortions. Where children become pregnant, and family courts have to consider their welfare, the Irish courts will only permit travel abroad for abortions when the children can show their lives are in danger. This is surprising, given that the Irish people voted to give women freedom to travel in 1992. So there are some stark examples from both sides of the Atlantic of problems that arise when ethical absolutes about fetal life are translated into law. Perhaps it is not so much a new ethics of abortion that is required, as a more inclusive one.

• ↵ Radcliffe Richards J. The sceptical feminist. London : Penguin, 1994.
• ↵ See reference 1: 279.
• ↵ A Joint World Health Organisation/UNFPA/UNICEF/World Bank statement. Reduction of maternal mortality. Geneva: World Health Organization, 1999: 14.
• ↵ Furedi A. Women versus babies: comment & analysis. The Guardian 2000 Feb 22: .
• ↵ Kant I. Fundamental principles of the metaphysic of morals. In Cahn SM, Markie P, eds. Ethics: history, theory and contemporary issues . New York: Oxford University Press, 1998: 297.
• ↵ Smith C. Contraception and the need for abortion. A quest for abortion: new research about obstacles, delays and negative attitudes . London: Voice for Choice, 1999: 3-4.
• ↵ Mill JS. On liberty. Three Essays London: Oxford University Press, 1975: 18.
• ↵ Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. London: Royal College of Obstetricians and Gynaecologists, 2000.
• ↵ See reference 8: 16: para 2.1
• ↵ See reference 8: 36.
• ↵ See reference 8: 26.
• ↵ See reference 1: 289.
• ↵ Malone v Metropolitan Police Commr, (1979)ch 344,537.
• ↵ St George's Healthcare NHS Trust v S [1999] Fam; 26 :46-7.
• ↵ Stenberg v Carhart US Supreme Court, June 28, 2000.
• ↵ Planned Parenthood v Casey (1992) 505 US 833.
• See reference 14: 49-50.
• ↵ Ferguson v City of Charleston , US Supreme Court 21 March 2001.
• ↵ Whitner v South Carolina , 492 SE2d 777 (SC 1997).
• ↵ Paltrow L. Pregnant drug users, fetal persons and the threat to Roe v Wade. Albany Law Review 1999 ; 62 : 999 –1014. OpenUrl
• ↵ Attorney-General v X [1992] 1 IR 1.
• ↵ A & B v Eastern Health Board [1998] 1 IR 464.

Barbara Hewson is a Barrister at Littman Chambers, 12 Gray's Inn Square, London WC1R 5JP.

Read the full text or download the PDF:

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• About the Survey

Religious and Moral Influence on the Debate

One-third of Americans (32%) say their religious beliefs are the primary influence on their attitudes toward abortion. Roughly one-in-five cite their education (21%), and one-in-seven point to their personal experience (14%). Fewer say the views of their family and friends (6%) or what they have seen or read in the media (5%) are the main influences on their opinion about abortion, but a sizable proportion (21%) say there is something else that most informs their view.

Religious beliefs hold much stronger sway over those who oppose abortion than over those on the pro-choice side of the abortion issue. More than half of those who say abortion should be illegal (53%) cite religious beliefs as the primary influence on their views, compared with only 11% among supporters of legal abortion. Instead of religion, supporters of legal abortion are much more likely to cite their education (30%) or a personal experience (20%) as the primary influence on their views on abortion.

Women are more apt than men to say that their religious beliefs have the most influence on their views about abortion (36% vs. 28%), and Americans 65 and older are much more likely than young adults to say this (44% among those 65 and older vs. 25% among those under age 30).

Among political groups, 53% of conservative Republicans say their attitudes are based primarily on their religious beliefs, compared with just 22% of moderate or liberal Republicans. More than a third of conservative or moderate Democrats (36%) and 17% of liberal Democrats single out the influence of their religious beliefs.

A majority of white evangelical Protestants (58%) say their religious beliefs drive their views on abortion. This figure approaches seven-in-ten (68%) among white evangelicals who attend services at least weekly. Mainline Protestants are much less likely to cite their religious beliefs (22%), but there is still a strong divide between white mainline Protestants who attend church at least weekly (41%) and those who attend less often (14%). White, non-Hispanic Catholics are similarly divided on the issue, with 60% of those who attend weekly services saying their religious beliefs are the main influence on their abortion views, compared with just 19% of those who attend less regularly. More than one-quarter of religiously unaffiliated Americans (28%) rely most on their education in formulating their opinion on abortion.

Half Say Abortion Is Morally Wrong

A slight majority of Americans (52%) say having an abortion is morally wrong. One quarter says it is not a moral issue, and just 10% say it is morally acceptable. (The remaining 12% say that the morality of abortion depends on the situation or refuse to express an opinion.)

There is a strong connection between views on whether abortion should be legal and views on the morality of having an abortion. Most opponents of legal abortion (80%) say having an abortion is morally wrong. Most supporters of legal abortion, on the other hand, say abortion is morally acceptable (18%) or that it is not a moral issue (42%). But more than a quarter of those who say abortion should be legal (28%) say it is morally wrong to have an abortion.

Consistent with this, the most pro-life groups more often say that abortion is morally wrong. Three-quarters of conservative Republicans say this, as do slight majorities of moderate or liberal Republicans (51%) and conservative or moderate Democrats (55%). Nearly a third of liberal Democrats (31%) say abortion is morally wrong, with 40% saying it is not a moral issue.

White evangelical Protestants are very likely to say abortion is morally wrong (74%). Majorities of black Protestants (58%) and Catholics (58%) also say this. Fewer than half of white mainline Protestants (40%) say that abortion is morally wrong. Among the unaffiliated, 30% say having an abortion is morally wrong, but 43% say it is not a moral issue. Attendance at worship services also plays a role, with those who attend most frequently being twice as likely as those who attend least often to say abortion is morally wrong (67% vs. 35%).

Influence of Religious and Moral Beliefs

Religious beliefs, when cited as the main source of thinking on abortion, are much more likely to influence adherents in a pro-life direction than in a pro-choice direction. Among those who say their religious beliefs have the most influence on their thinking about abortion, an overwhelming majority (82%) say abortion should be illegal. Less than one-in-five (18%) say it should be legal.

The opposite is true, however, among those who cite education or personal experience as their main influence. Strong majorities of these groups identify with a pro-choice viewpoint (72% among those saying education, 70% among those saying personal experience).

A similar though less-pronounced pattern is seen on the question of whether the country should find a middle ground on abortion. Those who cite religious beliefs as the primary influence on their abortion views and those who say abortion is morally wrong are considerably more likely than others to say that there is no room for compromise on the issue of abortion.

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A Brief History of Abortion in the U.S.

Abortion wasn’t always a moral, political, and legal tinderbox. What changed?

A bortion laws have never been more contentious in the U.S. Yet for the first century of the country’s existence—and most of human history before that—abortion was a relatively uncontroversial fact of life.

“Abortion has existed for pretty much as long as human beings have existed,” says Joanne Rosen, JD, MA , a senior lecturer in Health Policy and Management who studies the impact of law and policy on access to abortion.

Until the mid-19th century, the U.S. attitude toward abortion was much the same as it had often been elsewhere throughout history: It was a quiet reality, legal until “quickening” (when fetal motion could be felt by the mother). In the eyes of the law, the fetus wasn’t a “separate distinct entity until then,” but rather an extension of the mother, Rosen explains.

What changed?

America’s first anti-abortion movement wasn’t driven primarily by moral or religious concerns like it is today. Instead, abortion’s first major foe in the U.S. was physicians on a mission to regulate medicine.

Until this point, abortion services had been “women’s work.” Most providers were midwives, many of whom made a good living selling abortifacient plants. They relied on methods passed down through generations, from herbal abortifacients and pessaries—a tampon-like device soaked in a solution to induce abortion—to catheter abortions that irritate the womb and force a miscarriage, to a minor surgical procedure called dilation and curettage (D&C), which remains one of the most common methods of terminating an early pregnancy.

The cottage abortion industry caught the attention of the fledgling American Medical Association, which was established in 1847 and, at the time, excluded women and Black people from membership. The AMA was keen to be taken seriously as a gatekeeper of the medical profession, and abortion services made midwives and other irregular practitioners—so-called quacks—an easy target. Their rhetoric was strategic, says Mary Fissell, PhD , the J. Mario Molina professor in the Department of the History of Medicine at Johns Hopkins University. “You have to link those midwives to providing abortion as a way of kind of getting them out of business,” Fissell says. “So organized medicine very much takes the anti-abortion position and stays with that for some time.”

Early 19th century and before

Abortion is legal in the U.S. until “quickening”

AMA campaigns to end abortion

At least 40 anti-abortion statutes are enacted in the U.S.

Comstock Act makes it illegal to sell or mail contraceptives or abortifacients

Late 19th century

OB-GYN emerges as a specialty

Griswold v. Connecticut decision finds that the Constitution guarantees a right to privacy, specifically in prescribing contraceptives, paving the way for Roe v. Wade

Supreme Court decision in Roe v. Wade enshrines abortion as a constitutional right

Planned Parenthood of Southeastern Pennsylvania v. Casey protects a woman's right to have an abortion prior to  fetal viability

Four states pass trigger laws making it a felony to perform, procure, or prescribe an abortion if Roe is ever overturned

Roe v. Wade and Planned Parenthood v. Casey overturned; 13 states ban abortion by October 2022

In 1857, the AMA took aim at unregulated abortion providers with a letter-writing campaign pushing state lawmakers to ban the practice. To make their case, they asserted that there was a medical consensus that life begins at conception, rather than at quickening.

The campaign succeeded. At least 40 anti-abortion laws went on the books between 1860 and 1880.

And yet some doctors continued to perform abortions in the late 19th and early 20th centuries. By then, abortion was illegal in almost all states and territories, but during the Depression era, “doctors could see why women wouldn’t want a child,” and many would perform them anyway, Fissell says. In the 1920s and through the 1930s, many cities had physicians who specialized in abortions, and other doctors would refer patients to them “off book.”

That leniency faded with the end of World War II. “All across America, it’s very much about gender roles, and women are supposed to be in the home, having babies,” Fissell says. This shift in the 1940s and ’50s meant that more doctors were prosecuted for performing abortions, which drove the practice underground and into less skilled hands. In the 1950s and 1960s, up to 1.2 million illegal abortions were performed each year in the U.S., according to the Guttmacher Institute . In 1965, 17% of reported deaths attributed to pregnancy and childbirth were associated with illegal abortion.

A rubella outbreak from 1963–1965 moved the dial again, back toward more liberal abortion laws. Catching rubella during pregnancy could cause severe birth defects, leading medical authorities to endorse therapeutic abortions . But these safe, legal abortions remained largely the preserve of the privileged. “Women who are well-to-do have always managed to get abortions, almost always without a penalty,” says Fissell. “But God help her if she was a single, Black, working-class woman.”

Women who could afford it brought their cases to court to fight for access to hospital abortions. Other women gained approval for abortions with proof from a physician that carrying the pregnancy would endanger her life or her physical or mental health. These cases set off a wave of abortion reform bills in state legislatures that helped set the stage for Roe v. Wade . By the time Roe was decided in 1973, legal abortions were already available in 17 states—and not just to save a woman’s life.

But raising the issue to the level of the Supreme Court and enshrining abortion rights for all Americans also galvanized opposition to it and mobilized anti-abortion groups. “ Roe was under attack virtually from the moment it was decided,” says Rosen.  

In 1992 another Supreme Court case, Planned Parenthood of Southeastern Pennsylvania v. Casey posed the most significant existential threat to Roe . Rosen calls it “the case that launched a thousand abortion regulations,” upholding Roe but giving states far greater scope to regulate abortion prior to fetal viability. However, defining that nebulous milestone a became a flashpoint for debate as medical advancements saw babies survive earlier and earlier outside the womb. Sonograms became routine around the same time, making fetal life easier to grasp and “putting wind in the sails of the ‘pro-life’ movement,” Rosen says. Then in June, the Supreme Court overturned both Roe and Casey .

For many Americans, that meant the return to the conundrum that led Norma McCorvey—a.k.a. Jane Roe—to the Supreme Court in 1971: being poor and pregnant, and seeking an abortion in a state that had banned them in all but the narrowest of circumstances.

The history of abortion in the U.S. suggests the tides will turn again. “We often see periods of toleration followed by periods of repression,” says Fissell. The current moment is unequivocally marked by the latter. What remains to be seen is how long it will last.

From Public Health On Call Podcast

Abortion is first and foremost a moral issue

I n the Sunday edition of the Naples Daily News (March 24, 2024), the featured guest columnists presented an interesting contrast in beliefs.  One columnist was making the humanitarian argument in support of legislation providing shelter in Florida’s communities for those lost souls whose bad choices have left them homeless and seemingly without hope.  The other was making the case that good young family doctors will not want to locate in Florida due to abortion restrictions.

These are not new issues.  What is interesting is that the columnist advocating easing restrictions on abortion is a medical doctor, while the one making the case for human value is a politician.  So much for the Hippocratic oath, and so much for the belief that all politicians are without a soul!

Ever since Roe v. Wade in 1973, abortion has been a hot-button political issue, perhaps the most divisive issue in our country today.  Both sides of the argument operate as if a legal decision — better yet an all-inclusive constitutional decision — will “put the baby to rest” one way or the other.  Will it?  When did our government(s) become our moral conscience.

Government, being nothing more than a collection of people, is capable of doing good things, but it also lies, cheats, kills, and does a lot of stupid things as well.  Government is hardly a code of morality. 

Abortion is first and foremost a moral issue.  If you believe we are, with all our warts, children of a loving and all-knowing God, the debate ends there — when the sperm fuses with the egg, and a unique DNA comes into being.

If you don’t believe in a Creator, if you have your own moral code, or if your circumstances tempt you to put your moral code in a drawer, then there is support for your decision to sever the sperm from the egg at any point in the birthing process.  In Florida, beginning May 1 when the new law takes effect, it is legal to do so up to six weeks of pregnancy when the heartbeat can be detected.  In Minnesota it’s perfectly legal to abort until the “fetus” exits the womb and miraculously becomes a “baby.”

Florida’s six-week abortion law, I believe, is little different from that of other states which place restrictions on abortion with exceptions in case of rape, incest, human trafficking, diagnosis of fatal fetal abnormalities, and when required to protect the mother’s life or health.  When the Hippocratic oath causes the physician to choose between the procreator and the procreated, procreation favors the procreator.

Considering all that Florida has to offer in climate, leadership, education, opportunity, freedom, and a growing and diverse population, it is hard to believe primary care physicians of all ages and specialties would find Florida’s new six-week abortion law with its many exceptions in conflict with their Hippocratic Oath.  The good doctor columnist need only look elsewhere around the country, including the state of Minnesota, and see why everyone else is moving to Florida.  The OB/GYN/s will follow.

In the long history of abortion in this country, the moral issue of abortion has evolved in the legal realm from the offense of murder to the opposing view that “it’s my body to do with as I choose.”  I can’t help but wonder how many glowing expectant mothers truly believe this in their heart.

The Florida Supreme Court has recently ruled that the right to privacy in the Florida State Constitution does not include the right to an abortion.  In November, Floridians will vote to decide whether to amend the Constitution to include such a right.

John Bernardi, now a Florida resident, is a retired trial attorney with 45 years of experience in both civil and criminal private practice in central and northern Illinois. He was also the chief public defender for over 35 years, overseeing a team of 16 assistant public defenders.

This article originally appeared on Fort Myers News-Press: Abortion is first and foremost a moral issue

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5 Takeaways From the Supreme Court Arguments on Idaho’s Abortion Ban

The court’s ruling could extend to at least half a dozen other states that have similarly restrictive bans, and the implications of the case could stretch beyond abortion.

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By Pam Belluck

• April 24, 2024

The abortion case before the Supreme Court on Wednesday featured vigorous questioning and comments, particularly by the three liberal justices. At issue is whether Idaho’s near-total ban on abortion is so strict that it violates a federal law requiring emergency care for any patient, including providing abortions for pregnant women in dire situations.

A ruling could reverberate beyond Idaho, to at least half a dozen other states that have similarly restrictive bans.

The implications of the case could also extend beyond abortion, including whether states can legally restrict other types of emergency medical care and whether the federal law opens the door for claims of fetal personhood.

Here are some takeaways:

The case centers on whether Idaho’s abortion ban violates federal law.

Idaho’s ban allows abortion to save the life of a pregnant woman, but not to prevent her health from deteriorating. The federal government says it therefore violates the Emergency Medical Treatment and Labor Act, or EMTALA, which was enacted nearly 40 years ago.

EMTALA says that when a patient goes to an emergency room with an urgent medical issue, hospitals must either provide treatment to stabilize the patient or transfer the patient to a medical facility that can, regardless of the patient’s ability to pay. It says that if a state law conflicts with the federal law, the federal law takes precedence.

A lawyer representing Idaho, Joshua Turner, told the Supreme Court that the state does not believe its abortion ban conflicts with the federal law. He said the ban allows emergency departments to provide abortions if a pregnant woman has a medical problem that is likely to lead to her death, not just if she is facing imminent death.

The three liberal justices strongly objected to Mr. Turner’s interpretation and pointed out situations in which women in critical situations would be denied abortions under Idaho’s ban. When Justice Sonia Sotomayor asked if the ban would prevent abortion in a situation where a woman would otherwise lose an organ or have serious medical complications, Mr. Turner acknowledged that it would. “Yes, Idaho law does say that abortions in that case aren’t allowed,” he said.

The real-world consequences of Idaho’s ban for abortion and other medical care were apparent.

Solicitor General Elizabeth B. Prelogar, representing the federal government, said Idaho’s abortion ban, which was allowed to take effect this year, had significant consequences for pregnant women and emergency room doctors.

“Today, doctors in Idaho and the women in Idaho are in an impossible position,” she said. “If a woman comes to an emergency room facing a grave threat to her health, but she isn’t yet facing death, doctors either have to delay treatment and allow her condition to materially deteriorate or they’re airlifting her out of the state so she can get the emergency care that she needs.”

Justice Samuel A. Alito Jr., one of the most conservative justices, asserted that the federal government and the liberal justices were giving hypothetical examples. But Justice Elena Kagan, a liberal, noted that the hospital with the most advanced emergency room services in Idaho had needed to transfer six women to other states for emergency abortions so far this year.

There was also discussion about potential consequences for other types of medical care if Idaho’s ban was allowed to stand. Justice Sotomayor said that would allow states to pass laws saying “don’t treat diabetics with insulin, treat them only with pills,” contradicting the best medical judgment of a doctor who “looks at a juvenile diabetic and says, ‘Without insulin, they’re going to get seriously ill.’”

Conservative justices raised questions about fetal rights.

Justice Alito, in particular, focused on the fact that EMTALA includes several mentions of the phrase “unborn child.”

“Doesn’t that tell us something?” he asked. He suggested that it meant that “the hospital must try to eliminate any immediate threat to the child,” and that “performing an abortion is antithetical to that duty.”

That was an argument that supports efforts by abortion opponents to establish “fetal personhood” rights and declare that life begins at conception. Idaho’s lawyer, Mr. Turner, said on Wednesday that “there are two patients to consider” when pregnant women seek emergency room care.

The federal government has pointed out that three of the four mentions of “unborn child” in EMTALA refer only to when a woman in labor might be transferred to another hospital.

Ms. Prelogar described the intent of the fourth reference to “unborn child,” which was added to the law later. She said it referred to situations in which a pregnant woman goes to an emergency room and her pregnancy is in danger but her own health is not currently at risk. In that case, the law would require hospitals to do what they could to save the pregnancy. That would not be a situation where an abortion would be provided, she said.

Ms. Prelogar also emphasized that usually in the kinds of pregnancy emergencies in which an abortion is typically required, there is no possibility for a live birth. “In many of these cases, the very same pregnancy complication means the fetus can’t survive regardless,” she said. “There’s not going to be any way to sustain that pregnancy.”

In such cases, she said, “what Idaho is doing is waiting for women to wait and deteriorate and suffer the lifelong health consequences with no possible upside for the fetus. It stacks tragedy upon tragedy.”

The U.S. government disputed conservative claims that the federal law allows abortion for mental health emergencies.

Mr. Turner said that EMTALA would allow emergency rooms to provide abortions for pregnant women who are experiencing depression and other mental health issues. Abortion opponents have said that this could be used as a loophole to allow many patients to obtain abortions despite state bans.

Justice Amy Coney Barrett, another conservative, expressed some skepticism about Idaho’s claim. Justice Alito pressed the solicitor general about it.

“Let me be very clear about our position,” Ms. Prelogar replied. “That could never lead to pregnancy termination because that is not the accepted standard of practice to treat any mental health emergency.”

She said antipsychotic drugs and other psychiatric treatments would be administered to such patients. The treatment would not be abortion, she said, because “that won’t do anything to address the underlying brain chemistry issue that’s causing the mental health emergency in the first place.”

The federal emergency care law doesn’t require doctors who are morally opposed to abortion to provide them, the government said.

Justice Barrett and Chief Justice John G. Roberts Jr. asked if EMTALA’s requirement for emergency medical care prevented emergency room doctors or hospitals with moral or religious objections from opting out of providing abortions.

The solicitor general said that federal conscience protections take precedence. So individual doctors can invoke conscience rights to avoid providing abortions, Ms. Prelogar said. And although she said it would be rare for an entire hospital to invoke a moral objection to terminating pregnancies in the kinds of medical emergencies that EMTALA applies to, hospitals with such objections could opt out as well.

Pam Belluck is a health and science reporter, covering a range of subjects, including reproductive health, long Covid, brain science, neurological disorders, mental health and genetics. More about Pam Belluck

My faith puts health first. Supreme Court abortion ruling would pander to Christian extremists.

A small but loud group of christian extremists dominate the narrative around abortion and religion..

Your sister, daughter or best friend is pregnant and excited to be a mom. You fly back to Idaho to help her get ready to give birth, but once you land you realize something is wrong. She’s pale. She’s bleeding, and it won’t stop. You take her to the emergency room. The hospital can’t do anything about it because “she is not at risk of immediately dying.” So you wait. You watch as her condition worsens, her pain escalates, and you stand powerless as you watch a system that prioritizes a fetus at the expense of your loved one.

That looming reality is what’s at stake in  Idaho v. United States . On Wednesday, the Supreme Court will hear oral arguments on whether a state’s near-total abortion ban conflicts with federal requirements for emergency care under the Emergency Medical Treatment and Labor Act.

EMTALA was passed by Congress in 1986 to ensure that all patients can access emergency medical care, free of discrimination. We have all needed to use the emergency room at some point in our lives. This case will have real consequences on real lives and jeopardizes our fundamental right to religious freedom.

Protecting emergency reproductive care that prioritizes the life of the pregnant person is at its very core about our right to religious freedom in a country that claims to have separation of church and state. People of all faiths must be able to practice what their religion teaches.

For Jews, our values and text compel us to always prioritize and safeguard the well-being of the pregnant person if their life is at stake. 

Anti-abortion movement: Did conservatives win the battle on abortion but lose the culture war on life?

In Jewish faith, access to abortion care is sacred. Does SCOTUS care?

This is widely agreed upon among Jews in the United States –  83% of whom believe abortion should be legal in all or most cases. After the Supreme Court overturned Roe v. Wade, all major Jewish denominations issued statements sharing concern for our religious freedom, with particular consensus around cases where the life of the pregnant person is at risk.

A question emerges, indicating the severe implications around the outcome of this Supreme Court case for Jews, atheists and all minority religions: Must we die in order to preserve one Christian understanding of life?

Over the past two years, laws designed by Christian religious extremists, rooted in just one, narrow interpretation of when life begins, have led to dire consequences for people who don’t want to be pregnant and for those who do but face medical complications. The motivation behind these laws does not get talked about enough and should raise serious flags for all who uphold that the United States is a beacon of religious freedom.

The reality is Christian extremists manipulate our democratic system to preserve Christian theocracy. We saw that in the Dobbs v. Jackson Women's Health Organization ruling, when we later learned that some justices are reported to have  prayed with the anti-abortion evangelicals they cited about morality in the majority opinion.

We saw that when we looked into the funders behind both the Dobbs decision and the case to ban abortion medication and realized they are the same people who put out the “He Gets Us” Jesus ads during the Super Bowl broadcast. Whether on the screen or in our laws, Christian extremists are pulling all levers to advance their moral agenda. 

Abortion law is no coincidence: Arizona reinstates near-total abortion ban from 1864. Women must now fight for our lives.

There's no morality in denying women medical care

There is no morality in denying women the lifesaving emergency medical care they need. And when it comes to abortion, both those of faith and those of no faith support access. 

Ex odus 21 :22-23 recounts a story of two fighting men who injure a pregnant woman, resulting in her subsequent miscarriage. The common rabbinical conclusion of this verse is that the men did not commit murder because the fetus is not a person. Instead, the primary concern is the well-being of the person who was injured. This text has led to the understanding that Judaism values protecting the life of the mother at all stages of pregnancy. This sanctity is core to our religious freedom. 

Ironically, oral arguments for this Idaho case fall during the holy days of Passover , a time when we honor the liberation of Jews. During this time, we also traditionally abstain from working and traveling. Many Jews who would normally go to the Supreme Court to hear oral arguments or to engage with this case as it is happening won’t be able to.

The irony and pain of a case deciding our religious freedom being scheduled on a sacred day for Jews further hits at the fundamental idea that our nation is rooted in Christian theocracy despite the many faiths that make up our country.

It’s time to speak up. A small but loud group of Christian extremists dominate the narrative around abortion and religion. Religious freedom is meant to be a shield to protect and never a sword to discriminate – but in courts and state legislatures across the country, they have continually slashed our freedoms and our rights.

The Emergency Medical Treatment and Active Labor Act is one of the last remaining threads of federal reproductive care, and Christian extremists are threatening to destroy it.

When they go before the Supreme Court on Wednesday, once again using religious freedom as an excuse to deny emergency care to pregnant people in desperate circumstances, we need to ask: Whose faith are they championing? I know it’s not mine. 

Sheila Katz is the CEO of the  National Council of Jewish Women , a 130-year-old Jewish feminist civil rights organization with more than 210,000 advocates and 49 local sections across the United States.

Conservative justices appear skeptical federal law requires emergency abortion care

• ‘Health’ is a topic for debate when it comes to women and pregnancy
• The legal experts I spoke with in advance of this argument were expecting the justices to...
• As the oral arguments unfold, I’m getting texts from Biden administration officials and public health experts...

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• States where abortion is on the ballot in the 2024 election April 15, 2024 States where abortion is on the ballot in the 2024 election April 15, 2024
• States where abortion is legal, banned or under threat 3 hours ago States where abortion is legal, banned or under threat 3 hours ago
• Trump says it’s up to states whether to punish, monitor women for abortions April 30, 2024 Trump says it’s up to states whether to punish, monitor women for abortions April 30, 2024

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U.S. abortion access, reproductive rights

Tracking abortion access in the United States: Since the Supreme Court struck down Roe v. Wade , the legality of abortion has been left to individual states. The Washington Post is tracking states where abortion is legal, banned or under threat.

Abortion and the election: Voters in about a dozen states could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. Biden supports legal access to abortion , and he has encouraged Congress to pass a law that would codify abortion rights nationwide. After months of mixed signals about his position, Trump said the issue should be left to states . Here’s how Biden and Trump’s abortion stances have shifted over the years.

New study: The number of women using abortion pills to end their pregnancies on their own without the direct involvement of a U.S.-based medical provider rose sharply in the months after the Supreme Court eliminated a constitutional right to abortion , according to new research.

Abortion pills: The Supreme Court seemed unlikely to limit access to the abortion pill mifepristone . Here’s what’s at stake in the case and some key moments from oral arguments . For now, full access to mifepristone will remain in place . Here’s how mifepristone is used and where you can legally access the abortion pill .

Breaking News

How treatment of miscarriages is upending the abortion debate

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For decades, the abortion wars have centered on whether a woman should be able to decide when and whether she has a child. But with increasingly strict restrictions on reproductive rights being enacted across the United States, these debates are charting new, unfamiliar territory — medical care for women who have had miscarriages.

Up to 1 in 4 women who know they are pregnant will miscarry, according to the National Library of Medicine. Although most miscarriages resolve naturally, some require medical intervention that is similar to an elective abortion.

Democrats, who believe abortion led to strong outings in the 2020 and 2022 elections, are now showcasing the dangers of miscarriages as another reason to support abortion rights — and Democrats.

Arizona’s ban on abortion sets up the swing state for an election 2024 showdown

The Arizona Supreme Court’s ruling Tuesday made abortions illegal, except when a mother’s life is at risk. Attention quickly turned to the November election.

April 10, 2024

A seven-figure April ad buy in battleground states by President Biden’s reelection campaign highlights the story of a happily married pregnant Texas woman named Amanda Zurawski.

“At 18 weeks, Amanda’s water broke and she had a miscarriage,” the ad reads, with white lettering against a black background. “Because Donald Trump killed Roe v Wade, Amanda was denied standard medical care to prevent an infection, an abortion.”

The 60-second ad concludes “Donald Trump did this,” after showing Zurawski and her husband, Josh, looking through a box of items that they had bought in anticipation of the birth of their first child, including a baby book and the outfit they planned to dress her in to bring her home from the hospital.

The Biden campaign launched this ad a day before the Arizona Supreme Court upheld a near-total abortion ban dating back to 1864, a ruling that former President Trump, the presumptive 2024 GOP presidential nominee, Arizona Senate hopeful Kari Lake and other Republicans have struggled to explain as they simultaneously celebrate the U.S. Supreme Court overturning a federal right to abortion.

Inside an Arizona abortion clinic: Uncertainty looms and optimism reigns

Amid the political turmoil brought on by the Arizona Supreme Court reinstating an 1864 abortion law, it was business as usual at a Phoenix clinic. Optimism reigned for both proponents and foes of abortion rights.

April 22, 2024

But the ad also reflects a reframing of how abortion is discussed as a moral issue. Democrat Bill Clinton famously said the procedure should be “safe, legal and rare” during his successful 1992 presidential bid.

But now even liberals say the emphasis on “rare” failed to recognize the medical necessity of some abortions, such as those performed after a miscarriage. Clinton’s framing also carried a connotation of shame for a woman seeking an abortion, whatever the reason.

“That framework was harmful and perpetuates stigma,” said Kelly Baden, vice president for public policy at the Guttmacher Institute, a nonprofit research organization that supports abortion access. “Every situation is complex and every situation is unique. People would rather err on the side of having government stay out of it altogether rather than have politicians practice medicine.

“Everyone knows someone who has been pregnant or loves a pregnant person,” she added. “To think that somebody’s health might not be protected even in a wanted pregnancy really cuts through some of the stigma abortion has had to face in the last 50 years.”

NEWS ANALYSIS : Parties Seek Abortion Issue’s Middle Ground : Campaign: Bush and Clinton want to avoid charges of waffling, but neither wants to appear an extremist.

Even as political strategists for both parties continue to buzz over Vice President Dan Quayle’s recent comments on abortion, the Democratic and Republican presidential campaigns quietly have tried to shift toward the center of this emotional and divisive issue.

July 26, 1992

Evangelical leader Ralph Reed, the founder of the Faith and Freedom Coalition, counters that focusing on potential restrictions on miscarriage care — or fertility treatments in the aftermath of an Alabama Supreme Court ruling earlier this year — are red herrings put forth by liberals.

“This is a strategy to try and change the subject and shift the narrative,” Reed said.

“I know the Democrats want to develop it as a talking point,” he added, “but I can’t imagine that pro-life laws are going to lead women to not be able to get treated for a miscarriage. I think that’s the talking point they are trying to develop because they don’t want to talk about their own position on abortion. And frankly, I don’t blame them.”

About 80% of miscarriages among women who know they are pregnant resolve on their own within eight weeks, with the fetus passing through the woman’s body without medical intervention, according to a 2018 paper by the American College of Obstetricians and Gynecologists and a 2019 report by KFF, an independent health policy organization.

But if the fetus or some of the tissue doesn’t pass, it needs to be removed to avoid potentially fatal medical complications for the woman, such as a sepsis infection, through drug-induced or surgical treatment.

Reproductive rights have been a political tinderbox for decades. But in addition to core ideological disagreements, both parties are hyper-focused on this issue this electoral cycle because of the Supreme Court’s 2022 decision to overturn Roe vs. Wade, the landmark 1973 ruling that granted federal protection of abortion rights. Since then, several states have severely restricted abortion access, and others have enshrined such access in state constitutions.

The Supreme Court on Wednesday heard arguments in a case about whether the federal government can make hospitals that receive Medicare funding perform emergency abortions. Several justices appeared skeptical of an Idaho law that would make it illegal for physicians to perform such a procedure for a woman whose health was seriously jeopardized but life not at risk.

Supreme Court sounds wary of Idaho’s ban on emergency abortions for women whose health is in danger

The Supreme Court will decide whether emergency room doctors can perform abortions if a pregnant person’s health is threatened.

April 24, 2024

Restrictions on reproductive rights are expected to be a pivotal issue among suburban, college-educated women, a key voter bloc in places like Orange County, as well as the suburbs of Philadelphia and Atlanta, critical regions that could determine control of Congress, and in some states, the presidency.

“Politically speaking, this is a big problem for Republicans,” said Barrett Marson, an Arizona-based GOP strategist. Still, Marson called on Republicans to support the 1864 antiabortion law, even if it meant losing some elections.

“I have actually just started to say Republicans should embrace this law and go down with the ship,” he said. “Republicans should stand their moral ground. They have wanted to overturn Roe vs. Wade for generations. They finally have, and in Arizona, abortions are so limited, they literally only have one exception — the life of the mother. They should celebrate. That is horrendous campaign advice, but at least stick to your principles.”

The Arizona Supreme Court ruled recently that the pre-statehood law, which banned all abortions except to save the life of the woman and carried a two- to five-year prison sentence for abortion providers, could be enforced.

The Arizona House voted to repeal the law Wednesday and the state Senate is expected to do likewise next week.

But even if repealed, the law would still go into effect for a period of time because repeals do not take effect until 90 days after the end of the legislative session. Then the state would revert to its prior restrictions on abortions after 15 weeks except for medical emergencies. (There is no exception for rape or incest.)

The uncertainty over legal restrictions on abortion is prompting women to seek out states where the procedure is still available.

Planned Parenthood Los Angeles, one of the nation’s largest abortion providers, has already seen women from Arizona and elsewhere seeking medical treatment because they miscarried and couldn’t receive care in their home states.

California saw a surge in abortions after Dobbs. Providers are bracing for more

A decision by the Arizona Supreme Court that aims to impose a near-total abortion ban in the state has put Southern California providers on alert.

April 12, 2024

“The impact of abortion bans extends far beyond what many people think of when they hear the word ‘abortion,’” said Sue Dunlap, president and CEO of Planned Parenthood Los Angeles.

“We have seen multiple patients travel from out of state for miscarriage care,” Dunlap said. “In at least one example, a patient flew to Los Angeles because she was unsure of the status of her pregnancy and felt unable to access the care she needed in her local community.

“Ultimately, patients are traveling hundreds of miles for care that theoretically should be permissible in their home state but that, in practice, becomes impossible to access due to fear and legal confusion.”

More to Read

Editorial: Pregnant women are not incubators. Antiabortion states should not deny them emergency care

Emergency rooms refused to treat pregnant patients, leaving one woman to miscarry in a lobby restroom

April 20, 2024

Abortion ban has supercharged Arizona politics. What will GOP legislators do?

April 17, 2024

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Seema Mehta is a veteran political writer who is covering the 2024 presidential race as well as other state and national contests. She started at the Los Angeles Times in 1998, previously covered multiple presidential, state and local races, and completed a Knight-Wallace fellowship at the University of Michigan in 2019.

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