essay on causes of abortion

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Why Do People Have Abortions?

Partner and family issues, other children, health reasons.

• Late-Term Abortions

While every person has unique reasons for seeking an abortion, researchers have found that those who've had the procedure report a number of common factors that influenced their decision. Chief among them: financial concerns.

Other top issues that influence this choice are related to not being prepared to be a parent and the relationship with one's partner.

These findings are the result of a five-year survey of people who have had at least one abortion and were asked to give reasons they chose to terminate their pregnancy.

It's important to remember, however, that a wide range of factors affect the decision to have an abortion. These include very personal issues that cannot easily be understood by others or grouped into general categories.

This article looks at common reasons for abortions and important related considerations.

Economic concerns are the most commonly cited reasons women choose an abortion. There are numerous reasons why one may feel financially unprepared to be a parent.

Overall Cost

Having a child is expensive. According to the U.S. Department of Agriculture, the average cost of raising a child (from birth to age 18) is $233,610—or about $13,000 annually. And those figures are from 2015.

With inflation, the estimated cost of raising a child born in 2022 exceeds $310,000, according to Brookings, a nonprofit social policy research group. That's more than $17,000 a year.

Not Earning Enough

Many people are simply not making enough money to support the financial burden of having a child. Situations that impact financial security include being unemployed or underemployed.

Underemployed means that you are employed but not working in a position that fully uses your skills or pays what your skills are worth.

Having a baby also impacts a woman's future earning potential, a phenomenon known as the motherhood pay gap.

Lack of Health Insurance

Being uninsured falls under the financial umbrella as well. Government assistance is often available for pregnant women who lack health insurance or have low income, but not everyone qualifies.

Others may have the need but simply not want to rely on such aid.

Affording Healthcare

Most Americans qualify for subsidized coverage through an employer or a government program. Don't assume you cannot get affordable coverage.

Feeling that it isn’t the right time to have a child is the second most commonly cited reason for seeking an abortion.

Unplanned Pregnancy

When pregnancy is unplanned , women may feel they are too old, too busy, or not yet ready. Similarly, some women feel that they are not yet emotionally or mentally prepared to care for a child or even handle a pregnancy.

Negative Future Impacts

About 20% of those who seek an abortion specifically feel that being pregnant or having a child will negatively affect their future.

They may choose to have an abortion because they want to avoid changes to their educational plans or careers, or they want to wait until they're more settled in life.

There are many issues in a relationship that affect a woman's decision to have an abortion.

The majority of women who choose to have an abortion are unmarried. According to data from 2019, 85.5% of those who had abortions were single women.

For some of these women, the fact that they are unmarried contributes to their decision to seek an abortion. About 8% of those responding to the survey on reasons for having an abortion specifically note that they do not want to be a single parent.

Family Pressure

About 5% of women say that their choice was influenced by family. This may be because they believe their family will not support them. A small percentage of women also say that they were directly pressured to have an abortion by family or friends.

Toxic Relationship

Being in an abusive or unhappy relationship can also affect a person's decision to abort.

Researchers estimate intimate partner violence is involved in 6% to 22% of abortions. Another study found 77% of rape-related pregnancies were caused by current or former intimate partners.

Rape or Incest

In the United States, an estimated 25,000 to 35,000 pregnancies are caused by rape each year. Half of all rape-related pregnancies end in abortion.

The frequency of pregnancy from incest is not as well documented. However, studies show 1% of women disclose their reason for having an abortion is rape or incest.

About 59% of women who have abortions already have previously given birth to at least one child.  

In some instances, these women choose to have an abortion because they're concerned that they don’t have the time or resources to care for more children. These mothers may feel they are done having children or wish to space out their children. 

About 12% of abortions are related to health issues. This includes both concerns for the woman’s health related to serious illnesses and congenital medical conditions in the fetus.

Mother's Health

At times, the pregnancy itself can be a high risk to the mother's safety and well-being. In fact, an estimated 700 women die from pregnancy complications each year in the U.S.

Pregnancy can exacerbate underlying or pre-existing health conditions that severely compromise a woman's health. Women with renal or cardiac diseases are particularly at high risk for pregnancy-related death.

Fetal Health

There may also be worries about the health of the fetus. This can be found during genetic testing in early pregnancy or during an anatomy scan at about 20 weeks.

In some cases, concerns over fetal health may be related to the use of alcohol, drugs, or prescription medications that harm fetal development.

Reasons for Late-Term Abortions

In the United States, 93% of abortions occur during the first trimester, before 13 weeks. Another 6% of abortions take place before 20 weeks, the midpoint of the pregnancy. Less than 1% of abortions occur after 20 weeks.

What Is a Late-Term Abortion?

Late-term abortion is not an official medical term. The medical definition of late-term pregnancy is a pregnancy in its 41st week. (After that, it's a post-term pregnancy.)

Late-term abortion is a sociological or political term that refers to abortions that occur after 20 weeks. This accounts for less than 1% of abortions.

Medical Reasons

Abortions after 20 weeks often occur for medical reasons. Fetal abnormalities are often first identified at the 20-week anatomy scan.

Some women are unable to schedule this scan before 20 weeks. In other cases, they do not get the results until after 20 weeks.

Concerns over the mother's health are another medical reason for an abortion after 20 weeks. This can be due to pregnancy complications, such as pre-eclampsia or hyperemesis gravidarum (severe nausea and vomiting), or a non-pregnancy-related condition, such as cancer.

Other Factors

Other reasons women seek an abortion after 20 weeks include:

• Barriers to access
• Indecision or disagreeing with the father
• Lack of transportation access to care
• Not knowing about the pregnancy until later

Later abortions are also more common in women who are:

• Depressed or dealing with other mental health diagnoses
• In unstable or violent relationships
• Single mothers
• Using drugs
• Younger than 25

Reasons for abortion include financial concerns, marital status, and readiness to start a family, among others.

For many women who choose to have an abortion, not being able to manage the cost of raising a child plays a significant role in their decision. In each individual case, though, multiple factors go into making the decision to terminate a pregnancy.

Common reasons for abortion include economic, social, emotional, and family issues. Medical reasons for abortion include underlying health conditions that threaten the mother's life and fetal malformations that are inconsistent with life outside the womb.

Trauma from pregnancy caused by domestic violence, rape, or incest, mental health concerns, and active addiction are other reasons why a woman may decide to have an abortion.

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Chae S, Desai S, Crowell M, Sedgh G. Reasons why women have induced abortions: A synthesis of findings from 14 countries . Contraception . 2017;96(4):233-241. doi:10.1016/j.contraception.2017.06.014

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By Dawn Stacey, PhD, LMHC Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.

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In This Article Expand or collapse the "in this article" section Abortion

Introduction, general overviews, definitions, terminology, and reference resources, historical perspectives, laws and public health consequences, demography and epidemiology, safety, techniques, and health-related controversies, postabortion care, related articles expand or collapse the "related articles" section about, about related articles close popup.

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Abortion by Andrzej Kulczycki LAST REVIEWED: 25 February 2022 LAST MODIFIED: 24 May 2017 DOI: 10.1093/obo/9780199756797-0090

An abortion refers to the termination of a pregnancy. It can be induced (see Definitions, Terminology, and Reference Resources ) through a pharmacological or a surgical procedure, or it may be spontaneous (also called miscarriage ). Both in the United States and globally, approximately one-fifth of all known pregnancies end in abortion, which is currently one of the safest procedures in medicine when performed by a trained professional in hygienic conditions using modern methods. In 2016, it was estimated that about 56 million abortions were induced worldwide each year from 2010 to 2014, corresponding to about 35 abortions per 1,000 women of childbearing age. However, it was previously estimated that about 21.6 million abortions performed annually were unsafe, causing some 47,000 maternal deaths or 13 percent of all maternal deaths. Abortion-related mortality may have since fallen, but multiple challenges with measurement and data quality persist. The incidence of abortion may be reduced through good access to a range of effective contraceptive methods, sex education, and appropriate support for women who want to have a child. Historically, women who underwent abortions risked their personal health and social standing. In the 20th century, this situation changed slowly in many countries as abortion procedures became safer and efforts to legalize abortion gained momentum. Nevertheless, abortion is often a controversial matter of health and social policy due to divergent views on such matters as when human life begins, women’s roles and rights, and the role of government in individuals’ private lives. This entry reflects the broad scope of public health issues concerning the demography of abortion, its epidemiology, legality, and abortion-related methods. It also provides a collection of resources on postabortion care. This article first briefly reviews the terminology used for different types of abortion and outlines resources that detail the history of abortion as well as its general public heath contours in the United States and the world. Less attention is paid to the ethical aspects of abortion, arguments for or against the practice, different cultural or religious views on abortion, and public or political aspects of conflict concerning abortion.

Although recent textbooks on the public health aspects of abortion are lacking, Faúndes and Barzelatto 2006 provides an accessible account of many pertinent issues written in plain language for nonspecialists. Singh, et al. 2009 summarizes recent trends in abortion incidence, with a focus on unsafe abortion, as well as changes in legality, safety, and accessibility of abortion services worldwide. Sedgh, et al. 2016 presents the most recent abortion estimates for major world regions. Paul, et al. 2009 offers an informative text written primarily for clinicians on the provision of abortion care. A well-referenced handbook, World Health Organization 2012 (WHO), gives guidance to health professionals inside and outside governments who are working to reduce poor maternal health on the many ways of ensuring access to abortion care as allowed by law. Several reference guides explore the evolution of the US abortion debate from various viewpoints and may assist those working in the medical, social science, historical, legal, and public health fields. McBride 2007 includes a collection of biographical sketches, chronology, and excerpts from key statutes and court cases that have pushed the abortion controversy into the public arena, and Rose 2008 provides a selection of forty-one primary source documents from medical workers, judges, feminists, religious leaders, and politicians from the 19th century through 2007.

Faúndes, Anibal, and José S. Barzelatto. 2006. The human drama of abortion: A global search for consensus . Nashville: Vanderbilt Univ. Press.

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This book includes overviews of why women have abortions, the scale of the practice, consequences of unsafe abortions, effective interventions, values, and conclusions about what can be done to reach a necessary and practical societal consensus.

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McBride, Dorothy E. 2007. Abortion in the United States: A reference handbook . Santa Barbara, CA: ABC-CLIO.

This reference volume covers multiple aspects of how abortion is considered in the United States. The guide also provides commentary on major Supreme Court cases and state laws regulating abortion policy as well as other background information.

Paul, Maureen, E. Steve Lichtenberg, Lynn Borgatta, David A. Grimes, Phillip G. Stubblefield, and Mitchell D. Creinin, eds. 2009. Management of unintended and abnormal pregnancy: Comprehensive abortion care . Oxford: Wiley-Blackwell.

DOI: 10.1002/9781444313031 Save Citation » Export Citation » Share Citation »

This widely used evidence-based reference text in abortion care discusses abortion methods, pre- and postprocedure care, the management of ectopic and other abnormal pregnancies (including the risks of multiple pregnancies resulting from assisted reproductive technologies), and public health aspects of abortion service delivery.

Rose, Melody. 2008. Abortion: A documentary and reference guide . Westport, CT: Greenwood.

This reference work carries primary documents and commentary on the public health situation and sociopolitical controversy concerning abortion in the United States. Excerpts are also included from popular women’s self-help books, memoirs of early abortion providers, important legal papers, and the text of Pope Paul VI’s 1968 encyclical, Humanae Vitae .

Sedgh, Gilda, Jonathan Bearak, Susheela Singh, Akirinola Bankole, Anna Popinchalk, Bela Ganatra, et al. 2016. Abortion incidence between 1990 and 2014: Global, regional, and subregional levels and trends. Lancet 388.10041: 258–267.

DOI: 10.1016/S0140-6736(16)30380-4 Save Citation » Export Citation » Share Citation »

The most recent update on abortion levels and trends worldwide, including for countries and major regions in which abortion is legally permitted and generally available, as well as for those in which it is not. Available online for purchase or by subscription.

Singh, Susheela, Deirdre Wulf, Rubina Hussain, Akinrinola Bankole, and Gilda Sedgh. 2009. Abortion worldwide: A decade of uneven progress . New York: Guttmacher Institute.

This report reviews changes in abortion incidence, legality, and safety, with greater attention paid to unsafe abortion and the situation in low-income countries. The report also examines the relation among unintended pregnancy, contraception, and abortion. Also available in Spanish .

World Health Organization. 2012. Safe abortion: Technical and policy guidance for health systems . 2d ed. Geneva, Switzerland: World Health Organization.

This updated and expanded version of the report gives guidance to health professionals and others on actions to ensure the provision of safe, quality abortion services as allowed by law. It also provides an overview of the public health challenges, including clinical aspects of care, health system issues, and the legal, regulatory, and policy environment for improving the quality and accessibility of care.

Definitions of abortion vary across and within countries as well as among different institutions. Language used to refer to abortion often also reflects societal and political opinions and not only scientific knowledge ( Grimes and Gretchen 2010 ). Popular use of the word abortion implies a deliberate pregnancy termination, whereas a miscarriage is used to refer to spontaneous fetal loss when the fetus is not viable (i.e., not yet unable to survive independently outside the womb). Spontaneous abortions may account for up to one in four pregnancies. Most occur in the first two weeks after conception, typically due to embryonic malformations or chromosomal abnormalities, and before a woman is aware that she is pregnant ( Wilcox 2010 ). Induced abortion is the deliberate termination of pregnancy before viability (which may vary from twenty to twenty-eight weeks’ gestation, but medical advances now imply that viability can be generally assumed at about twenty-four weeks). An abortion can be induced for medical reasons or because of an elective decision to end the pregnancy. In an incomplete abortion, parts of the fetus or placental tissue are retained in the uterus and can result in hemorrhage, intense pain, uterine infection, and death if left untreated. An unsafe abortion may have adverse consequences for women’s health because it is performed by persons lacking the necessary skills in an environment lacking the minimal medical standards, or both. Many electronic resources maintained by various nonprofit organizations provide helpful and free downloadable materials on different aspects of abortion. Health professional organizations with useful websites include the Association of Reproductive Health Professionals , whose members provide reproductive health services and education, conduct reproductive health research, and influence reproductive health policy. Another authoritative source is the American College of Obstetricians and Gynecologists , whose 52,000 members comprise over 90 percent of US board-certified obstetrician-gynecologists. The broad international focus of the WHO’s Sexual and Reproductive Health division means that many of its materials relate to all major parts of the world. Gynuity Health Projects and Ipas conduct research and technical assistance focused on improving and expanding access to methods, including safe and more acceptable abortion services that reduce maternal mortality and morbidity. The Guttmacher Institute conducts research and policy analysis related to abortion in the United States and internationally and makes much of its information available online.

American College of Obstetricians and Gynecologists .

This website includes various publications and resource guides on abortion as well as on many other aspects of women’s health care.

Association of Reproductive Health Professionals .

This website carries links to featured research, clinical publications and resources, and news on abortion as well as vetted links to organizations for patients seeking abortion information.

Grimes, David A., and Stuart B. Gretchen. 2010. Abortion jabberwocky: The need for better terminology. Contraception 81.2: 93–96.

DOI: 10.1016/j.contraception.2009.09.005 Save Citation » Export Citation » Share Citation »

This article is a lively critique of widely used but imprecise, misleading, and ambiguous terminology associated with how abortion is considered in both the lay and the professional literature. The authors discuss a number of such problematic terms in the public health, medical, and social science fields. Available online for purchase or by subscription.

Guttmacher Institute .

The Guttmacher Institute makes available online a range of resources, including fact sheets, media kits, state policy briefs, reports, and policy and research articles related to abortion.

Gynuity Health Projects .

Gynuity Health Projects maintains a website that includes links to various resources and publications that it has developed for health-care providers, policy makers, and advocates.

HRP: Sexual and Reproductive Health .

The WHO’s special program for research on human reproduction, HRP, conducts research to help eliminate unsafe abortion. HRP’s website makes the agency’s publications and research findings available.

Ipas provides a number of resources related to abortion, both for health-care providers and researchers, that are accessible through its website.

Wilcox, Allen J. 2010. Fertility and pregnancy: An epidemiologic perspective . New York: Oxford Univ. Press.

Written by an epidemiologist, this informative textbook on reproduction and pregnancy includes a discussion of early pregnancy loss.

Abortion and infanticide were historically used after conception to control fertility. Riddle 1992 documents how women from ancient Egyptian times to the 15th century relied on an extensive pharmacopoeia of herbal abortifacients and contraceptives as well as manipulation to regulate fertility. Himes 1963 outlines the widespread knowledge of such ancient and premodern practices and of their menstrual-regulating qualities, which herbalists, laywomen, and health healers across the world handed down for generations. However, knowledge of these practices, many risky and ineffective, gradually became viewed with more suspicion by medical and pharmaceutical personnel keen to assert their professional role and interests. Mohr 1978 reviews the history of abortion in the United States since the colonial days, with a focus on the enactment of restrictive 19th-century laws at the state level. The author further examines how the medical establishment was far more instrumental than religious activism in pushing through the late-19th-century wave of antiabortion legislation, even though it became among its foremost advocates a century later. Stringent antiabortion laws were also passed in Europe in the 19th century. Both Gordon 2007 and Joffe 1995 report how safe abortions were performed for some women by highly skilled laypersons and physicians through the 20th century, when attitudes slowly became more liberal. Tribe 1990 provides one of the more widely cited surveys of the historical, legal, and moral issues related to abortion. By the 1970s, abortion had been legalized in Japan and most European countries. In the United States, the 1973 Supreme Court ruling Roe v. Wade permitted abortions during the first three months of pregnancy and with increasing restrictions thereafter. The Court subsequently reaffirmed its landmark decision despite numerous legal challenges, although in 1976 the US Congress passed the Hyde Amendment, which barred the use of Medicaid funds for abortion except for all but the most extreme circumstances (rape, incest, or if the pregnant woman’s life was threatened). Abortion-related mortality fell greatly after nationwide legalization as documented by numerous sources, including Coble, et al. 1992 . However, conflict over abortion continues, with many of its underpinnings described in Luker 1984 . This authoritative study avoids common negative stereotypes and shows that the contrasting worldviews of pro-choice and pro-life activists are rooted in different sets of values and ideas about women’s roles.

Coble, Yank D., E. Harvey Estes, C. Alvin Head, et al. 1992. Induced termination of pregnancy before and after Roe v. Wade : Trends in the mortality and morbidity of women. Journal of the American Medical Association 268.22: 3231–3239.

DOI: 10.1001/jama.1992.03490220075032 Save Citation » Export Citation » Share Citation »

This article compares the mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision with mortality and morbidity after Roe v. Wade . Available online for purchase or by subscription.

Gordon, Linda. 2007. The moral property of women: A history of birth control politics in America . Rev. ed. Urbana: Univ. of Illinois Press.

An updated edition of a widely cited history of the intense struggles over reproductive rights, including abortion, that have taken place over the past 150 years in America as seen from the perspective of women who are seeking sexual and reproductive self-determination.

Himes, Norman E. 1963. Medical history of contraception . New York: Gamut.

Written by an anthropologist, this significant study provides extensive documentation of the use of birth control from preliterate cultures to the 1930s and reports that many earlier societies relied on abortion and infanticide. Originally published in 1936.

Joffe, Carole E. 1995. Doctors of conscience: The struggle to provide abortion before and after Roe v. Wade . Boston: Beacon.

In contrast to other accounts, this study of the experiences of physicians is placed within a discussion of important health policy issues. It also examines how the medical profession has marginalized abortion services before and since their legalization as well as the role it could play in improving abortion services.

Luker, Kristin. 1984. Abortion and the politics of motherhood . Berkeley: Univ. of California Press.

Based on detailed fieldwork, this work is a detailed sociological examination of the different perceptions of abortion and related issues held by different groups of women.

Mohr, James C. 1978. Abortion in America: The origins and evolution of national policy, 1800–1900 . New York: Oxford Univ. Press.

An influential and heavily cited history of abortion in 19th-century America. This study also highlights the role of regularly trained physicians in the movement to criminalize abortion.

Riddle, John M. 1992. Contraception and abortion from the ancient world to the Renaissance . Cambridge, MA: Harvard Univ. Press.

This study collates disparate historical sources of knowledge about fertility control and how this female-centered, oral culture was passed on until it was lost in the Early Modern period due to the organization of medicine. Physicians’ ties with folk traditions were broken as they became increasingly trained in universities, where fertility regulation was not part of the curriculum.

Tribe, Laurence H. 1990. Abortion: The clash of absolutes . New York: Norton.

This work is a review by a well-known constitutional law scholar of the historical, legal, and moral issues related to abortion both in the United States and in different parts of the world.

Laws determine the official availability of abortion services and also their safety. Changes in abortion legislation monitored by the United Nations show modest increases for the period 1996–2013 in the number of countries allowing early abortion for social or economic reasons, or on request, but only about one-third permit it on such grounds ( United Nations Department of Economic and Social Affairs 2014 ). Kulczycki 1999 analyzes the forces shaping the abortion debate and controversy globally and how these have shaped abortion trends and policies beyond Western liberal democracies. Cook, et al. 2014 examines recent transnational legal developments. Although the risk of death and injury to women seeking abortion is always present in countries where abortion is illegal, safe abortion services are readily accessible for those able to pay for them, as in nearly all of Latin America, the region of the world with the most restrictive abortion laws ( Kulczycki 2011 ). Two well-documented case studies demonstrate how legalizing abortion increases the safety of the procedure. When Romania banned abortion and contraceptives in 1966, maternal deaths soared, but after the procedure was legalized again in 1990 and access to modern contraceptives improved, they fell sharply ( David 1999 ; Stephenson, et al. 1992 ). After abortion became available on the request of a pregnant woman in South Africa in 1997 and postabortion care and family planning services improved, abortion-related deaths fell by 91 percent during the period 1994–2001, with steep declines in serious morbidity also observed ( Jewkes, et al. 2005 ). The actual implementation of laws and societal and cultural views on sexuality and reproduction, further condition access to abortion. India has more abortion-related deaths than any other country despite closely following the United Kingdom in allowing abortion on public health grounds. Poor and rural women are most likely to have clandestine procedures, often performed by untrained persons in unhygienic conditions at sites other than registered government institutions. Many women are not aware of the legal status of abortion and services are insufficient to meet the demand. In 1994, India banned prenatal testing when done solely to determine the sex of the fetus, but Jha, et al. 2011 shows that most of India’s population now lives in states where selective abortion of girls is common, especially for pregnancies after a first-born girl. The diffusion of safer, less costly abortion methods and ultrasound examination technology and the persistence of son preference in various South and East Asian societies have contributed to the rise of sex-selective abortion. However, normative changes have driven a reversal of this trend in South Korea.

Cook, Rebecca J., Joanna N. Erdman, and Bernard M. Dickens, eds. 2014. Abortion law in transnational perspective: Cases and controversies . Philadelphia: Univ. of Philadelphia Press.

This edited volume examines recent transnational legal developments, including judicial decisions, constitutional texts, and regulatory reforms of abortion law in a number of countries and regions.

David, Henry, ed. 1999. From abortion to contraception: A resource to public policies and reproductive behavior in central and eastern Europe from 1917 to the present . Westport, CT: Greenwood.

This edited work chronicles the interaction of public policies and private reproductive behavior in the twenty-eight formerly socialist countries of central and eastern Europe and the USSR successor states from 1917 to the present.

Jewkes, Rachel, Helen Rees, Kim Dickson, Heather Brown, and Jonathan Levin. 2005. The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change . British Journal of Obstetrics and Gynaecology 112.3: 355–359.

DOI: 10.1111/j.1471-0528.2004.00422.x Save Citation » Export Citation » Share Citation »

A descriptive study using hospital data to show that legalization of abortion in South Africa reduced abortion mortality and morbidity, especially in younger women. Comparisons are drawn to an earlier study undertaken in 1994 before legislative change.

Jha, Prabhat, Maya A. Kesler, Rajesh Kumar, et al. 2011. Trends in selective abortions of girls in India: Analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011. Lancet 377.9781: 1921–1928.

DOI: 10.1016/S0140-6736(11)60649-1 Save Citation » Export Citation » Share Citation »

This study assesses sex ratios by birth order from 1990 to 2005 using nationally representative surveys and quantifies the totals of selective abortions of girls with census cohort data. Declines in the conditional sex ratio of second-order births after a firstborn girl are much greater in more educated mothers and in wealthier households. This is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. Available online for purchase or by subscription.

Kulczycki, Andrzej. 1999. The abortion debate in the world arena . New York: Routledge.

DOI: 10.1057/9780230379183 Save Citation » Export Citation » Share Citation »

This book examines abortion trends and debate, reproductive behavior, and related public health considerations in three countries in particular (Kenya, Mexico, and Poland), seen as regional bellwethers of how abortion is treated, including within the policy-making process.

Kulczycki, Andrzej. 2011. Abortion in Latin America: Changes in practice, growing conflict, and recent policy developments. Studies in Family Planning 42.3: 199–220.

DOI: 10.1111/j.1728-4465.2011.00282.x Save Citation » Export Citation » Share Citation »

This article is a regional analysis of the rapidly changing practice and context of abortion in Latin America, including legal and policy developments, and contrasting country situations. Available online for purchase or by subscription.

Stephenson, Patricia, Marsden Wagner, Mihaela Badea, and Florina Serbanescu. 1992. Commentary: The public health consequences of restricted induced abortion; Lessons from Romania . American Journal of Public Health 82.10: 1328–1331.

DOI: 10.2105/AJPH.82.10.1328 Save Citation » Export Citation » Share Citation »

This article reviews the public health consequences of restricted abortion in Romania, where the pronatalist policies of the Ceaucescu regime resulted in the highest maternal mortality rate in Europe and in thousands of unwanted children in institutions.

United Nations Department of Economic and Social Affairs. 2014. Abortion policies and reproductive health around the world . New York: United Nations.

The United Nations tracks changes in the legal status of induced abortion worldwide. Its most recent overview includes a tabulated summary of key reproductive health indicators and governments’ officially stated levels of concern and support for various reproductive health policies.

An estimated one in five pregnancies worldwide are aborted, but the incidence of abortion is known in detail only for those countries where abortion is legally permitted with few restrictions and official statistics are reasonably complete. Sedgh, et al. 2016 (cited under General Overviews ) provides a recent summary of these trends. Rossier 2003 and Singh, et al. 2010 review the range of estimation methodologies developed for use in contexts where abortion is legally restricted and where it remains a very sensitive issue. In the United States, the Centers for Disease Control and Prevention compiles annual numbers and basic characteristics of women obtaining abortions, such as its report for 2013 ( Jatlaoui, et al. 2016 ). However, these data are unavailable for some states and are of varying reliability for others in which reporting is not mandatory or is poorly enforced. A more complete count of the total number of abortions is available from the Guttmacher Institute based on its periodic census of abortion providers, with certain characteristics also available through its surveys of women having abortions. The US abortion rate fell to an estimated 15 abortions per 1,000 women aged 15–44 in 2014, primarily due to improved contraceptive use ( Jones and Jerman 2017 ). Both unintended pregnancy and abortion rates are higher among certain groups of women, typically including those under age thirty, in poverty, and from more disadvantaged racial and ethnic minority groups. The World Health Organization presents national, regional, and global estimates of unsafe abortion and associated mortality ( Åhman and Shah 2011 ). It also estimated that abortion-related deaths still account for about 8 percent of maternal mortality worldwide, although these deaths are often underreported ( Say, et al. 2014 ). Evidence from a diverse set of countries shows that, over time, abortion rates fall as levels of contraceptive use rise ( Marston and Cleland 2003 ). The highest abortion rates in the world are found in many former Soviet bloc republics, and Westoff 2005 reports how levels of abortion fell to a varying degree as the availability, accessibility, and quality of available contraceptive options improved. However, even widespread modern contraceptive use will not entirely eliminate abortions because no contraceptive works perfectly every time. Women have abortions for many reasons, most often because they feel unable in their current circumstances to fulfill their parental responsibilities as they would like or to provide the kind of family support they believe their children deserve ( Biggs, et al. 2013 ).

Åhman, Elisabeth, and Iqbal Shah. 2011. Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008 . 6th ed. Geneva, Switzerland: World Health Organization.

The sixth update in a series of reports on the topic, with this round pertaining to 2008.

Biggs, M. Antonia, Heather Gould, and Diana G. Foster. 2013. Understanding why women seek abortions in the US . BMC Women’s Health 13:29.

DOI: 10.1186/1472-6874-13-29 Save Citation » Export Citation » Share Citation »

This study of 954 women recruited at thirty different abortion facilities across the United States identified eleven predominant themes, although most women reported multiple reasons for seeking an abortion, in common with previous studies.

Jatlaoui, Tara C., Alexander Ewing, Michele G. Mandel, et al. 2016. Abortion Surveillance—United States, 2013. Morbidity and Mortality Weekly Report Surveillance Summaries 65.12: 1–44.

CDC’s surveillance system compiles information on legal induced abortions. More information is available online . This source provides the latest available annual assessment, which is also available online .

Jones, Rachel K., and Jenna Jerman. 2017. Abortion incidence and service availability in the United States, 2014. Perspectives on Sexual and Reproductive Health 49.1: 3–14.

DOI: 10.1363/psrh.12015 Save Citation » Export Citation » Share Citation »

This report shows the long-term decline in US abortion incidence, which in 2014 fell below one million for the first time since abortion was legalized nationally in 1973. Available online for purchase or by subscription.

Marston, Cicely, and John Cleland. 2003. Relationships between contraception and abortion: A review of the evidence. International Family Planning Perspectives 29.1: 6–13.

DOI: 10.2307/3180995 Save Citation » Export Citation » Share Citation »

This article reviews data from countries with reliable information on both contraception and abortion. It also explores how the relationship between them may be mediated by the stability of levels of fertility.

Rossier, Clémentine. 2003. Estimating induced abortion rates: A review. Studies in Family Planning 34.2: 87–102.

DOI: 10.1111/j.1728-4465.2003.00087.x Save Citation » Export Citation » Share Citation »

The author describes the methodological requirements, advantages and disadvantages, and empirical records of eight methods used to estimate the frequency of abortion. Available online for purchase or by subscription.

Say, Lale, Doris Chou, Alison Gemmill, et al. 2014. Global causes of maternal death: A WHO systematic analysis. Lancet Global Health 2.6: e323–e333.

DOI: 10.1016/S2214-109X(14)70227-X Save Citation » Export Citation » Share Citation »

This article develops and analyses global, regional, and subregional estimates of major causes of maternal death, including abortion, during 2003–09.

Singh, Susheela, Remez Lisa, and Alyssa Tartaglione, eds. 2010. Methodologies for estimating abortion incidence and abortion-related morbidity: A review . New York: Guttmacher Institute.

Based on a seminar convened on the topic by the International Union for the Scientific Study of Population, each of the fourteen chapters in this volume is available separately, along with the full report, online .

Westoff, Charles F. 2005. Recent trends in abortion and contraception in 12 countries . Calverton, MD: ORC Macro.

This report analyzes recent trends in abortion and contraception in twelve central Asian and eastern European countries where abortion had long been an important birth control method. All have experienced sharp declines in the number of children desired and in fertility rates, and most, but not all, have seen falling abortion and rising contraceptive prevalence rates.

Abortion is one of the safest procedures in medicine when conducted early in a pregnancy by a trained provider under hygienic conditions. Estimates show that for the United States the risk of death associated with childbirth is about fourteen times higher than that associated with all abortions ( Raymond and Grimes 2012 ) and would be even lower with improved prevention of unintended pregnancy and increased access to early abortion services ( Zane, et al. 2015 ). Paul, et al. 2009 (cited under General Overviews ) describes both surgical and medical methods of abortion. Vacuum aspiration is the preferred surgical method prior to twelve weeks’ gestation and the suction mechanism may be electric or manual (MVA). Dilatation and curettage (D&C or sharp curettage) carries higher risks and is now recommended by the WHO only when MVA is unavailable, although it remains performed for a variety of other gynecological reasons. A medical (or medication abortion) ends an early-term pregnancy (typically before nine weeks’ gestation) by pharmacological drugs. It involves a combination of mifepristone (an antiprogestogen, also known by its brand name, Mifeprex and previously as RU-486) followed by a prostaglandin, usually misoprostol, that causes uterine contractions. It is safe, effective, and acceptable to most women. Early abortion before nine weeks gestation with mifepristone/misoprostol combinations has replaced many surgical procedures. Although less effective, the use of misoprostol alone for abortion has increased throughout Latin America, reducing complications related to self-induced procedures and other unsafe abortions, thereby also decreasing the number of women admitted to hospitals ( Ipas 2010 ). In the United States, about one in nine abortions are performed in the second trimester, for which a very rare procedure, intact dilatation and extraction, was federally banned in 2003. Opponents labeled it “partial-birth abortion,” a term that remains in use in the vernacular but is not recognized medically ( Johnson, et al. 2005 ). Several hypothesized potential side-effects of abortion have been the subject of much controversy. Breast cancer and adverse mental health effects are two such disputed side effects. Abortion has been postulated to increase the risk of developing breast cancer, but the scientific consensus is that no such association exists (e.g., National Cancer Institute 2003– , Collaborative Group on Hormonal Factors in Breast Cancer 2004 ). Claims have also been made about the emotional effects of abortion, but these are largely benign, at least in countries where abortion is legal and safely performed ( Charles, et al. 2008 ). Also, postabortion syndrome is not a valid psychiatric or medical diagnosis ( Major, et al. 2008 ). Being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes than having an abortion, but outcomes for both groups eventually converge ( Biggs, et al. 2017 ).

Biggs, M. Antonia, Ushma D. Upadhyay, Charles E. McCulloch, et al. 2017. Women’s mental health and well-being 5 years after receiving or being denied an abortion: A prospective, longitudinal cohort study. JAMA Psychiatry 74.2: 169–178.

DOI: 10.1001/jamapsychiatry.2016.3478 Save Citation » Export Citation » Share Citation »

Findings from a five-year longitudinal (“Turnaway”) study that examined mental health and other effects of receiving or being denied an abortion. Psychological well-being improved over time so that both groups of women eventually converged.

Charles, Vignetta E., Chelsea B. Polis, Srinivas K. Sridhara, and Robert W. Blum. 2008. Abortion and long term mental health outcomes: A systematic review of the evidence. Contraception 78.6: 436–450.

DOI: 10.1016/j.contraception.2008.07.005 Save Citation » Export Citation » Share Citation »

Articles focused on the potential association between abortion and long-term mental health outcomes are rated for their methodological quality and appropriateness to explore the research question. Better quality studies suggest few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae. Available online for purchase or by subscription.

Collaborative Group on Hormonal Factors in Breast Cancer. 2004. Breast cancer and abortion: Collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. Lancet 363.9414: 1007–1016.

DOI: 10.1016/S0140-6736(04)15835-2 Save Citation » Export Citation » Share Citation »

A meta-analysis of available epidemiological evidence worldwide, this study shows no relation between induced abortion (or previous miscarriage) and the risk of subsequent breast cancer. Available online for purchase or by subscription.

Ipas. 2010. Misoprostol and medical abortion in Latin America and the Caribbean . Chapel Hill, NC: Ipas.

This report discusses how misoprostol, a proven medication for a variety of obstetric and gynecologic uses, is being increasingly used in Latin America, thereby reducing incomplete abortions and related mortality and morbidity.

Johnson, Timothy R. B., Lisa H. Harris, Vanessa K. Dalton, and Joel D. Howell. 2005. Language matters: Legislation, medical practice, and the classification of abortion procedures. Obstetrics & Gynecology 105.1: 201–204.

DOI: 10.1097/01.AOG.0000149803.31623.b0 Save Citation » Export Citation » Share Citation »

This article discusses changing medical practice concerning abortion, efforts to clarify and obfuscate medical language, and legislative attempts to keep up with such changes. Available online for purchase or by subscription.

Major, Brenda, Mark Appelbaum, Linda Beckman, Mary Ann Dutton, Nancy Felipe Russo, and Carolyn West. 2008. Report of the APA task force on mental health and abortion . Washington, DC: American Psychological Association.

This report concludes that a first abortion does not lead to any increased risk of mental health problems. Evidence for multiple terminations is more equivocal in part due to methodological difficulties and also because the same factors that predispose a woman to multiple unwanted pregnancies may also predispose her to mental health problems.

National Cancer Institute. 2003–. Summary report: Early reproductive events and breast cancer workshop . Atlanta: National Institutes of Health.

This report emerged from an extensive workshop on early reproductive events and cancer and was updated with more recent evidence in 2010. The review of the available evidence does not support any hypothesis that early termination of pregnancy causes breast cancer.

Raymond, Elizabeth G., and David A. Grimes. 2012. The comparative safety of legal induced abortion and childbirth in the United States. Obstetrics & Gynecology 119.2, Part 1: 215–219.

DOI: 10.1097/AOG.0b013e31823fe923 Save Citation » Export Citation » Share Citation »

Using national surveillance, survey, and birth certificate data for 1998–2005, the authors find that the risk of death associated with childbirth (8.8 deaths per 100,000 live births) is approximately fourteen times higher than that with abortion (0.6 deaths per 100,000). Similarly, the overall morbidity associated with childbirth exceeds that with abortion. Available online for purchase or by subscription.

Zane, Suzanne, Andreea A. Creanga, Cynthia J. Berg, et al. 2015. Abortion-related mortality in the United States, 1998–2010. Obstetrics & Gynecology 126.2: 258–265.

DOI: 10.1097/AOG.0000000000000945 Save Citation » Export Citation » Share Citation »

This article examines characteristics and causes of legal induced abortion-related deaths. Abortion mortality rates are computed by maternal age, gestational age, and race and the distribution of causes of death by gestational age and procedure.

Postabortion care (PAC) is needed to provide both emergency treatment for complications caused by incomplete or spontaneous abortion and family planning counseling and services to prevent future unplanned pregnancies that may result in repeat abortions. The Postabortion Care Consortium was formed in 1993 by family planning and reproductive health agencies, nongovernmental organizations, and donor agencies. Its expanded and updated Essential Elements of PAC model includes emergency treatment of postabortion complications, strengthening contraceptive provision and family planning services, providing referrals to other accessible facilities for other reproductive health services, building partnerships with communities and service providers, and counseling for women’s emotional and physical health needs and other concerns. Billings and Benson 2005 and Senlet, et al. 2001 describe the experience of several Latin American countries and Turkey, respectively, in institutionalizing the provision of the main elements of PAC. The revised PAC model was extended in practice by the CATALYST Consortium of reproductive health and family planning agencies initiated by the US Agency for International Development (USAID; CATALYST Consortium 2005 ). Curtis 2007 describes more recent strategies by USAID in tandem with multiple organizations to provide this critical health-care service, and multiple downloadable resources are available from USAID’s Information and Knowledge for Optimal Health (INFO) Project and the Postabortion Care Consortium . Huber, et al. 2016 reviews findings from PAC studies published in the peer-reviewed and gray literature and proceeds to highlight programmatic implications. Overall, PAC services have expanded in a number of countries and their quality has generally improved, but a recent assessment— RamaRao, et al. 2011 —points out that in many countries where abortion is legally restricted or otherwise sensitive, PAC services are often deficient, and postabortion contraceptive counseling is still poorly integrated with family planning and other reproductive health care.

Billings, Deborah L., and Janie Benson. 2005. Postabortion care in Latin America: Policy and service recommendations from a decade of operations research . Health Policy and Planning 20.3: 158–166.

DOI: 10.1093/heapol/czi020 Save Citation » Export Citation » Share Citation »

This article reviews results from ten major PAC operations research projects conducted in public sector hospitals in seven Latin American countries. These operations achieved positive outcomes and indicated that more comprehensive PAC can and should be made available.

CATALYST Consortium. 2005. PAC compilation document . Washington, DC: US Agency for International Development.

This report documents PAC programs implemented in Bolivia, Egypt, and Peru as well as lessons learned.

Curtis, Carolyn. 2007. Meeting health care needs of women experiencing complications of miscarriage and unsafe abortion: USAID’s postabortion care program. Journal of Midwifery & Women’s Health 52.4: 368–375.

DOI: 10.1016/j.jmwh.2007.03.005 Save Citation » Export Citation » Share Citation »

This article describes the five-year strategy initiated in 2003 by USAID to provide financial and technical assistance for PAC services in seven countries. Available online for purchase or by subscription.

Huber, Douglas, Carolyn Curtis, Laili Irani, Sara Pappa, and Lauren Arrington. 2016. Postabortion care: 20 years of strong evidence on emergency treatment, family planning, and other programming components. Global Health: Science and Practice 4.3: 481–494.

A review of findings from studies published between 1994 and 2013 that offer strong evidence on postabortion care (PAC) and its components, particularly in low- and middle-income countries. In addition, the article considers some of the important programmatic implications.

Postabortion Care Consortium .

This website describes the essential elements of a widely adopted model of PAC care. It also makes available information and resources about PAC care, with examples from different parts of the world.

RamaRao, Saumya, John W. Townsend, Nafissatou Diop, and Sarah Raifman. 2011. Postabortion care: Going to scale . International Perspectives on Sexual and Reproductive Health 37.1: 40–44.

DOI: 10.1363/3704011 Save Citation » Export Citation » Share Citation »

This article reviews what is required to scale up PAC programs in many countries and obstacles that must be overcome to make such services more accessible.

Senlet, Pinar, Levent Cagatay, Julide Ergin, and Jill Mathis. 2001. Bridging the gap: Integrating family planning with abortion services in Turkey . International Family Planning Perspectives 27.2: 90–95.

DOI: 10.2307/2673821 Save Citation » Export Citation » Share Citation »

This article reviews Turkey’s experience of implementing and scaling up postabortion family planning services, which were delivered through three related phases. This process reduced abortion through increasing contraceptive use, tilting the method mix toward more effective methods, and securing the commitment of decision makers.

US Agency for International Development. Information and Knowledge for Optimal Health (INFO) Project .

The INFO project website provides multiple resources that can be freely downloaded on PAC. These include a guide to research evidence on PAC, recommended policies, service delivery guidelines, assessment tools, and other documents and tools.

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Is Abortion Sacred?

By Jia Tolentino

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More on Abortion and Roe v. Wade

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

The study that debunks most anti-abortion arguments .

Of course the Constitution has nothing to say about abortion .

How the real Jane Roe shaped the abortion wars.

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

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

When abortion is criminalized, women make desperate choices .

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By Amanda Petrusich

By Dhruv Khullar

By Eric Lach

By Elizabeth Kolbert

• Made by History

The Abortion Fight Isn’t a ‘War on Women.’ It’s a War on Poor Women

O n April 9, Arizona’s supreme court ruled that its 1864 almost total abortion ban remains in place. That came a week after Florida’s supreme court upheld an abortion ban, triggering an even stricter six-week ban. The onslaught of anti-abortion laws and court decisions has led liberals like California Governor Gavin Newsom to assert that the political right has declared “a war on women .”

This concept isn’t new, but it actually distorts the history of anti-abortion legislation. Abortion regulations have never applied equally to all doctors or all women. Understanding this history reveals that today — as in the past — abortion bans affect both women and providers differently depending upon factors like their race, class, and social standing. The people impacted most have changed over time, but one thing has remained consistent: abortion restrictions are less a war on women than a war on poor women.

The conditions that created these class and social dynamics began to emerge almost two centuries ago. In 1829, for example, New York State enacted a law defining abortion as second-degree manslaughter — but only if the woman was “pregnant with a quick child,” that is, if she’d felt the fetus moving inside of her, something that typically happened around 20 weeks. 

In the late 1850s, that law — and others like it — came under attack by Boston doctor Horatio R. Storer. In an 1859 essay, he argued that these laws defined the crime of abortion too leniently. “By the Moral Law, THE WILFUL KILLING OF A HUMAN BEING AT ANY STAGE OF ITS EXISTENCE IS MURDER.” He also argued, without evidence, that women could face dire medical consequences from an abortion, including, on occasion, death. 

But Storer wasn’t just worried about women as a universal class. He reserved his greatest scorn for white middle- and upper-class women, whom he claimed were seeking abortions in greater numbers than poor and immigrant women. He claimed that middle-class women boasted to each other about their successful abortions, in the same way they might brag about a new dress or a social coup. In Storer’s view, these women who sought abortions were not just victims of a purportedly dangerous medical procedure, but dangerous criminals who were outside the reach of the law.

Read More: What to Know About the Arizona Supreme Court Abortion Ban Ruling

Storer’s anti-abortion activism occurred at a time when he and other “medical men” of similar social standing were attempting to professionalize medicine by implementing rigorous educational and training standards. As part of this push, these doctors hoped to take over what would become the lucrative fields of obstetrics and gynecology from female midwives and other providers they considered untrained and dangerous — those who Storer claimed “frequently cause abortion openly and without disguise.”

In Storer’s view, white, educated “medical men” like him had to seek justice as “the physical guardians of women and their offspring.” It was their responsibility to “stand… in the breach fast making in the public morality, decency, and conscience.” Behind these righteous pronouncements, though, lurked Storer’s unspoken fear: that if men like him did not intervene, middle-class wives would shirk their childbearing duties, leaving their husbands without heirs while poor and immigrant families swelled their ranks. 

Storer spent the latter part of the 1850s, and much of the 1860s, organizing letter-writing campaigns by new professional medical societies, including state affiliates of the American Medical Association (AMA). He hoped to pressure states into passing ever-stricter abortion bans. In New York, the effort paid off in 1869 when the legislature made abortion second-degree manslaughter at any stage of pregnancy if it resulted in the death of the mother or the termination of the pregnancy.

In the fall of 1871, the new statute led to the conviction of abortion provider Jacob Rosenzweig for manslaughter in the death of Alice Bowlsby in New York City. Railway officials had found Bowlsby's body in a trunk bound for Chicago only days after the New York Times had published an exposé on abortionists, including Rosenzweig, titled “The Evil of the Age.”

The paper had described Rosenzweig as having a $40 degree, and purportedly knowing “more of the saloon business than of medicine.” Nonetheless, he did “a large business” — part of a “frightful profusion” of discreet abortions performed by untrained practitioners. 

It took less than two hours for a jury to find Rosenzweig guilty, and a judge sentenced him to seven years’ hard labor in the Albany State Penitentiary, the maximum sentence possible.

Meanwhile, just weeks after Bowlsby's death, a young Albany waitress named Margaret Campbell died from an abortion performed by “Mrs. Dr. Emma Burleigh,” a well known abortionist. After colleagues of Burleigh’s tried to cover it up — including spiriting Campbell’s body away to an unmarked grave in the local cemetery — a second autopsy revealed that the young woman’s abdomen was inflamed, her uterus was missing, and her breasts were full of milk. A laceration was found in her vagina, “occupied by a clot of blood.”

The outcome for Burleigh, however, was very different than for Rosenzweig. Under cross-examination at the coroner’s inquest, she got the doctors who performed the autopsy to admit that alternate explanations existed for all of their findings. There was no definitive proof that Campbell had been pregnant, that she’d had an abortion, or that the operation had caused her death. The jury agreed that the cause of death was simple peritonitis , and Burleigh walked free. 

The disparity between the two cases was no accident. The abortion statute really wasn’t about protecting women from unqualified practitioners, nor was it a war on women, as Storer might have hoped. Instead, it was a weapon of class warfare. 

Rosenzweig was a Jewish immigrant — a dangerous outsider. Meanwhile, Burleigh — who lied about having a medical degree in advertisements, but had taken medical classes — was an educated white woman. That made her less of a threat to the native-born doctors like Storer who were working to consolidate medical authority under their own control. 

Class also separated the two victims: Newspaper accounts of Bowlsby’s death painted her as a young lady from “respectable society,” with “relatives in the highest circles.” In other words, she was an ideal victim for the villain of the immigrant doctor. Campbell, by contrast, was, in the words of one prominent abortion opponent, an obscure Irish waitress who was “evidently…not of correct moral habits.”

Read More: How Ronald Reagan Helped Abortion Take Over the Republican Agenda

In 1872, New York toughened the law further, defining abortion as a felony with a possible sentence of 20 years in prison. Yet even under this law, wealthy, typically white women continued to seek and receive safe abortions. Often, it was trained male physicians of similar social and class standing who performed them without legal penalties. Strict enforcement of abortion laws didn’t ramp up until the mid-20th century , when medical care moved from private offices exclusive to a well-off clientele into public hospitals and clinics serving the poor along with the wealthy. 

Understanding how New York’s abortion laws functioned in the 19th century creates a new perspective on abortion bans in 2024. 

They, too, are far more of a weapon of class warfare than a war on all women.

Strict abortion bans are more likely to exist in states where a high number of women of childbearing age have incomes below 200% of the federal poverty line. Of the five states with the highest levels of poverty among women of childbearing age —  Mississippi, Arkansas, Louisiana, West Virginia, and New Mexico — all but New Mexico fall into the Guttmacher Institute’s  “most restrictive” abortion law category. Poverty strengthens the effects of abortion bans, since poor women can’t afford to miss work, book travel, arrange childcare, and pay out of pocket for procedures if they do not have health insurance. 

Abortion bans also exacerbate poverty. A University of California San Francisco study found that women denied an abortion saw an increase in poverty for at least four years and were more likely to see drops in their credit scores . These impacts don’t hurt poor women in isolation: abortion bans also put their children, their husbands, and their wider communities at a disadvantage by making the cycle of poverty harder to escape.

By contrast, just as in the 19th century, wealthier women — those who have health insurance, who can afford a pharmaceutical or surgical copay, and who have the means to take time off work and travel to a state with more lenient regulations — are far more insulated from the most potent and cascading impacts of abortion bans. So, too, are their families and communities.  

As in the 19th century, class, hand in hand with race, provides a more useful lens of analysis for understanding abortion legislation in the U.S. In restricting abortion, “medical men” like Storer worked to consolidate medical authority among the white upper classes. Today, it is often men from a similarly high social and class standing, serving in state legislatures and on courts, who are once again pushing for abortion restrictions that most adversely impact Americans with less social and economic capital.

R.E. Fulton is an independent historian of medicine, gender, and crime whose work focuses on abortion practitioners in 19th-century New York. Their book The Abortionist of Howard Street , out May 2024 from Cornell University Press, studies the life and career of Josephine McCarty, alias Emma Burleigh.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here . Opinions expressed do not necessarily reflect the views of TIME editors .

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Write to Made by History / R.E. Fulton at [email protected]

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• School Education /

Essay on Abortion in English in 650 Words

• Updated on  
• Feb 5, 2024

Essay on Abortion: Abortion is the termination of pregnancy. The termination happens due to the removal of the embryo or fetus. 

The process of abortion can be natural as well as intentional. The intentional forces abortion involves a decision to end the pregnancy while when this process unfolds naturally without any external forces such as genetic abnormalities, maternal age, hormonal imbalances, or lifestyle, it is termed as miscarriage or spontaneous abortion. It is important to understand the difference between intentional abortion and miscarriage to explore reproductive health. 

Master the art of essay writing with our blog on How to Write an Essay in English .

Table of Contents

• 1 Types of Abortion
• 2 Law in India for Abortion
• 3.1 1. Comprehensive Sex Education 
• 3.2 2. Access to Contraceptives
• 3.3 3. Support System for Pregnant Women 

Also Read: 3-Minute Speech on Motherhood and Education

Types of Abortion

Abortion procedures can be classified into two main types, Medical abortion and Surgical abortion. Medical abortion involves the termination of pregnancy using medications, such as the combination of mifepristone and misoprostol. This medication method is generally effective within nine weeks of pregnancy and does not involve any penetration or incision of the body or the insertion of instruments into the body. 

On the other hand, surgical abortion involves a physical procedure to remove the pregnancy. The common surgical abortion method includes aspiration (suction) abortion, dilation and curettage (D&C), and dilation and evacuation (D&E) also called vacuum aspiration.

Law in India for Abortion

Laws of abortion play a vital role in the complexities of reproductive health. These laws aim to safeguard the well-being of women by ensuring that the abortion procedures are conducted under safe and medically supervised conditions.

In India, the legal framework for governing abortion primarily comes under the guidance of the Medical Termination of Pregnancy (MTP) Act. The act was enacted in the year 1971 and aimed to liberalize the voluntary absorption largely decriminalized Section 312 of the IPC. To have safe and legal abortion services in India The Medical Termination of Pregnancy Regulations,2003 were issued under the MTP Act. 

Further in the year 2021, certain amendments were passed for safe abortion services in case of failures of contraceptive failures, increase in gestation limit to 24 weeks, and the opinion of one abortion service provider up to 20 weeks of gestation. Moreover, the amendment also supported abortion until 24 weeks of pregnancy. The amendment acknowledges 7 specific circumstances to the MTP Act where a female can go for an abortion and those include Minor pregnancies, rape survivors, women with mental and physical disabilities, and more. 

Alternative and Support of Abortion

Some alternative measures that will help to raise awareness about abortion are as follows:

1. Comprehensive Sex Education 

The physical experience of abortion for women can be hazardous too, therefore, to provide an alternative it is necessary that comprehensive sex education should be provided in schools beyond subjects like Biology, healthy relationships, consent, and making responsible choices. Through this knowledge, students will not only be equipped with information but will also navigate relationships and avoid unintended pregnancies.

2. Access to Contraceptives

Easy access to contraceptives is another way to empower women to take charge of their reproductive health. Whether it is condoms, birth control pills, or any other methods of protection ensures to make responsible decisions and help in taking precautions against unplanned pregnancies.

3. Support System for Pregnant Women 

To support women with unwanted pregnancies it is important to create a supportive environment for them mentally as well as emotionally. The government can offer counselling services, and access to healthcare information, and can provide resources to help pregnant women make informed choices or decisions about their future for example parenting classes, legal guidance and financial assistance programs. 

In conclusion, we can say that the topic of abortion is complex as well as deep with emotions as well as with different perspectives. The ethical, religious, and legal debate on this sophisticated topic makes it challenging to find a common ground. Therefore it is necessary to have open and respectful communication, understanding empathy and healthcare options for the women. 

Also Read: National Safe Motherhood Day 2023

Ans. 1 Abortion is the termination of pregnancy. The termination happens due to the removal of the embryo or fetus. 

Ans. 2 As she was going through many health issues the family decided to go for an abortion. 

The causes of abortion in the first trimester can be emotional or psychological, maternal health concerns, unintended pregnancies, contraceptive failure and more.  

Ans. 4 The opposite of abortion is success, continuation, accomplishment, and achievement.

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Deepika Joshi

Deepika Joshi is an experienced content writer with expertise in creating educational and informative content. She has a year of experience writing content for speeches, essays, NCERT, study abroad and EdTech SaaS. Her strengths lie in conducting thorough research and ananlysis to provide accurate and up-to-date information to readers. She enjoys staying updated on new skills and knowledge, particulary in education domain. In her free time, she loves to read articles, and blogs with related to her field to further expand her expertise. In personal life, she loves creative writing and aspire to connect with innovative people who have fresh ideas to offer.

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America’s Abortion Quandary

2. social and moral considerations on abortion, table of contents.

• Broad public agreement that abortion should be legal if pregnancy endangers a woman’s health or is the result of rape 
• Most Americans open to some restrictions on abortion
• Views of penalties for abortion in situations where it is illegal 
• Partisan differences in views of abortion 
• Women are more likely than men to have thought ‘a lot’ about abortion, but there are only modest gender differences in views of legality
• White evangelicals are most opposed to abortion – but majorities across Christian subgroups see gray areas
• Guide to this report
• Abortion at various stages of pregnancy 
• Abortion and circumstances of pregnancy 
• Parental notification for minors seeking abortion
• Penalties for abortions performed illegally 
• Public views of what would change the number of abortions in the U.S.
• A majority of Americans say women should have more say in setting abortion policy in the U.S.
• How do certain arguments about abortion resonate with Americans?
• In their own words: How Americans feel about abortion 
• Personal connections to abortion 
• Religion’s impact on views about abortion
• Acknowledgments
• The American Trends Panel survey methodology

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

There are wide differences on this question by political party and religious affiliation. Among Republicans and independents who lean toward the Republican Party, most say that abortion is morally wrong either in most (48%) or all cases (20%). Among Democrats and Democratic leaners, meanwhile, only about three-in-ten (29%) hold a similar view. About four-in-ten Democrats say abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say abortion is not a moral issue. 

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

There is strong alignment between people’s views of whether abortion is morally wrong and whether it should be illegal. For example, among U.S. adults who take the view that abortion should be illegal in all cases without exception, fully 86% also say abortion is always morally wrong. The prevailing view among adults who say abortion should be legal in all circumstances is that abortion is not a moral issue (44%), though notable shares of this group also say it is morally acceptable in all (27%) or most (22%) cases. 

Most Americans who say abortion should be illegal with some exceptions take the view that abortion is morally wrong in  most  cases (69%). Those who say abortion should be legal with some exceptions are somewhat more conflicted, with 43% deeming abortion morally acceptable in most cases and 26% saying it is morally wrong in most cases; an additional 24% say it is not a moral issue. 

The survey also asked respondents who said abortion is morally wrong in at least some cases whether there are situations where abortion should still be legal  despite  being morally wrong. Roughly half of U.S. adults (48%) say that there are, in fact, situations where abortion is morally wrong but should still be legal, while just 22% say that whenever abortion is morally wrong, it should also be illegal. An additional 28% either said abortion is morally acceptable in all cases or not a moral issue, and thus did not receive the follow-up question.

Across both political parties and all major Christian subgroups – including Republicans and White evangelicals – there are substantially more people who say that there are situations where abortion should still be  legal  despite being morally wrong than there are who say that abortion should always be  illegal  when it is morally wrong.

Asked about the impact a number of policy changes would have on the number of abortions in the U.S., nearly two-thirds of Americans (65%) say “more support for women during pregnancy, such as financial assistance or employment protections” would reduce the number of abortions in the U.S. Six-in-ten say the same about expanding sex education and similar shares say more support for parents (58%), making it easier to place children for adoption in good homes (57%) and passing stricter abortion laws (57%) would have this effect. 

While about three-quarters of White evangelical Protestants (74%) say passing stricter abortion laws would reduce the number of abortions in the U.S., about half of religiously unaffiliated Americans (48%) hold this view. Similarly, Republicans are more likely than Democrats to say this (67% vs. 49%, respectively). By contrast, while about seven-in-ten unaffiliated adults (69%) say expanding sex education would reduce the number of abortions in the U.S., only about half of White evangelicals (48%) say this. Democrats also are substantially more likely than Republicans to hold this view (70% vs. 50%). 

Democrats are somewhat more likely than Republicans to say support for parents – such as paid family leave or more child care options – would reduce the number of abortions in the country (64% vs. 53%, respectively), while Republicans are more likely than Democrats to say making adoption into good homes easier would reduce abortions (64% vs. 52%).

Majorities across both parties and other subgroups analyzed in this report say that more support for women during pregnancy would reduce the number of abortions in America.

More than half of U.S. adults (56%) say women should have more say than men when it comes to setting policies around abortion in this country – including 42% who say women should have “a lot” more say. About four-in-ten (39%) say men and women should have equal say in abortion policies, and 3% say men should have more say than women. 

Six-in-ten women and about half of men (51%) say that women should have more say on this policy issue. 

Democrats are much more likely than Republicans to say women should have more say than men in setting abortion policy (70% vs. 41%). Similar shares of Protestants (48%) and Catholics (51%) say women should have more say than men on this issue, while the share of religiously unaffiliated Americans who say this is much higher (70%).

Seeking to gauge Americans’ reactions to several common arguments related to abortion, the survey presented respondents with six statements and asked them to rate how well each statement reflects their views on a five-point scale ranging from “extremely well” to “not at all well.” 

The list included three statements sometimes cited by individuals wishing to protect a right to abortion: “The decision about whether to have an abortion should belong solely to the pregnant woman,” “If legal abortions are too hard to get, then women will seek out unsafe abortions from unlicensed providers,” and “If legal abortions are too hard to get, then it will be more difficult for women to get ahead in society.” The first two of these resonate with the greatest number of Americans, with about half (53%) saying each describes their views “extremely” or “very” well. In other words, among the statements presented in the survey, U.S. adults are most likely to say that women alone should decide whether to have an abortion, and that making abortion illegal will lead women into unsafe situations.

The three other statements are similar to arguments sometimes made by those who wish to restrict access to abortions: “Human life begins at conception, so a fetus is a person with rights,” “If legal abortions are too easy to get, then people won’t be as careful with sex and contraception,” and “If legal abortions are too easy to get, then some pregnant women will be pressured into having an abortion even when they don’t want to.” 

Fewer than half of Americans say each of these statements describes their views extremely or very well. Nearly four-in-ten endorse the notion that “human life begins at conception, so a fetus is a person with rights” (26% say this describes their views extremely well, 12% very well), while about a third say that “if legal abortions are too easy to get, then people won’t be as careful with sex and contraception” (20% extremely well, 15% very well).

When it comes to statements cited by proponents of abortion rights, Democrats are much more likely than Republicans to identify with all three of these statements, as are religiously unaffiliated Americans compared with Catholics and Protestants. Women also are more likely than men to express these views – and especially more likely to say that decisions about abortion should fall solely to pregnant women and that restrictions on abortion will put women in unsafe situations. Younger adults under 30 are particularly likely to express the view that if legal abortions are too hard to get, then it will be difficult for women to get ahead in society.

In the case of the three statements sometimes cited by opponents of abortion, the patterns generally go in the opposite direction. Republicans are more likely than Democrats to say each statement reflects their views “extremely” or “very” well, as are Protestants (especially White evangelical Protestants) and Catholics compared with the religiously unaffiliated. In addition, older Americans are more likely than young adults to say that human life begins at conception and that easy access to abortion encourages unsafe sex.

Gender differences on these questions, however, are muted. In fact, women are just as likely as men to say that human life begins at conception, so a fetus is a person with rights (39% and 38%, respectively).

Analyzing certain statements together allows for an examination of the extent to which individuals can simultaneously hold two views that may seem to some as in conflict. For instance, overall, one-in-three U.S. adults say that  both  the statement “the decision about whether to have an abortion should belong solely to the pregnant woman” and the statement “human life begins at conception, so the fetus is a person with rights” reflect their own views at least somewhat well. This includes 12% of adults who say both statements reflect their views “extremely” or “very” well. 

Republicans are slightly more likely than Democrats to say both statements reflect their own views at least somewhat well (36% vs. 30%), although Republicans are much more likely to say  only  the statement about the fetus being a person with rights reflects their views at least somewhat well (39% vs. 9%) and Democrats are much more likely to say  only  the statement about the decision to have an abortion belonging solely to the pregnant woman reflects their views at least somewhat well (55% vs. 19%).

Additionally, those who take the stance that abortion should be legal in all cases with no exceptions are overwhelmingly likely (76%) to say only the statement about the decision belonging solely to the pregnant woman reflects their views extremely, very or somewhat well, while a nearly identical share (73%) of those who say abortion should be  illegal  in all cases with no exceptions say only the statement about human life beginning at conception reflects their views at least somewhat well.

When asked to describe whether they had any other additional views or feelings about abortion, adults shared a range of strong or complex views about the topic. In many cases, Americans reiterated their strong support – or opposition to – abortion in the U.S. Others reflected on how difficult or nuanced the issue was, offering emotional responses or personal experiences to one of two open-ended questions asked on the survey. 

One open-ended question asked respondents if they wanted to share any other views or feelings about abortion overall. The other open-ended question asked respondents about their feelings or views regarding abortion restrictions. The responses to both questions were similar. 

Overall, about three-in-ten adults offered a response to either of the open-ended questions. There was little difference in the likelihood to respond by party, religion or gender, though people who say they have given a “lot” of thought to the issue were more likely to respond than people who have not. 

Of those who did offer additional comments, about a third of respondents said something in support of legal abortion. By far the most common sentiment expressed was that the decision to have an abortion should be solely a personal decision, or a decision made jointly with a woman and her health care provider, with some saying simply that it “should be between a woman and her doctor.” Others made a more general point, such as one woman who said, “A woman’s body and health should not be subject to legislation.” 

About one-in-five of the people who responded to the question expressed disapproval of abortion – the most common reason being a belief that a fetus is a person or that abortion is murder. As one woman said, “It is my belief that life begins at conception and as much as is humanly possible, we as a society need to support, protect and defend each one of those little lives.” Others in this group pointed to the fact that they felt abortion was too often used as a form of birth control. For example, one man said, “Abortions are too easy to obtain these days. It seems more women are using it as a way of birth control.” 

About a quarter of respondents who opted to answer one of the open-ended questions said that their views about abortion were complex; many described having mixed feelings about the issue or otherwise expressed sympathy for both sides of the issue. One woman said, “I am personally opposed to abortion in most cases, but I think it would be detrimental to society to make it illegal. I was alive before the pill and before legal abortions. Many women died.” And one man said, “While I might feel abortion may be wrong in some cases, it is never my place as a man to tell a woman what to do with her body.” 

The remaining responses were either not related to the topic or were difficult to interpret.

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What the data says about abortion in the U.S.

Support for legal abortion is widespread in many countries, especially in europe, nearly a year after roe’s demise, americans’ views of abortion access increasingly vary by where they live, by more than two-to-one, americans say medication abortion should be legal in their state, most latinos say democrats care about them and work hard for their vote, far fewer say so of gop, most popular, report materials.

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Factors Influencing Abortion Decision-Making Processes among Young Women

Mónica frederico.

1 International Centre for Reproductive Health (ICRH), Ghent University, 9000 Gent, Belgium; [email protected]

2 Centro de Estudos Africanos, Universidade Eduardo Mondlane, C. P. 1993, Maputo, Mozambique; [email protected]

Kristien Michielsen

Carlos arnaldo, peter decat.

3 Department of Family Medicine and primary health care, Ghent University, 9000 Gent, Belgium; [email protected]

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective : The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods : A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results : The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions : Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique.

1. Introduction

Abortion among adolescents and youth is a major public health issue, especially in developing countries. Estimates indicate that 2.2 million unplanned pregnancies and 25% (2.5 million) unsafe abortions occur each year, in sub-Saharan Africa, among adolescents [ 1 ]. In 2008, of the 43.8 million induced abortions, 21.6 million were estimated to be unsafe, and nearly all of them (98%) took place in developing countries, with 41% (8.7 million) being performed on women aged 15 to 24 [ 2 ].

The consequences of abortion, especially unsafe abortion, are well documented and include physical complications (e.g., sepsis, hemorrhage, genital trauma), and even death [ 3 , 4 , 5 , 6 ]. The physical complications are more severe among adolescents than older women and increase the risk of morbidity and mortality [ 6 , 7 ]. However, the detrimental effects of unsafe abortion are not limited to the individual but also affect the entire healthcare system, with the treatment of complications consuming a significant share of resources (e.g., including hospital beds, blood supply, drugs) [ 5 , 8 ].

The decision if and how to terminate a pregnancy is influenced by a variety of factors at different levels [ 9 ]. At the individual level these factors include: their marital status, whether they were the victim of rape or incest [ 10 , 11 ], their economic independence and their education level [ 10 , 12 ]. Interpersonally factors include support from one’s partner and parental support [ 12 ]. Societal determinants include social norms, religion [ 9 , 13 ], the stigma of premarital and extra-marital sex [ 14 ], adolescents’ status, and autonomy within society [ 12 ]. At the organizational level, the existence of sex education [ 10 , 14 ], the health care system, and abortion laws influence the decisions if and where to have an abortion.

Those factors are related to power and (gender) inequalities. They limit young women’s autonomy and make them vulnerable to pressure. Additionally, the situation is exacerbated when there is a lack of clarity and information on abortion status, despite the existence of a progressive law in this regard.

For example, Mozambican law has allowed abortion if the woman’s health is at risk since the 1980s [ 15 , 16 , 17 , 18 ]. In 2014, a new abortion law was established that broadened the scope of the original law: women are now also allowed to terminate their pregnancy: (1) if they requested it and it is performed during the first 12 weeks; (2) in the first 16 weeks if it was the result of rape or incest, or (3) in the first 24 weeks if the mother’s physical or mental health was in danger or in cases of fetus disease or anomaly. Women younger than 16 or psychically incapable of deciding need parental consent [ 19 , 20 ].

Notwithstanding the progressive abortion laws in Mozambique, hospital-based studies report that unsafe abortion remains one of the main causes of maternal death in Mozambique [ 3 ]. However, hospital cases are only a small share of unsafe abortions in the country. Many women undergo an abortion in illegal and unsafe circumstances for a variety of reasons [ 3 ], such as legal restrictions, the fear of stigma [ 21 , 22 , 23 ], and a lack of knowledge of the availability of abortion services [ 3 , 9 , 23 ].

According to the 2011 Mozambican Demographic Health Survey (DHS), at least 4.5% of all adolescents reported having terminated a pregnancy [ 24 ]. Unpublished data from the records of Mozambican Association for Family Development (AMODEFA) which has a clinic that offers sexual and reproductive health services, including safe abortion, indicate that from 2010 to 2016 a total of 70,895 women had an induced abortion in this clinic, of which 43% were aged 15 to 24. Of the 1500 women that had an induced abortion in the AMODEFA clinic in the first three months of 2017, 27.9% were also in this age group [ 25 ]. These data show the high demand for (safe) abortion among young women.

For all this described above, Mozambique is an interesting place to study this decision-making process; given the changing legal framework, women may have to navigate gray areas in terms of legality, safety, and access when seeking abortion, which is stigmatized but necessary for the health, well-being, and social position of many young women.

The objective of this study is to explore the individual, interpersonal and environmental factors behind the abortion decision-making process. This entails both the decision to have an abortion and the decision on how to have the abortion. By examining fourteen stories of young women with an episode of induced abortion, we contribute to the documentation of the circumstances around the abortion decision making, and also to inform the policymakers on complexity of this issue for, which in turn can contribute to improve the strategies designed to reduce the cases of maternal morbidity and mortality in Mozambique.

2. Materials and Methods

This is an exploratory study using in-depth interview to explore factors related to abortion decision-making in a changing context. As research on this topic is limited, we opted for a qualitative research framework that aims to identify factors influencing this decision-making process.

2.1. Location of the Study

The study was conducted in two Mozambican cities, Maputo and Quelimane. These cities were selected because they registered more abortions than other cities in the same region. According to the 2014 data from the Direcção Nacional de Planificação, 629 and 698 women, respectively, were admitted to the hospital due to induced abortion complications in Maputo and Quelimane [ 26 ]. Furthermore, the two differ radically in terms of culture, with Maputo in the South being patrilineal and Quelimane in the Central Region matrilineal, which could influence the abortion decision-making process. The fieldwork took place between July–August 2016 and January–February 2017.

2.2. Data Collection

The data were collected through in-depth interviews, asking participants about their experiences with induced abortion and what motivated them to get an abortion. To approach and recruit participants ( Figure 1 ), we used the information collected during a cross-sectional survey with women in the reproductive age (15–49), These women were selected randomly applying multistage cluster based on household registers. The survey was designed to understand women’s sexual and reproductive health and included filter questions that allowed us to identify participants who had undergone an abortion. The information sheet and informed consent form for this household survey included information about a possible follow-up study.

The process of recruitment of the participants.

Participants who were within the age-range 15–24 years and who reported having had an abortion were contacted by phone. In this contact, the researcher (MF) introduced herself, reminded the participant of the study she took part in, explained the follow-up study and asked whether she was willing to participate in this. If she did, an appointment was made at a convenient location. Before each interview, we explained to each participant why she was invited to the second interview. Participants were also informed of interview procedures, confidentiality and anonymity in the management of the data, and the possibility to withdraw from the interview at any time. In total 14, young women (15–24) agreed to participate: nine in Maputo and five in Quelimane. Six of them were interviewed twice to explore further aspects that remained unclear after the first interview. The interviews were conducted in Portuguese.

To start the interview, the participant was invited to tell her life history from puberty until the moment when the abortion occurred. During the conversation, we used probing questions to elicit more details. Gradually, we added questions related to the abortion and factors that influenced the decision process. The main questions were related to the pregnancy history, abortion decision-making, and help-seeking behaviour. The guideline was adapted from WHO tools [ 27 , 28 ]. Before the implementation of the guideline, it was discussed first with another Mozambican researcher to see how they fell regarding the question. After those questions were revised or removed from the guideline.

2.3. Data Analysis

The analysis consisted of three steps: transcription, reading, and codification with NVivo version 11(QSR International Pty Ltd., Doncaster, Australia). After an initial reading, one of the authors (MF) developed a coding tree on factors determining the decision-making. A structured thematic analysis was used to make inferences and elicit key emerging themes from the text-based data [ 29 , 30 ]. The coding tree was based on the ecological model, which is a comprehensive framework that emphasizes the interaction between, and interdependence of factors within and across all levels of a health problem since it considers that the behaviour affects and is affected by multiple levels of influence [ 31 , 32 ].

Next, the codes and the classification were discussed among the researchers (Mónica Frederico, Kristien Michielsen, Carlos Arnaldo and Peter Decat). Finally, the data was interpreted, and conclusions were drawn [ 33 ].

2.4. Ethical Consideration

Before the implementation of this research, we obtained ethical approval from the Institutional Committee of the Faculty of Medicine and Nacional Bioethical Committee for Health (IRB00002657). We also asked for the institutional approval of the Minister of Health and authorities at the provincial and community levels. The participants gave their informed consent after the objectives and interview procedures had been explained to them. The participants were informed that they might be contacted and invited, within six months, to participate in another interview.

2.5. Concepts

The providers are the people who carried out the abortion procedure. These may be categorized into skilled and unskilled providers: the former refers to a professional (i.e., nurse or doctor) offering abortion services to a client, while the latter is someone without any medical training. Another concept that requires further explanation is the legal procedure. This corresponds to a set of steps to be followed to comply with the law [ 19 , 20 ]. Specifically, this means that a committee should authorize the induced abortion and an identification document should be available, as well as an informed consent form from the pregnant woman. If the woman is a minor, consent is given by her legal guardian. An ultrasound exam is required to determine the gestational age.

3.1. Characteristics of the Participants

The characteristics of the interviewees are summarized in Table 1 . The 14 participants were aged 17 to 24 years. Eight had completed secondary school, four had achieved the second level of primary school, and two were university students. Almost all (13) were Christian. Five participants were studying, eight were unemployed, and one was working. The median age of their first sexual intercourse was 15.5 years. Participants reported living with one or both parents (12), with their uncle (1) or alone (1). They lived in suburban areas of Maputo and Quelimane, which are slums with poor living conditions. In these areas, most households earn their income through small businesses that also involve child labour (e.g., selling food or drinks).

Socio-demographic characteristics and abortion procedure.

Among the participants, five reported more than one pregnancy. One interviewee first had a stillbirth and then two abortions. Another woman gave birth to a girl and afterward terminated two pregnancies. Two interviewees reported two pregnancies, the first of which was brought to full term and the second one terminated. One woman first had an abortion and afterward gave birth to a child. In short, 14 interviewees in total reported on the experiences and decision-making of 16 abortions. One participant stated that the pregnancy was the consequence of rape. Of the 16 reported abortions, seven were performed after the new law came into force at the end of 2014, and nine were carried out before this time.

3.2. Abortions Stories

In this study, 12 abortions were done by skilled providers and two by unskilled providers. The unskilled providers were a mother and a husband, respectively. None of the cases, whose abortion was done by a skilled provider, included in this study followed the legal procedure.

In the analysis of the interviews, we studied the personal, interpersonal and environmental factors that influenced six different types of abortion stories, see Table 2 : (1) an abortion was performed because the pregnancy was unwanted; (2) an abortion was carried out although the pregnancy was wanted; (3) the abortion was done by an unskilled provider at home; (4) an abortion was carried out by a skilled provider outside the hospital; (5) a particular abortion procedure (medical or chirurgical) was chosen, and (6) the legal procedure was not followed in the hospital. Factors influencing the choice for a particular technical procedure were also examined.

Summary of induced abortion stories. (We changed the table format, please confirm.)

* The result of rape; ** Seven participants; *** six participants.

3.3. Abortion Following an Unwanted Pregnancy

In the stories about unwanted pregnancies, mostly personal factors were mentioned as reasons, with some interviewees stating that they felt unable to be a mother at the time of the pregnancy: “ (It) was at the time that I was taking pills that I got pregnant, and I induced abortion because I was not prepared (for motherhood). ” (24 years)

Some had had a bad experience in the past: “ Maybe I would be abandoned and it would be the same. (Sigh)... I learned with my first pregnancy. ” (23 years)

Also, the existence of another child was mentioned as a reason to have an abortion: “ I got pregnant when I was 20, and I had a baby. When I became pregnant again, my daughter was a child, and I could not have another child. ” (23 years)

For other participants, studies were the main reason why the pregnancy was not wanted: “ He was informed about it, and he said that I should keep it. However, as I wanted to continue my studies, I told him no, no (I) do not. ” (17 years)

At the interpersonal level, a lack of support from the partner was often mentioned as a reason for not wanting the baby: “ He said that he recognizes the paternity, but it is not to keep that pregnancy. ” (22 years)

Women frequently mentioned environmental circumstances related to their poor socio-economic situation: “ I am staying at Mom's house; it is not okay to still be having babies there.” (23 years)

“ At home, we do not have any resources to take care of this child! ” (20 years)

3.4. Abortion Following a Wanted Pregnancy

In these cases, the decision to abort the pregnancy was not made by the woman herself but imposed by others or by the circumstances.

Some participants reported that their parents/family had decided what had to be done: “ They decided while I was at school. If (it) was my decision I would keep it because I wanted it. ” (18 years).

Other young women indicated the refusal of paternity as a reason to terminate the pregnancy.

“ Because my son’s father did not accept the (second) pregnancy. There was a time, we argued with each other, and we terminated the relationship. Later, we started dating again, and I got pregnant. He said it was not possible. ” (21 years)

“ (he) impregnated me and after that, he dumped me, (smiles)… I went to him, and I said that I was pregnant. He said eee: I do not know, that is not my child. ” (20 years).

Some women told the interviewers that they were convinced by their boyfriend to have an abortion: “ I talked to him, and he said okay we are going to have an abortion and I accepted. ” (22 years)

Others mentioned their partner’s indecision and changing attitude as a reason to get an abortion, even though they did want the baby:

“ I told him I was pregnant. First, he said to keep it. (Next) He was different. Sometimes he was calling me, and other times not. I understood that he did not want me. ” (20 years)

The fear of being excluded from their family due to their pregnancy was another reason reported by participants: “ So I went to talk with my older sister, and she said eee, you must abort because daddy will kick you out of our home. ” (20 years)

“ As I am an orphan, and I live with my uncle, they were going to kick me out. No one would assist me. ” (20 years)

3.5. Location of the Abortion: Home-Based Versus Hospital-Based

Two young women reported having had the abortion at home by an unskilled provider. It seems that these unskilled providers than the women (i.e. family members, partner) made the decisions.

“ It was mammy and my sister (who provided the induced abortion services). My sister knows these things. ” (18 years)

“ He (the father of the child) came to my house and took me back to his house. It was that moment when I aborted. ” (21 years)

Of the 16 abortions, seven were performed through health services, by a skilled provider. For some of them, the choice for a health service was influenced by the fact of knowing someone at the health facility.

“ I went to talk to her (friend), and she said that “I have an aunt who works at the hospital, she can help you. Just take money”. ” (20 years)

“ I Already knew who could induce it (abortion). No, I knew that person. I went to the hospital, and I talked to her, (and) she helped me. ” (22 years)

Other participants went to the health facility, but due to the lack of money to pay for an abortion at the facilities they sought help out of the health facility: “ They charged us money that we did not have. The ladies did not want to negotiate anything. I think they wanted 1200 mt (17.1 euros) if I am not wrong. He had a job, but he (boyfriend) did not have that amount of money. ” (22 years)

Some participants reported that they had an abortion outside regular facilities because the health provider recommended going to his house: “ She (mother) was the one who accompanied me. She is the one who knows the doctor. We went to the central hospital, but he (the doctor) was very busy, and he told us to go to his house. ” (17 years)

Others reported the fear of signing a document as a reason to seek help outside of official channels: “ I heard that to induce abortion at the hospital it is necessary for an adult to sign a consent form. I was afraid because I did not know who could accompany me. Because at that time I only wanted to hide it from others. ” (22 years).

3.6. Abortion Procedure

The women were not able to explain why a particular abortion procedure (i.e., pills or aspiration, curettage) was used. It appears that they were not given the opportunity to choose and that they submitted themselves to the procedure proposed by the provider.

“ The abortion was done here at home. They just went to the pharmacy, bought pills and gave them to me. ” (18 years)

3.7. Legal Procedure

None of those treated at the hospital stated that legal procedures were followed. They also mentioned that they had to pay without receiving any official receipt.

“ First we got there and talked to a servant (a helper of the hospital). The servant asked for money for a refreshment so he could talk to a doctor. After we spoke (with servant), he went to the doctor, and the doctor came, and we arranged everything with him. ” (22 years)

“ We went to the health center, and we talked to those doctors or nurses I mean, they said that they could provide that service. It was 1200 mt (17.1 euros), and they were going to deal with everything. They did not give us the chance to sign a document and follow those procedures. ” (20 years)

4. Discussion

The objective of this study was to describe abortion procedures and to explore factors influencing the abortion decision-making process among young women in Maputo and Quelimane.

The study pointed out determinants at the personal, interpersonal and environmental level. Analysing the results, we were confronted with four recurring factors that negatively impacted on the decision-making process: (1) women’s lack of autonomy to make their own decisions regarding the termination of the pregnancy, (2) their general lack of knowledge, (3) the poor availability of local abortion services, and (4) the overpowering influence of providers on the decisions made.

The first factor involves women’s lack of autonomy. In our study, most women indicate that decisions regarding the termination of a pregnancy are mostly taken by others, sometimes against their will. Parents, family members, partners, and providers decide what should happen. As shown in the literature, this lack of autonomy in abortion decision-making is linked to power and gender inequality [ 34 , 35 , 36 , 37 , 38 ]. On the one hand, power reflects the degree to which individuals or groups can impose their will on others, with or without the consent of those others [ 34 , 37 , 38 ]. In this case, the power of the parent/family is observed when they, directly or indirectly, influence their daughters to induce an abortion, for instance by threatening to kick them out of their home. On the other hand, gender inequality is also a factor. This refers to the power imbalance between men and women and is reflected by cases in which the partner makes the decision to terminate the pregnancy [ 38 ]. Besides this, the contextual environment of male chauvinism in Mozambique also makes it more socially acceptable for men to reject responsibility for a pregnancy [ 34 , 35 , 37 , 39 , 40 ]. Finally, women’s economic dependence makes them more vulnerable, dependent and subordinated. For economic reasons, women, have no other choice but to obey and follow the family or partner’s decisions. Closely linked with women’s lack of autonomy is their lack of knowledge. Interviewees report that they do not know where abortion services are provided. They are not acquainted with the legal procedures and do not know their sexual rights. This lack of knowledge among women contributes to the high prevalence of pregnancy termination outside of health facilities and not in accordance with legal procedures.

Our participants often report that abortion services are absent at a local level, as has also been pointed out by Ngwena [ 41 ]. This is a particular problem in Mozambique. Not all tertiary or quaternary health facilities are authorized to perform abortions. The fact that only some tertiary and quaternary facilities are allowed to do so creates a shortage of abortion centres to cover the demand. In fact, only people with a certain level of education and a sufficiently large social network have access to legal and proper abortion procedures.

Finally, our study shows that providers mostly decide on the location, the methods used and the legality of abortion procedures. Patients are highly dependent on the health providers’ commitment, professionality and accuracy and the selected procedures are not mutually decided by the provider and the patient. Providers often do not refer the client to the reference health facility or do not inform them of the legal procedures, creating a gap between law and practice that stimulates illegal and unsafe procedures. The reasons for this are unclear. It might be due to a lack of knowledge among health providers too, and, perhaps, provider saw here an opportunity to supplement the low salary [ 42 ]. Participants who seek help at the health facility they do so contacting the provider in particular, as indication given by someone.

This corroborates with studies conducted by Ngwena [ 41 , 43 ], Doran et al. [ 44 ], Pickles [ 45 ], Mantshi [ 46 ], and Ngwena [ 47 ], which pointed out the obstacles related to the availability of services and providers’ attitudes towards safe abortion, although the law grants the population this right [ 41 , 43 , 44 , 45 , 46 , 47 ]. As Ngwena [ 41 , 43 ] argues, the liberalization of abortion laws is not always put into practice and abortion rights merely exist on paper. Braam’ study [ 48 ] therefore highlights the necessity of clarifying and informing women and providers of the current legislation and ensuring that abortion services are available in all circumstances described in the law.

Finally, despite cultural differences between Maputo and Quelimane, the result did not suggest differences between two areas studied regarding factors influencing the decision to terminate and how the abortion is done. However, the Figure 1 suggests that there was trend to have more participants from Maputo reporting abortion episode in her life than Quelimane. This difference maybe be because Maputo is much more multicultural and the people of this city have more access to information that gives them the opportunity to learn about matter of reproductive health including abortion, than Quelimane. So, due to this there is trend decrease the taboo relation to abortion in Maputo than in Quelimane.

These abortion stories illustrate the lack of autonomy in decision-making process given the power and gender inequalities between adults and young women, and also between man and women . They also show the lack of knowledge not only on the availability of abortion services at some health facilities, as well as, on the new law on abortion. All these lacks that women have are reinforced by poor availability of abortion services and the fact that the providers we not taking their role to help those women, as it is exposed in the next sections.

This study interviewed young women who had an induced abortion at some point in their lives (15 years up to their age at interview date). As such, it does not provide any information on the factors behind the decisions of those who did not terminate their pregnancy.

The results presented in this paper only reflect the perceptions of the young women who had an induced abortion, not those of their parents or partners. The paper is based on qualitative data that provides insights into factors influencing abortion decision-making. Since the sample included in the study is not representative for the population of young women in Mozambique, the results cannot be generalized.

5. Conclusions

Based on the results of the study, we recommend the following measures to improve the abortion decision-making process among young women:

First, strategies should be implemented to increase women's autonomy in decision-making: The study highlighted that gender and power inequalities obstructed young women to make their decision with autonomy. We reiterate the Chandra-Mouli and colleges [ 49 ] message. There is a need to address gender and power inequalities. Addressing gender inequality, and promotion of more equitable power relations leads to improved health outcomes. The interventions to promote gender-equitable and power relationships, as well as human rights, need to be central to all future programming and policies [ 49 ].

Second, patients and the whole population should be better informed about national abortion laws, the recommended and legal procedures and the location of abortion services, since, despite the decision to terminate pregnancy resulted to the imposition, if they were well informed on that, maybe they could be decide on safe and legal abortion, avoiding double autonomy deprivation. At the same time, providers must be informed about the status of national abortion laws. Additionally, they should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.

Third, the number of health facilities providing abortions services should be increased, particularly in remote areas.

Finally, health providers should be trained in communication skills to promote shared decision-making and patient orientation in abortion counseling.

The abortion decision-making by young women is an important topic because it refers the decision made during the transitional period from childhood to adulthood. The decision may have life-long consequences, compromising the individual health, career, psychological well-being, and social acceptance. This paper, on abortion decision-making, calls attention to some attitudes that lead to the illegality of abortion despite it was done at a health facility.

Acknowledgments

Authors gratefully acknowledge the support, contribution, and comments from all those who collaborated direct or indirectly, especially Olivier Degomme, Eunice Remane Jethá, Emilia Gonçalves, Cátia Taibo, Beatriz Chongo, Hélio Maúngue and Rehana Capruchand.

Author Contributions

All authors contributed significantly to the manuscript. Mónica Frederico collected data and developed the first analysis. The themes were intensively discussed with Kristien Michielsen, Carlos Arnaldo and Peter Decat. The subsequent versions of the article were written with the active participation of all authors.

Conflicts of Interest

The authors declare no conflicts of interest.

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‘Trump did this’: abortion ruling hands Biden opening in Arizona

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Lauren Fedor in Tucson, Arizona

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Rachel Walker was still wearing scrubs when she arrived at a community centre in Tucson, Arizona, on Friday afternoon to hear Kamala Harris deliver a speech defending abortion rights.

The US vice-president was in Arizona three days after the state’s supreme court upheld a 160-year-old law banning nearly all abortions , with no exceptions for victims of rape and incest. The ruling tore up the status quo in a swing state that could decide November’s presidential election.

Democrats are now trying to capitalise on the public outrage, blaming Donald Trump for appointing the US Supreme Court justices who curtailed abortion rights by striking down Roe vs Wade two years ago. Trump and Republican allies such as US Senate hopeful Kari Lake are struggling to contain the backlash.

It makes Arizona another state where November’s big vote could be as much about abortion rights as it is about who next occupies the White House.

For Walker, a 41-year-old obstetrician-gynaecologist in Tucson, the cause is personal.

“Women’s lives are literally at risk,” she said. She and other doctors are likely to change the way they treat patients, including those suffering miscarriages, if the ban goes into effect as expected in June.

The so-called territorial law — enacted before Arizona became a state in 1912 — carries a penalty of up to five years in prison for medical providers who terminate pregnancies.

“It feels like we continue to take a step forward and then move two back,” Walker said.

Democrats are banking on many voters around the country feeling the same way.

“Republicans can’t run away from this issue fast enough,” said Mike Noble, founder of the Phoenix-based non-partisan pollster Noble Predictive Insights. “Any chance Democrats get to have the discussion on abortion, they are winning.

“Will it make an impact in Arizona? 100 per cent.”

Chuck Coughlin, a veteran Republican strategist in the state, agreed. “This is the abortion cycle. It is still immigration. It is still inflation. It is still housing. But [the abortion issue] is definitely going to have an impact.”

In Tucson on Friday, Harris tore into Trump for his role in curbing women’s reproductive rights.

“The overturning of Roe was a seismic event. And this ban in Arizona is one of the biggest aftershocks yet,” she said to a room of several hundred supporters, mostly women. “We all must understand who is to blame. It is the former president, Donald Trump.”

Democrats have made the same point in reaction to a wave of abortion restrictions across the US since 2022, when the US Supreme Court, with its conservative majority, including three Trump appointees, struck down Roe , the 1973 ruling enshrining the constitutional right to abortion.

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The Biden campaign last week announced a “seven-figure” investment in an ad campaign in Arizona to attack Trump on the issue, including television spots and billboards in English and Spanish. “Abortion is banned in Arizona thanks to Donald Trump,” they read.

“The abortion issue has supercharged this election,” Ruben Gallego, the Democratic congressman who is running against Lake for the Senate, told the Financial Times. “Trump did this and Kari Lake was cheerleading . . . We are going to keep talking about it all the way.”

A day before the Arizona court ruling, Trump said he was “proudly the person responsible” for ending Roe. But he also said abortion laws should be decided by states, rather than the national ban championed by some anti-abortion advocates.

It was the former president’s attempt to moderate his position on a polarising issue that has dragged on Republicans in several elections since 2022 — and threatens his chances in this year’s White House race.

Republicans underperformed in the 2022 midterm elections, and lost several high-profile races in off-year elections in 2023, including the gubernatorial race in Kentucky, where Trump won in 2016 and 2020.

To halt the backlash in Arizona, Trump tried to distance himself from the state court’s decision.

“The Supreme Court in Arizona went too far on their abortion ruling,” he wrote on social media on Friday. The state’s governor and lawmakers should “use heart, common sense and act immediately to remedy what has happened”.

Lake, who in 2022 described the territorial statute as a “great law”, has also reversed her position, saying on Thursday that the court’s ruling was “out of line with where the people of this state are”.

“I’ll tell you this, I’m pro-life, I’m not going to apologise for that. I want to save as many babies as possible,” Lake told an audience at the University of Arizona in Tucson. “But I don’t get to push my personal beliefs on everybody.”

“Have you noticed how quickly they are backpedalling now?” said Nina Trasoff, a 77-year-old voter who attended Harris’s speech on Friday.

“To see this many years later, the clock turned back this much . . . it is unconscionable and unacceptable, and we just have to fight like hell to change it. People have to realise that there are consequences all the way down the ballot,” she said.

You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.

Arizonans could have their say on abortion in November, if campaigners succeed in putting on the ballot a referendum on whether to enshrine abortion rights in the state’s constitution.

Polling suggests such a ballot measure would pass comfortably, much like other referendums around the country since Roe was overturned. A New York Times/Siena College poll conducted last autumn found that 59 per cent of Arizona voters said abortion should be “always” or “mostly” legal, compared with 34 per cent who said the procedure should be illegal in most or all cases.

And there are signs that voters — especially independents who make up a larger share of the Arizona electorate than either of the main parties — could turn away from Republican candidates over abortion. Many analysts also expect the issue could motivate younger voters, who skew Democratic, to turn up in November.

It could be critical for Democrats’ chances. RealClearPolitics’ latest polling average puts Trump ahead of Biden in Arizona by 4.5 percentage points. In 2020, Biden won the state by about 10,000 votes, or just 0.3 of a point.

Those polls were conducted before the state’s supreme court decision, however, and many Democrats are cautiously optimistic Biden will be able to gain ground.

“We have a lot of independents and people who want the ability to make decisions for themselves in Arizona,” said Trish Muir, a Democratic voter and local labour leader in Tucson. “Having this sort of draconian measure put on to us stifles that. I think we will see a lot of Arizonans who say no.”

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Guest Essay

Mike Pence: Donald Trump Has Betrayed the Pro-Life Movement

By Mike Pence

Mr. Pence was vice president of the United States from 2017 to 2021 and a candidate for the 2024 Republican presidential nomination.

Serving as vice president in the most pro-life administration in American history was one of the greatest honors of my life. Of all our accomplishments, I am perhaps most proud that the Supreme Court justices we confirmed voted to send Roe v. Wade to the ash heap of history, ending a travesty of jurisprudence that led to the death of more than 63 million unborn Americans.

Since Roe was overturned, I have been inspired by the efforts of pro-life leaders in states across the country, including Indiana , to advance strong protections for the unborn and vulnerable women.

But while nearly half of our states have enacted strong pro-life laws, some Democrats continue to support taxpayer-funded abortions up to the moment of birth in the rest of the country.

Which is why I believe the time has come to adopt a minimum national standard restricting abortion after 15 weeks in order to end late-term abortions nationwide.

The majority of Americans favor some form of restriction on abortions, and passing legislation prohibiting late-term abortions would largely reflect that view. Democrats in Washington have already attempted to legalize abortion up to the moment of birth, and they failed. But they will try again, with similar extremism, if abortion restrictions are not put in place at the federal level.

Contrary to Democrats’ claims, prohibiting abortions after 15 weeks is entirely reasonable.

While Democrats often hold up Europe as a model for America to emulate, the vast majority of European countries have national limits on elective abortion after 15 weeks. Germany and Belgium have a gestational limit of up to 14 weeks. A majority of European countries are even more restrictive, with Norway, Switzerland, Denmark, Greece, Austria, Italy and Ireland banning abortion on demand after 12 weeks.

When it comes to abortion policy, America today appears closer to communist China and North Korea than to the nations of Europe. By prohibiting late-term abortions after 15 weeks, America can move away from the radical fringe and squarely back into the mainstream of Western thought and jurisprudence.

That’s why it was so disheartening for me to see former President Trump’s recent retreat from the pro-life cause. Like so many other advocates for life, I was deeply disappointed when Mr. Trump stated that he considered abortion to be a state-only issue and would not sign a bill prohibiting late-term abortions after 15 weeks of pregnancy, even if it came to his desk.

I know firsthand just how committed he was to the pro-life movement during our time in office. Who can forget the way candidate Donald Trump denounced late-term abortion during a debate with Hillary Clinton in 2016, highlighting how she and other Democrats would allow doctors to “rip the baby out of the womb of the mother just prior to the birth of the baby.”

In 2018, ahead of a Senate vote on a 20-week national ban that was passed earlier by the House, the president publicly stated that he “strongly supported” efforts to end late-term abortions nationwide with exceptions for rape, incest or the life of the mother.

Now, not only is Mr. Trump retreating from that position; he is leading other Republicans astray. One recent example is an Arizona Republican running for the U.S. Senate, who followed Trump’s lead and pledged to oppose a federal ban on late-term abortions. When our leaders aren’t firmly committed to life, others will waver too. Courage inspires imitation. So does weakness.

While some worry about the political ramifications of adopting a 15-week minimum national standard, history has proved that when Republicans stand for life without apology and contrast our common-sense positions with the extremism of the pro-abortion left, voters reward us with victories at the ballot box. In fact, voters overwhelmingly re-elected Governors Mike DeWine of Ohio, Greg Abbott of Texas, and Brian Kemp of Georgia, after they signed bills prohibiting abortion after six weeks.

But what should concern us far more than the politics of abortion is the immorality of ending an unborn human life. At 15 weeks of development, a baby’s face is well-formed and her eyes are sensitive to light. She can suck her thumb and make a fist. She is beginning to move and stretch. And she is created in the image of God, the same as you or me.

Now is not the time to surrender any ground in the fight for the right to life. While the former president has sounded the retreat on life at the national level, I pray that he will rediscover the passion for life that defined our four years in office and rejoin the fight to end late-term abortions in America once and for all. The character of our nation and the lives of generations not yet born demand nothing less.

Mike Pence was vice president of the United States from 2017 to 2021. A former governor of Indiana, he was a candidate for the 2024 Republican presidential nomination.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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'Betrayed': Mike Pence says he's 'deeply disappointed' in Donald Trump over abortion stance

Former Vice President Mike Pence criticized  former President Donald Trump  over his abortion stance, accusing his former boss of "retreating" from the  anti-abortion movement .

Pence in an  opinion essay in the New York Times  published Saturday said his role in  overturning Roe v. Wade  was an accomplishment he was “perhaps most proud” of during his time as vice president. The Trump administration appointed three justices to the Supreme Court who rejected the landmark decision that previously guaranteed the right to an abortion from coast to coast.

But Pence in his op-ed alleged that Trump was no longer committed to the cause. Trump earlier this month said that abortion restrictions  should be left to individual states  and avoided the topic of a national abortion ban, prompting criticism from both the left and the right.

Democrats have accused Trump of simply trying to court more moderate voters, and many right-wing Republicans have called for nationwide abortion restrictions.

Pence, who has long supported an abortion ban after 15 weeks, said he was “deeply disappointed” with Trump’s statement.

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“Now, not only is Mr. Trump retreating from that position; he is leading other Republicans astray,” Pence wrote, adding that other Republican leaders have and could follow Trump’s lead. The former vice president also accused Trump of betraying anti-abortion causes.

Pence said that in office, Trump was very committed to restricting abortion access, saying he “strongly supported” efforts to end abortions later in pregnancy nationwide.

It’s a similar refrain to Democrats, who say Trump’s recent statements are meaningless because of his history of backing state abortion bans and his role in appointing the Supreme Court justices who helped overturn Roe v. Wade.

“While the former president has sounded the retreat on life at the national level, I pray that he will rediscover the passion for life that defined our four years in office,” wrote Pence.