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1. americans’ views on whether, and in what circumstances, abortion should be legal.

As the long-running debate over abortion reaches another  key moment at the Supreme Court  and in  state legislatures across the country , a majority of U.S. adults continue to say that abortion should be legal in all or most cases. About six-in-ten Americans (61%) say abortion should be legal in “all” or “most” cases, while 37% think abortion should be  illegal  in all or most cases. These views have changed little over the past several years: In 2019, for example, 61% of adults said abortion should be legal in all or most cases, while 38% said it should be illegal in all or most cases.    Most respondents in the new survey took one of the middle options when first asked about their views on abortion, saying either that abortion should be legal in  most  cases (36%) or illegal in  most  cases (27%). 

Respondents who said abortion should either be legal in  all  cases or illegal in  all  cases received a follow-up question asking whether there should be any exceptions to such laws. Overall, 25% of adults initially said abortion should be legal in all cases, but about a quarter of this group (6% of all U.S. adults) went on to say that there should be some exceptions when abortion should be against the law.

One-in-ten adults initially answered that abortion should be illegal in all cases, but about one-in-five of these respondents (2% of all U.S. adults) followed up by saying that there are some exceptions when abortion should be permitted. 

Altogether, seven-in-ten Americans say abortion should be legal in some cases and illegal in others, including 42% who say abortion should be generally legal, but with some exceptions, and 29% who say it should be generally illegal, except in certain cases. Much smaller shares take absolutist views when it comes to the legality of abortion in the U.S., maintaining that abortion should be legal in all cases with no exceptions (19%) or illegal in all circumstances (8%). 

There is a modest gender gap in views of whether abortion should be legal, with women slightly more likely than men to say abortion should be legal in all cases or in all cases but with some exceptions (63% vs. 58%). 

Younger adults are considerably more likely than older adults to say abortion should be legal: Three-quarters of adults under 30 (74%) say abortion should be generally legal, including 30% who say it should be legal in all cases without exception. 

But there is an even larger gap in views toward abortion by partisanship: 80% of Democrats and Democratic-leaning independents say abortion should be legal in all or most cases, compared with 38% of Republicans and GOP leaners.  Previous Center research  has shown this gap widening over the past 15 years. 

Still, while partisans diverge in views of whether abortion should mostly be legal or illegal, most Democrats and Republicans do not view abortion in absolutist terms. Just 13% of Republicans say abortion should be against the law in all cases without exception; 47% say it should be illegal with some exceptions. And while three-in-ten Democrats say abortion should be permitted in all circumstances, half say it should mostly be legal – but with some exceptions. 

There also are sizable divisions within both partisan coalitions by ideology. For instance, while a majority of moderate and liberal Republicans say abortion should mostly be legal (60%), just 27% of conservative Republicans say the same. Among Democrats, self-described liberals are twice as apt as moderates and conservatives to say abortion should be legal in all cases without exception (42% vs. 20%).

Regardless of partisan affiliation, adults who say they personally know someone who has had an abortion – such as a friend, relative or themselves – are more likely to say abortion should be legal than those who say they do not know anyone who had an abortion.

Views toward abortion also vary considerably by religious affiliation – specifically among large Christian subgroups and religiously unaffiliated Americans. 

For example, roughly three-quarters of White evangelical Protestants say abortion should be illegal in all or most cases. This is far higher than the share of White non-evangelical Protestants (38%) or Black Protestants (28%) who say the same. 

Despite  Catholic teaching on abortion , a slim majority of U.S. Catholics (56%) say abortion should be legal. This includes 13% who say it should be legal in all cases without exception, and 43% who say it should be legal, but with some exceptions. 

Compared with Christians, religiously unaffiliated adults are far more likely to say abortion should be legal overall – and significantly more inclined to say it should be legal in all cases without exception. Within this group, atheists stand out: 97% say abortion should be legal, including 53% who say it should be legal in all cases without exception. Agnostics and those who describe their religion as “nothing in particular” also overwhelmingly say that abortion should be legal, but they are more likely than atheists to say there are some circumstances when abortion should be against the law.

Although the survey was conducted among Americans of many religious backgrounds, including Jews, Muslims, Buddhists and Hindus, it did not obtain enough respondents from non-Christian groups to report separately on their responses.

Abortion at various stages of pregnancy 

As a  growing number of states  debate legislation to restrict abortion – often after a certain stage of pregnancy – Americans express complex views about when   abortion should generally be legal and when it should be against the law. Overall, a majority of adults (56%) say that how long a woman has been pregnant should matter in determining when abortion should be legal, while far fewer (14%) say that this should  not  be a factor. An additional one-quarter of the public says that abortion should either be legal (19%) or illegal (8%) in all circumstances without exception; these respondents did not receive this question.

Among men and women, Republicans and Democrats, and Christians and religious “nones” who do not take absolutist positions about abortion on either side of the debate, the prevailing view is that the stage of the pregnancy should be a factor in determining whether abortion should be legal.

Americans broadly are more likely to favor restrictions on abortion later in pregnancy than earlier in pregnancy. Many adults also say the legality of abortion depends on other factors at every stage of pregnancy. 

One-in-five Americans (21%) say abortion should be  illegal  at six weeks. This includes 8% of adults who say abortion should be illegal in all cases without exception as well as 12% of adults who say that abortion should be illegal at this point. Additionally, 6% say abortion should be illegal in most cases and how long a woman has been pregnant should not matter in determining abortion’s legality. Nearly one-in-five respondents, when asked whether abortion should be legal six weeks into a pregnancy, say “it depends.” 

Americans are more divided about what should be permitted 14 weeks into a pregnancy – roughly at the end of the first trimester – although still, more people say abortion should be legal at this stage (34%) than illegal (27%), and about one-in-five say “it depends.”

Fewer adults say abortion should be legal 24 weeks into a pregnancy – about when a healthy fetus could survive outside the womb with medical care. At this stage, 22% of adults say abortion should be legal, while nearly twice as many (43%) say it should be  illegal . Again, about one-in-five adults (18%) say whether abortion should be legal at 24 weeks depends on other factors. 

Respondents who said that abortion should be illegal 24 weeks into a pregnancy or that “it depends” were asked a follow-up question about whether abortion at that point should be legal if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Most who received this question say abortion in these circumstances should be legal (54%) or that it depends on other factors (40%). Just 4% of this group maintained that abortion should be illegal in this case.

This pattern in views of abortion – whereby more favor greater restrictions on abortion as a pregnancy progresses – is evident across a variety of demographic and political groups. 

Democrats are far more likely than Republicans to say that abortion should be legal at each of the three stages of pregnancy asked about on the survey. For example, while 26% of Republicans say abortion should be legal at six weeks of pregnancy, more than twice as many Democrats say the same (61%). Similarly, while about a third of Democrats say abortion should be legal at 24 weeks of pregnancy, just 8% of Republicans say the same. 

However, neither Republicans nor Democrats uniformly express absolutist views about abortion throughout a pregnancy. Republicans are divided on abortion at six weeks: Roughly a quarter say it should be legal (26%), while a similar share say it depends (24%). A third say it should be illegal. 

Democrats are divided about whether abortion should be legal or illegal at 24 weeks, with 34% saying it should be legal, 29% saying it should be illegal, and 21% saying it depends. 

There also is considerable division among each partisan group by ideology. At six weeks of pregnancy, just one-in-five conservative Republicans (19%) say that abortion should be legal; moderate and liberal Republicans are twice as likely as their conservative counterparts to say this (39%). 

At the same time, about half of liberal Democrats (48%) say abortion at 24 weeks should be legal, while 17% say it should be illegal. Among conservative and moderate Democrats, the pattern is reversed: A plurality (39%) say abortion at this stage should be illegal, while 24% say it should be legal. 

Christian adults are far less likely than religiously unaffiliated Americans to say abortion should be legal at each stage of pregnancy.  

Among Protestants, White evangelicals stand out for their opposition to abortion. At six weeks of pregnancy, for example, 44% say abortion should be illegal, compared with 17% of White non-evangelical Protestants and 15% of Black Protestants. This pattern also is evident at 14 and 24 weeks of pregnancy, when half or more of White evangelicals say abortion should be illegal.

At six weeks, a plurality of Catholics (41%) say abortion should be legal, while smaller shares say it depends or it should be illegal. But by 24 weeks, about half of Catholics (49%) say abortion should be illegal. 

Among adults who are religiously unaffiliated, atheists stand out for their views. They are the only group in which a sizable majority says abortion should be  legal  at each point in a pregnancy. Even at 24 weeks, 62% of self-described atheists say abortion should be legal, compared with smaller shares of agnostics (43%) and those who say their religion is “nothing in particular” (31%). 

As is the case with adults overall, most religiously affiliated and religiously unaffiliated adults who originally say that abortion should be illegal or “it depends” at 24 weeks go on to say either it should be legal or it depends if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Few (4% and 5%, respectively) say abortion should be illegal at 24 weeks in these situations.

Abortion and circumstances of pregnancy 

The stage of the pregnancy is not the only factor that shapes people’s views of when abortion should be legal. Sizable majorities of U.S. adults say that abortion should be legal if the pregnancy threatens the life or health of the pregnant woman (73%) or if pregnancy is the result of rape (69%). 

There is less consensus when it comes to circumstances in which a baby may be born with severe disabilities or health problems: 53% of Americans overall say abortion should be legal in such circumstances, including 19% who say abortion should be legal in all cases and 35% who say there are some situations where abortions should be illegal, but that it should be legal in this specific type of case. A quarter of adults say “it depends” in this situation, and about one-in-five say it should be illegal (10% who say illegal in this specific circumstance and 8% who say illegal in all circumstances). 

There are sizable divides between and among partisans when it comes to views of abortion in these situations. Overall, Republicans are less likely than Democrats to say abortion should be legal in each of the three circumstances outlined in the survey. However, both partisan groups are less likely to say abortion should be legal when the baby may be born with severe disabilities or health problems than when the woman’s life is in danger or the pregnancy is the result of rape. 

Just as there are wide gaps among Republicans by ideology on whether how long a woman has been pregnant should be a factor in determining abortion’s legality, there are large gaps when it comes to circumstances in which abortions should be legal. For example, while a clear majority of moderate and liberal Republicans (71%) say abortion should be permitted when the pregnancy is the result of rape, conservative Republicans are more divided. About half (48%) say it should be legal in this situation, while 29% say it should be illegal and 21% say it depends.

The ideological gaps among Democrats are slightly less pronounced. Most Democrats say abortion should be legal in each of the three circumstances – just to varying degrees. While 77% of liberal Democrats say abortion should be legal if a baby will be born with severe disabilities or health problems, for example, a smaller majority of conservative and moderate Democrats (60%) say the same. 

White evangelical Protestants again stand out for their views on abortion in various circumstances; they are far less likely than White non-evangelical or Black Protestants to say abortion should be legal across each of the three circumstances described in the survey. 

While about half of White evangelical Protestants (51%) say abortion should be legal if a pregnancy threatens the woman’s life or health, clear majorities of other Protestant groups and Catholics say this should be the case. The same pattern holds in views of whether abortion should be legal if the pregnancy is the result of rape. Most White non-evangelical Protestants (75%), Black Protestants (71%) and Catholics (66%) say abortion should be permitted in this instance, while White evangelicals are more divided: 40% say it should be legal, while 34% say it should be  illegal  and about a quarter say it depends. 

Mirroring the pattern seen among adults overall, opinions are more varied about a situation where a baby might be born with severe disabilities or health issues. For instance, half of Catholics say abortion should be legal in such cases, while 21% say it should be illegal and 27% say it depends on the situation. 

Most religiously unaffiliated adults – including overwhelming majorities of self-described atheists – say abortion should be legal in each of the three circumstances. 

Parental notification for minors seeking abortion

Seven-in-ten U.S. adults say that doctors or other health care providers should be required to notify a parent or legal guardian if the pregnant woman seeking an abortion is under 18, while 28% say they should not be required to do so.  

Women are slightly less likely than men to say this should be a requirement (67% vs. 74%). And younger adults are far less likely than those who are older to say a parent or guardian should be notified before a doctor performs an abortion on a pregnant woman who is under 18. In fact, about half of adults ages 18 to 24 (53%) say a doctor should  not  be required to notify a parent. By contrast, 64% of adults ages 25 to 29 say doctors  should  be required to notify parents of minors seeking an abortion, as do 68% of adults ages 30 to 49 and 78% of those 50 and older. 

A large majority of Republicans (85%) say that a doctor should be required to notify the parents of a minor before an abortion, though conservative Republicans are somewhat more likely than moderate and liberal Republicans to take this position (90% vs. 77%). 

The ideological divide is even more pronounced among Democrats. Overall, a slim majority of Democrats (57%) say a parent should be notified in this circumstance, but while 72% of conservative and moderate Democrats hold this view, just 39% of liberal Democrats agree. 

By and large, most Protestant (81%) and Catholic (78%) adults say doctors should be required to notify parents of minors before an abortion. But religiously unaffiliated Americans are more divided. Majorities of both atheists (71%) and agnostics (58%) say doctors should  not  be required to notify parents of minors seeking an abortion, while six-in-ten of those who describe their religion as “nothing in particular” say such notification should be required. 

Penalties for abortions performed illegally 

Americans are divided over who should be penalized – and what that penalty should be – in a situation where an abortion occurs illegally. 

Overall, a 60% majority of adults say that if a doctor or provider performs an abortion in a situation where it is illegal, they should face a penalty. But there is less agreement when it comes to others who may have been involved in the procedure. 

While about half of the public (47%) says a woman who has an illegal abortion should face a penalty, a nearly identical share (50%) says she should not. And adults are more likely to say people who help find and schedule or pay for an abortion in a situation where it is illegal should  not  face a penalty than they are to say they should.

Views about penalties are closely correlated with overall attitudes about whether abortion should be legal or illegal. For example, just 20% of adults who say abortion should be legal in all cases without exception think doctors or providers should face a penalty if an abortion were carried out in a situation where it was illegal. This compares with 91% of those who think abortion should be illegal in all cases without exceptions. Still, regardless of how they feel about whether abortion should be legal or not, Americans are more likely to say a doctor or provider should face a penalty compared with others involved in the procedure. 

Among those who say medical providers and/or women should face penalties for illegal abortions, there is no consensus about whether they should get jail time or a less severe punishment. Among U.S. adults overall, 14% say women should serve jail time if they have an abortion in a situation where it is illegal, while 16% say they should receive a fine or community service and 17% say they are not sure what the penalty should be. 

A somewhat larger share of Americans (25%) say doctors or other medical providers should face jail time for providing illegal abortion services, while 18% say they should face fines or community service and 17% are not sure. About three-in-ten U.S. adults (31%) say doctors should lose their medical license if they perform an abortion in a situation where it is illegal.

Men are more likely than women to favor penalties for the woman or doctor in situations where abortion is illegal. About half of men (52%) say women should face a penalty, while just 43% of women say the same. Similarly, about two-thirds of men (64%) say a doctor should face a penalty, while 56% of women agree.

Republicans are considerably more likely than Democrats to say both women and doctors should face penalties – including jail time. For example, 21% of Republicans say the woman who had the abortion should face jail time, and 40% say this about the doctor who performed the abortion. Among Democrats, far smaller shares say the woman (8%) or doctor (13%) should serve jail time.  

White evangelical Protestants are more likely than other Protestant groups to favor penalties for abortions in situations where they are illegal. Fully 24% say the woman who had the abortion should serve time in jail, compared with just 12% of White non-evangelical Protestants or Black Protestants. And while about half of White evangelicals (48%) say doctors who perform illegal abortions should serve jail time, just 26% of White non-evangelical Protestants and 18% of Black Protestants share this view.

• Only respondents who said that abortion should be legal in some cases but not others and that how long a woman has been pregnant should matter in determining whether abortion should be legal received questions about abortion’s legality at specific points in the pregnancy.  ↩

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Princeton Legal Journal

The First Amendment and the Abortion Rights Debate

Sofia Cipriano

Following Dobbs v. Jackson ’s (2022) reversal of Roe v. Wade (1973) — and the subsequent revocation of federal abortion protection — activists and scholars have begun to reconsider how to best ground abortion rights in the Constitution. In the past year, numerous Jewish rights groups have attempted to overturn state abortion bans by arguing that abortion rights are protected by various state constitutions’ free exercise clauses — and, by extension, the First Amendment of the U.S. Constitution. While reframing the abortion rights debate as a question of religious freedom is undoubtedly strategic, the Free Exercise Clause is not the only place to locate abortion rights: the Establishment Clause also warrants further investigation. 

Roe anchored abortion rights in the right to privacy — an unenumerated right with a long history of legal recognition. In various cases spanning the past two centuries, t he Supreme Court located the right to privacy in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments . Roe classified abortion as a fundamental right protected by strict scrutiny, meaning that states could only regulate abortion in the face of a “compelling government interest” and must narrowly tailor legislation to that end. As such, Roe ’s trimester framework prevented states from placing burdens on abortion access in the first few months of pregnancy. After the fetus crosses the viability line — the point at which the fetus can survive outside the womb  — states could pass laws regulating abortion, as the Court found that   “the potentiality of human life”  constitutes a “compelling” interest. Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) later replaced strict scrutiny with the weaker “undue burden” standard, giving states greater leeway to restrict abortion access. Dobbs v. Jackson overturned both Roe and Casey , leaving abortion regulations up to individual states. 

While Roe constituted an essential step forward in terms of abortion rights, weaknesses in its argumentation made it more susceptible to attacks by skeptics of substantive due process. Roe argues that the unenumerated right to abortion is implied by the unenumerated right to privacy — a chain of logic which twice removes abortion rights from the Constitution’s language. Moreover, Roe’s trimester framework was unclear and flawed from the beginning, lacking substantial scientific rationale. As medicine becomes more and more advanced, the arbitrariness of the viability line has grown increasingly apparent.  

As abortion rights supporters have looked for alternative constitutional justifications for abortion rights, the First Amendment has become increasingly more visible. Certain religious groups — particularly Jewish groups — have argued that they have a right to abortion care. In Generation to Generation Inc v. Florida , a religious rights group argued that Florida’s abortion ban (HB 5) constituted a violation of the Florida State Constitution: “In Jewish law, abortion is required if necessary to protect the health, mental or physical well-being of the woman, or for many other reasons not permitted under the Act. As such, the Act prohibits Jewish women from practicing their faith free of government intrusion and thus violates their privacy rights and religious freedom.” Similar cases have arisen in Indiana and Texas. Absent constitutional protection of abortion rights, the Christian religious majorities in many states may unjustly impose their moral and ethical code on other groups, implying an unconstitutional religious hierarchy. 

Cases like Generation to Generation Inc v. Florida may also trigger heightened scrutiny status in higher courts; The Religious Freedom Restoration Act (1993) places strict scrutiny on cases which “burden any aspect of religious observance or practice.”

But framing the issue as one of Free Exercise does not interact with major objections to abortion rights. Anti-abortion advocates contend that abortion is tantamount to murder. An anti-abortion advocate may argue that just as religious rituals involving human sacrifice are illegal, so abortion ought to be illegal. Anti-abortion advocates may be able to argue that abortion bans hold up against strict scrutiny since “preserving potential life” constitutes a “compelling interest.”

The question of when life begins—which is fundamentally a moral and religious question—is both essential to the abortion debate and often ignored by left-leaning activists. For select Christian advocacy groups (as well as other anti-abortion groups) who believe that life begins at conception, abortion bans are a deeply moral issue. Abortion bans which operate under the logic that abortion is murder essentially legislate a definition of when life begins, which is problematic from a First Amendment perspective; the Establishment Clause of the First Amendment prevents the government from intervening in religious debates. While numerous legal thinkers have associated the abortion debate with the First Amendment, this argument has not been fully litigated. As an amicus brief filed in Dobbs by the Freedom From Religion Foundation, Center for Inquiry, and American Atheists  points out, anti-abortion rhetoric is explicitly religious: “There is hardly a secular veil to the religious intent and positions of individuals, churches, and state actors in their attempts to limit access to abortion.” Justice Stevens located a similar issue with anti-abortion rhetoric in his concurring opinion in Webster v. Reproductive Health Services (1989) , stating: “I am persuaded that the absence of any secular purpose for the legislative declarations that life begins at conception and that conception occurs at fertilization makes the relevant portion of the preamble invalid under the Establishment Clause of the First Amendment to the Federal Constitution.” Judges who justify their judicial decisions on abortion using similar rhetoric blur the line between church and state. 

Framing the abortion debate around religious freedom would thus address the two main categories of arguments made by anti-abortion activists: arguments centered around issues with substantive due process and moral objections to abortion. 

Conservatives may maintain, however, that legalizing abortion on the federal level is an Establishment Clause violation to begin with, since the government would essentially be imposing a federal position on abortion. Many anti-abortion advocates favor leaving abortion rights up to individual states. However, in the absence of recognized federal, constitutional protection of abortion rights, states will ban abortion. Protecting religious freedom of the individual is of the utmost importance  — the United States government must actively intervene in order to uphold the line between church and state. Protecting abortion rights would allow everyone in the United States to act in accordance with their own moral and religious perspectives on abortion. 

Reframing the abortion rights debate as a question of religious freedom is the most viable path forward. Anchoring abortion rights in the Establishment Clause would ensure Americans have the right to maintain their own personal and religious beliefs regarding the question of when life begins. In the short term, however, litigants could take advantage of Establishment Clauses in state constitutions. Yet, given the swing of the Court towards expanding religious freedom protections at the time of writing, Free Exercise arguments may prove better at securing citizens a right to an abortion. 

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There Are More Than Two Sides to the Abortion Debate

Readers share their perspectives.

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Earlier this week I curated some nuanced commentary on abortion and solicited your thoughts on the same subject. What follows includes perspectives from several different sides of the debate. I hope each one informs your thinking, even if only about how some other people think.

We begin with a personal reflection.

Cheryl was 16 when New York State passed a statute legalizing abortion and 19 when Roe v. Wade was decided in 1973. At the time she was opposed to the change, because “it just felt wrong.” Less than a year later, her mother got pregnant and announced she was getting an abortion.

She recalled:

My parents were still married to each other, and we were financially stable. Nonetheless, my mother’s announcement immediately made me a supporter of the legal right to abortion. My mother never loved me. My father was physically abusive and both parents were emotionally and psychologically abusive on a virtually daily basis. My home life was hellish. When my mother told me about the intended abortion, my first thought was, “Thank God that they won’t be given another life to destroy.” I don’t deny that there are reasons to oppose abortion. As a feminist and a lawyer, I can now articulate several reasons for my support of legal abortion: a woman’s right to privacy and autonomy and to the equal protection of the laws are near the top of the list. (I agree with Ruth Bader Ginsburg that equal protection is a better legal rationale for the right to abortion than privacy.) But my emotional reaction from 1971 still resonates with me. Most people who comment on the issue, on both sides, do not understand what it is to go through childhood unloved. It is horrific beyond my powers of description. To me, there is nothing more immoral than forcing that kind of life on any child. Anti-abortion activists often like to ask supporters of abortion rights: “Well, what if your mother had decided to abort you?” All I can say is that I have spent a great portion of my life wishing that my mother had done exactly that.

Steven had related thoughts:

I have respect for the idea that there should be some restrictions on abortion. But the most fundamental, and I believe flawed, unstated assumptions of the anti-choice are that A) they are acting on behalf of the fetus, and more importantly B) they know what the fetus would want. I would rather not have been born than to have been born to a mother who did not want me. All children should be wanted children—for the sake of all concerned. You can say that different fetuses would “want” different things—though it’s hard to say a clump of cells “wants” anything. How would we know? The argument lands, as it does generally, with the question of who should be making that decision. Who best speaks in the fetus’s interests? Who is better positioned morally or practically than the expectant mother?

Geoff self-describes as “pro-life” and guilty of some hypocrisy. He writes:

I’m pro-life because I have a hard time with the dehumanization that comes with the extremes of abortion on demand … Should it be okay to get an abortion when you find your child has Down syndrome? What of another abnormality? Or just that you didn’t want a girl? Any argument that these are legitimate reasons is disturbing. But so many of the pro-life just don’t seem to care about life unless it’s a fetus they can force a woman to carry. The hypocrisy is real. While you can argue that someone on death row made a choice that got them to that point, whereas a fetus had no say, I find it still hard to swallow that you can claim one life must be protected and the other must be taken. Life should be life. At least in the Catholic Church this is more consistent. I myself am guilty of a degree of hypocrisy. My wife and I used IVF to have our twins. There were other embryos created and not inserted. They were eventually destroyed. So did I support killing a life? Maybe? I didn’t want to donate them for someone else to give birth to—it felt wrong to think my twins may have brothers or sisters in the world they would never know about. Yet does that mean I was more willing to kill my embryos than to have them adopted? Sure seems like it. So I made a morality deal with myself and moved the goal post—the embryos were not yet in a womb and were so early in development that they couldn’t be considered fully human life. They were still potential life.

Colleen, a mother of three, describes why she ended her fourth pregnancy:

I was young when I first engaged this debate. Raised Catholic, anti-choice, and so committed to my position that I broke my parents’ hearts by giving birth during my junior year of college. At that time, my sense of my own rights in the matter was almost irrelevant. I was enslaved by my body. One husband and two babies later I heard a remarkable Jesuit theologian (I wish I could remember his name) speak on the matter and he, a Catholic priest, framed it most directly. We prioritize one life over another all the time. Most obviously, we justify the taking of life in war with all kinds of arguments that often turn out to be untrue. We also do so as we decide who merits access to health care or income support or other life-sustaining things. So the question of abortion then boils down to: Who gets to decide? Who gets to decide that the life of a human in gestation is actually more valuable than the life of the woman who serves as host—or vice versa? Who gets to decide when the load a woman is being asked to carry is more than she can bear? The state? Looking back over history, he argued that he certainly had more faith in the person most involved to make the best decision than in any formalized structure—church or state—created by men. Every form of birth control available failed me at one point or another, so when yet a 4th pregnancy threatened to interrupt the education I had finally been able to resume, I said “Enough.” And as I cried and struggled to come to that position, the question that haunted me was “Doesn’t MY life count?” And I decided it did.

Florence articulates what it would take to make her anti-abortion:

What people seem to miss is that depriving a woman of bodily autonomy is slavery. A person who does not control his/her own body is—what? A slave. At its simplest, this is the issue. I will be anti-abortion when men and women are equal in all facets of life—wages, chores, child-rearing responsibilities, registering for the draft, to name a few obvious ones. When there is birth control that is effective, where women do not bear most of the responsibility. We need to raise boys who are respectful to girls, who do not think that they are entitled to coerce a girl into having sex that she doesn’t really want or is unprepared for. We need for sex education to be provided in schools so young couples know what they are getting into when they have sex. Especially the repercussions of pregnancy. We need to raise girls who are confident and secure, who don’t believe they need a male to “complete” them. Who have enough agency to say “no” and to know why. We have to make abortion unnecessary … We have so far to go. If abortion is ruled illegal, or otherwise curtailed, we will never know if the solutions to women’s second-class status will work. We will be set back to the 50s or worse. I don’t want to go back. Women have fought from the beginning of time to own their bodies and their lives. To deprive us of all of the amazing strides forward will affect all future generations.

Similarly, Ben agrees that in our current environment, abortion is often the only way women can retain equal citizenship and participation in society, but also agrees with pro-lifers who critique the status quo, writing that he doesn’t want a world where a daughter’s equality depends on her right “to perform an act of violence on their potential descendents.” Here’s how he resolves his conflictedness:

Conservatives arguing for a more family-centered society, in which abortion is unnecessary to protect the equal rights of women, are like liberals who argue for defunding the police and relying on addiction, counselling, and other services, in that they argue for removing what offends them without clear, credible plans to replace the functions it serves. I sincerely hope we can move towards a world in which armed police are less necessary. But before we can remove the guardrails of the police, we need to make the rest of the changes so that the world works without them. Once liberal cities that have shown interest in defunding the police can prove that they can fund alternatives, and that those alternatives work, then I will throw my support behind defunding the police. Similarly, once conservative politicians demonstrate a credible commitment to an alternative vision of society in which women are supported, families are not taken for granted, and careers and short-term productivity are not the golden calves they are today, I will be willing to support further restrictions on abortion. But until I trust that they are interested in solving the underlying problem (not merely eliminating an aspect they find offensive), I will defend abortion, as terrible as it is, within reasonable legal limits.

Two readers objected to foregrounding gender equality. One emailed anonymously, writing in part:

A fetus either is or isn’t a person. The reason I’m pro-life is that I’ve never heard a coherent defense of the proposition that a fetus is not a person, and I’m not sure one can be made. I’ve read plenty of progressive commentary, and when it bothers to make an argument for abortion “rights” at all, it talks about “the importance of women’s healthcare” or something as if that were the issue.

Christopher expanded on that last argument:

Of the many competing ethical concerns, the one that trumps them all is the status of the fetus. It is the only organism that gets destroyed by the procedure. Whether that is permissible trumps all other concerns. Otherwise important ethical claims related to a woman’s bodily autonomy, less relevant social disparities caused by the differences in men’s and women’s reproductive functions, and even less relevant differences in partisan commitments to welfare that would make abortion less appealing––all of that is secondary. The relentless strategy by the pro-choice to sidestep this question and pretend that a woman’s right to bodily autonomy is the primary ethical concern is, to me, somewhere between shibboleth and mass delusion. We should spend more time, even if it’s unproductive, arguing about the status of the fetus, because that is the question, and we should spend less time indulging this assault-on-women’s-rights narrative pushed by the Left.

Jean is critical of the pro-life movement:

Long-acting reversible contraceptives, robust, science-based sex education for teens, and a stronger social safety net would all go a remarkable way toward decreasing the number of abortions sought. Yet all the emphasis seems to be on simply making abortion illegal. For many, overturning Roe v. Wade is not about reducing abortions so much as signalling that abortion is wrong. If so-called pro-lifers were as concerned about abortion as they seem to be, they would spend more time, effort, and money supporting efforts to reduce the need for abortion—not simply trying to make it illegal without addressing why women seek it out. Imagine, in other words, a world where women hardly needed to rely on abortion for their well-being and ability to thrive. Imagine a world where almost any woman who got pregnant had planned to do so, or was capable of caring for that child. What is the anti-abortion movement doing to promote that world?

Destiny has one relevant answer. She writes:

I run a pro-life feminist group and we often say that our goal is not to make abortion illegal, but rather unnecessary and unthinkable by supporting women and humanizing the unborn child so well.

Robert suggests a different focus:

Any well-reasoned discussion of abortion policy must include contraception because abortion is about unwanted children brought on by poorly reasoned choices about sex. Such choices will always be more emotional than rational. Leaving out contraception makes it an unrealistic, airy discussion of moral philosophy. In particular, we need to consider government-funded programs of long-acting reversible contraception which enable reasoned choices outside the emotional circumstances of having sexual intercourse.

Last but not least, if anyone can unite the pro-life and pro-choice movements, it’s Errol, whose thoughts would rankle majorities in both factions as well as a majority of Americans. He writes:

The decision to keep the child should not be left up solely to the woman. Yes, it is her body that the child grows in, however once that child is birthed it is now two people’s responsibility. That’s entirely unfair to the father when he desired the abortion but the mother couldn’t find it in her heart to do it. If a woman wants to abort and the man wants to keep it, she should abort. However I feel the same way if a man wants to abort. The next 18+ years of your life are on the line. I view that as a trade-off that warrants the male’s input. Abortion is a conversation that needs to be had by two people, because those two will be directly tied to the result for a majority of their life. No one else should be involved with that decision, but it should not be solely hers, either.

Thanks to all who contributed answers to this week’s question, whether or not they were among the ones published. What subjects would you like to see fellow readers address in future installments? Email [email protected].

By submitting an email, you’ve agreed to let us use it—in part or in full—in this newsletter and on our website. Published feedback includes a writer’s full name, city, and state, unless otherwise requested in your initial note.

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June 23, 2022

Abortion and bioethics: Principles to guide US abortion debates

by Nancy S. Jecker, The Conversation

The U.S. Supreme Court will soon decide the fate of Roe v. Wade , the landmark 1973 decision that established the nationwide right to choose an abortion. If the court's decision hews close to the leaked draft opinion first published by Politico in May 2022, the court's new conservative majority will overturn Roe.

Rancorous debate about the ruling is often dominated by politics . Ethics garners less attention, although it lies at the heart of the legal controversy. As a philosopher and bioethicist , I study moral problems in medicine and health policy , including abortion.

Bioethical approaches to abortion often appeal to four principles : respect patients' autonomy; nonmaleficence, or "do no harm"; beneficence, or provide beneficial care; and justice. These principles were first developed during the 1970s to guide research involving human subjects . Today, they are essential guides for many doctors and ethicists in challenging medical cases .

Patient autonomy

The ethical principle of autonomy states that patients are entitled to make decisions about their own medical care when able. The American Medical Association's Code of Medical Ethics recognizes a patient's right to " receive information and ask questions about recommended treatments " in order to "make well-considered decisions about care." Respect for autonomy is enshrined in laws governing informed consent , which protect patients' right to know the medical options available and make an informed voluntary decision.

Some bioethicists regard respect for autonomy as lending firm support to the right to choose abortion, arguing that if a pregnant person wishes to end their pregnancy, the state should not interfere. According to one interpretation of this view, the principle of autonomy means that a person owns their body and should be free to decide what happens in and to it .

Abortion opponents do not necessarily challenge the soundness of respecting people's autonomy, but may disagree about how to interpret this principle. Some regard a pregnant person as " two patients "—the pregnant person and the fetus .

One way to reconcile these views is to say that as an immature human being becomes " increasingly self-conscious, rational and autonomous it is harmed to an increasing degree ," as philosopher Jeff McMahan writes. In this view, a late-stage fetus has more interest in its future than a fertilized egg, and therefore the later in pregnancy an abortion takes place, the more it may hinder the fetus's developing interests. In the U.S., where 92.7% of abortions occur at or before 13 weeks' gestation , a pregnant person's rights may often outweigh those attributed to the fetus. Later in pregnancy, however, rights attributed to the fetus may assume greater weight. Balancing these competing claims remains contentious.

Nonmaleficence and beneficence

The ethical principle of "do no harm" forbids intentionally harming or injuring a patient. It demands medically competent care that minimizes risks. Nonmaleficence is often paired with a principle of beneficence, a duty to benefit patients. Together, these principles emphasize doing more good than harm .

Minimizing the risk of harm figures prominently in the World Health Organization's opposition to bans on abortion because pregnant people facing barriers to abortion often resort to unsafe methods, which represent a leading cause of avoidable maternal deaths and morbidities worldwide .

Although 97% of unsafe abortions occur in developing countries , developed countries that have narrowed abortion access have produced unintended harms. In Poland , for example, doctors fearing prosecution have hesitated to administer cancer treatments during pregnancy or remove a fetus after a pregnant person's water breaks early in the pregnancy, before the fetus is viable. In the U.S., restrictive abortion laws in some states, like Texas, have complicated care for miscarriages and high-risk pregnancies , putting pregnant people's lives at risk.

However, Americans who favor overturning Roe are primarily concerned about fetal harm. Regardless of whether or not the fetus is considered a person, the fetus might have an interest in avoiding pain. Late in pregnancy, some ethicists think that humane care for pregnant people should include minimizing fetal pain irrespective of whether a pregnancy continues. Neuroscience teaches that the human capacity to experience feeling or sensation requires consciousness, , which develops between 24 and 28 weeks gestation.

Justice, a final principle of bioethics, requires treating similar cases similarly. If the pregnant person and fetus are moral equals, many argue that it would be unjust to kill the fetus except in self-defense, if the fetus threatens the pregnant person's life. Others hold that even in self-defense, terminating the fetus's life is wrong because a fetus is not morally responsible for any threat it poses .

Yet defenders of abortion point out that even if abortion results in the death of an innocent person, that is not its goal. If the ethics of an action is judged by its goals, then abortion might be justified in cases where it realizes an ethical aim, such as saving a woman's life or protecting a family's ability to care for their current children. Defenders of abortion also argue that even if the fetus has a right to life, a person does not have a right to everything they need to stay alive . For example, having a right to life does not entail a right to threaten another's health or life, or ride roughshod over another's life plans and goals.

Justice also deals with the fair distribution of benefits and burdens. Among wealthy countries, the U.S. has the highest rate of deaths linked to pregnancy and childbirth. Without legal protection for abortion, pregnancy and childbirth for Americans could become even more risky. Studies show that women are more likely to die while pregnant or shortly thereafter in states with the most restrictive abortion policies .

Minority groups may have the most to lose if the right to choose abortion is not upheld because they utilize a disproportionate share of abortion services . In Mississippi, for example, people of color represent 44% of the population, but 81% of those receiving abortions . Other states follow a similar pattern, leading some health activists to conclude that "abortion restrictions are racist."

Other marginalized groups, including low-income families, could also be hard hit by abortion restrictions because abortions are expected to get pricier .

Politics aside, abortion raises profound ethical questions that remain unsettled, which courts are left to settle using the blunt instrument of law. In this sense, abortion " begins as a moral argument and ends as a legal argument ," in the words of law and ethics scholar Katherine Watson .

Putting to rest legal controversies surrounding abortion would require reaching moral consensus. Short of that, articulating our own moral views and understanding others' can bring all sides closer to a principled compromise .

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A concise history of the US abortion debate

Professor of Women's, Gender and Sexuality Studies, The Ohio State University

Disclosure statement

Treva B. Lindsey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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On Nov. 14, 1972, a controversial two-part episode of the groundbreaking television show, “Maude” aired.

Titled “Maude’s Dilemma,” the episodes chronicled the decision by the main character to have an abortion.

The landmark Supreme Court ruling in Roe v. Wade was issued two months after these episodes. The ruling affirmed the right to have an abortion during the first 12 weeks of pregnancy. “Maude’s Dilemma” brought the battle over abortion from the streets and courthouses to prime-time television.

Responses to the episodes ranged from celebration to fury , which mirrored contemporary attitudes about abortion.

In the almost 50 years since Roe v. Wade, the debate over abortion has pervaded politics in the U.S.

While many may think that the political arguments over abortion now are fresh and new, scholars of women’s, medical and legal history note that this debate has a long history in the U.S.

It began at more than a century before Roe v. Wade.

The era of ‘The Pill’

Less than 10 years before “Maude’s Dilemma” aired, the Food and Drug Administration approved the first commercially produced birth control pill , Enovid-10.

Although various forms of birth control predate the birth control pill, the FDA’s approval of Enovid-10 was a watershed in the national debate around family planning and reproductive choice.

Commonly known as “The Pill,” the wider accessibility of birth control is seen as an early victory of the nascent women’s liberation movement.

Abortion also emerged as a prominent issue within this burgeoning movement. For many feminist activists of the 1960s and 1970s, women’s right to control their own reproductive lives became inextricable from the larger platform of gender equality.

From unregulated to criminalized

From the nation’s founding through the early 1800s, pre-quickening abortions – that is, abortions before a pregnant person feels fetal movement – were fairly common and even advertised.

Women from various backgrounds sought to end unwanted pregnancies before and during this period both in the U.S. and across the world. For example, enslaved black women in the U.S. developed abortifacients – drugs that induce abortions – and abortion practices as means to stop pregnancies after rapes by, and coerced sexual encounters with, white male slave owners.

In the mid- to late-1800s, an increasing number of states passed anti-abortion laws sparked by both moral and safety concerns. Primarily motivated by fears about high risks for injury or death, medical practitioners in particular led the charge for anti-abortion laws during this era.

By 1860, the American Medical Association sought to end legal abortion. The Comstock Law of 1873 criminalized attaining, producing or publishing information about contraception, sexually transmitted infections and diseases, and how to procure an abortion.

A spike in fears about new immigrants and newly emancipated black people reproducing at higher rates than the white population also prompted more opposition to legal abortion.

There’s an ongoing dispute about whether famous women’s activists of the 1800s such as Elizabeth Cady Stanton and Susan B. Anthony opposed abortion.

The anti-abortion movement references statements made by Anthony that appear to denounce abortion. Abortion rights advocates reject this understanding of Stanton, Anthony and other early American women’s rights activists’ views on abortion. They assert that statements about infanticide and motherhood have been misrepresented and inaccurately attributed to these activists.

These differing historical interpretations offer two distinct framings for both historical and contemporary abortion and anti-abortion activism.

Abortion in the sixties

By the turn of the 20th century, every state classified abortion as a felony , with some states including limited exceptions for medical emergencies and cases of rape and incest.

Despite the criminalization, by the 1930s , physicians performed almost a million abortions every year. This figure doesn’t account for abortions performed by non-medical practitioners or through undocumented channels and methods.

Nevertheless, the commonality of abortions didn’t become a hotly contested political issue until the women’s liberation movement and the sexual revolution of the 1960s and 1970s. These movements brought renewed interest in public discussions about reproductive rights, family planning, and access to legal and safe abortion services.

In 1962, the story of Sherri Finkbine , the local Phoenix, Arizona host of the children’s program, “Romper Room,” became national news.

Finkbine had four children, and had taken a drug, thalidomide, before she realized she was pregnant with her fifth child. Worried that the drug could cause severe birth defects, she tried to get an abortion in her home state, Arizona, but could not. She then traveled to Sweden for a legal abortion. Finkbine’s story is credited with helping to shift public opinion on abortion and was central to a growing, national call for abortion reform laws.

Two years after Finkbine’s story made headlines, the death of Gerri Santoro , a woman who died seeking an illegal abortion in Connecticut, ignited a renewed fervor among those seeking to legalize abortion.

Santoro’s death, along with many other reported deaths and injuries also sparked the founding of underground networks such as The Jane Collective to offer abortion services to those seeking to end pregnancies.

In 1967, Colorado became the first state to legalize abortion in cases of rape, incest, or if the pregnancy would cause permanent physical disability to the birth parent.

By the time “Maude’s Dilemma” aired, abortion was legal under specific circumstances in 20 states. A rapid growth in the number of pro- and anti-abortion organizations occurred in the 1960s and 1970s.

On Jan. 22, 1973, the Supreme Court’s ruling in Roe v. Wade nullified existing state laws that banned abortions and provided guidelines for abortion availability based upon trimesters and fetal viability. This ruling remains the most important legal statute for abortion access in modern U.S. history.

With numerous states recently passing bills banning abortions after six to eight weeks – a challenge to Roe’s legalization of abortions up to 12 weeks of pregnancy – it is unsurprising that many people are asking questions about both the history and future of abortion in the U.S. Due to current legal challenges , these bills are not yet in effect.

The legal battle to overturn or uphold Roe v. Wade is in full swing. Regardless of whether Roe v. Wade stands, history suggests that this will not be the last chapter in the political struggle over legal abortion.

• Birth control
• Abortion law
• US Supreme Court
• Abortion rights
• right to life
• Abortion pills
• women's liberation movement

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A better abortion debate is possible. Here’s where we can start.

Editor’s note: The Supreme Court overturned Roe v Wade on June 24 in a 6 to 3 decision, returning the issue of abortion restrictions to the states. America has published several essays on the decision, which was first leaked to the press in May. Read other views on abortion and the reversal of Roe v. Wade here .

In 2016, I opened my doors for what I expected would be the worst event I would ever host. In the wake of the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt, my husband and I invited about a dozen pro-choice and pro-life friends over to eat cookies and talk about abortion.

I had been part of terrible conversations on this topic, online and off-line, and I knew I wanted something different. I had friends on both sides of the divide, and it was surreal to be in a position where we all thought the other side was complicit in grave evil.

In my work at Braver Angels, I help design debates that bring people together across the political divide . When I do my opening spiel on our format and rules, I often ask people to raise their hands if they have had a bad conversation on that night’s topic before. Whatever the topic of our debate, nearly all the hands go up. Sometimes, when a topic has been in the news, I ask people to raise their hands if they have had a bad conversation about this topic in the past week ; a majority of hands go up.

I had friends on both sides of the abortion divide, and it was surreal to be in a position where we all thought the other side was complicit in grave evil.

I ask because I want everyone in the room to see that their opponents are here as an act of trust. Even though these conversations may have never gone well in the past, the attendees at a Braver Angels debate show up because they think it is possible that disagreement can be fruitful. And the higher the stakes of the issue, the more urgency they feel to find a better way to talk about what divides us.

When I asked people to come together in my living room on that night in 2016, I didn’t rely on the parliamentary structures I use at my job; I wanted to find a way to mark this night out as different from other arguments we had had. I asked my friends to look over two readings before coming over so we would have something we all shared to ground our discussion.

The essays I chose were “Thanksgiving in Mongolia,” by Ariel Levy, and “The Empathy Exams,” by Leslie Jamison. Both authors, to the best of my knowledge, identify as pro-choice. Levy’s essay narrates her miscarriage at 19 weeks; Jamison’s essay blends her experiences as both a fake patient helping doctors in training and a real patient having an abortion. I picked these two essays because they weren’t written as salvos in the abortion debate but as attempts to reckon with what it means to care for each other.

The higher the stakes of the issue, the more urgency they feel to find a better way to talk about what divides us.

If I were making my reading list now—and if I felt I could get away with asking people to read whole books, not just articles—I’d suggest a few other works.

The first is Defenders of the Unborn: The Pro-Life Movement before Roe v. Wade, by Daniel K. Williams, a history covering the period before pro-life activism became sharply polarized. Advocating for children before birth was an important cause for progressives, who saw it as part and parcel with advocating for those who could not speak for themselves.

Another book I would recommend is The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade, by Ann Fessler. I picked up Fessler’s book because I wanted to know what adoption as an alternative to abortion looked like. Her interviews with mothers who surrendered their children make it clear that a post-Roe world must not be a return to pre-Roe norms. Many mothers wanted to raise their children, but they were coerced into adoption because no one was willing to support them as mothers. The partings were traumatic and created lasting wounds where there should have been families.

And most of all, I would want people to read What It Means to Be Human , by O. Carter Snead. Snead’s book on law and bioethics explores how we respond to vulnerability and dependence. It covers abortion extensively but not exclusively. Snead writes about how the logic of abortion is seeded throughout our culture, which is quick to write off the humanity of anyone in need.

When the final Dobbs ruling comes out, our conversations will be better if they are an image of hope, even when we are angry or afraid.

Each of these three books exposes what must change in tandem with abortion law to create a humane culture.

I run Other Feminisms, a Substack newsletter that aims to foster a culture that values mutual dependence instead of demanding autonomy. In the wake of the leak of the possible Dobbs opinion, I asked my readers, who span the gamut from pro-choice to pro-life, what they would ask people to read to begin a conversation .

Their suggestions were marked by the tenderness and precarity that had drawn me to Levy and Jamison. People’s biggest fear is that there is not enough care to go around. Pregnancy makes babies dependent on their mothers and mothers dependent on everyone around them. A culture that takes autonomy as the norm will neglect both mother and child. Thus, it can feel like any care for a child comes at the mother’s expense since we do not trust each other or our policymakers to respond justly to her need.

At the gathering in my living room, I do not think anyone’s mind was changed on the spot, but there were some surprising moments. Some pro-lifers were surprised by how willing pro-choice friends were to consider that a child in the womb had some moral claims, even if they did not see a way to honor them without harming women. Another moment that stuck with me was when one pro-choice attendee explained he had become a vegan a few years ago because he had concluded, “If it looks like suffering, I should err on the side of assuming it is suffering.”

He knew what the pro-life rejoinder was going to be, and the tension of being so tender with a chicken or a fish but not a fetus worried him, too. But he felt stuck. He saw suffering all around, and it felt more possible to give up meat than to give up abortion, which he considered a backstop. He had found room for a little mercy for animals, but he had trouble imagining there was enough to go around for all humans.

When the final Dobbs ruling comes out, our conversations will be better if they are an image of hope, even when we are angry or afraid. Moving a conversation from online to off-line, from public venue to private, from a large group to an intimate one—all of these make it easier to ask and answer questions honestly. Ask yourself: If I were complicit in a grave, widespread evil, what would I need to be able to recognize that, repent and avoid despair? Try to give your friends the welcome and patience you would require in order to so profoundly change your life.

Leah Libresco Sargeant is the author of Building the Benedict Option , and she runs the Substack newsletter Other Feminisms . She will be helping Braver Angels host a debate on abortion on May 19th .

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Everything You Need to Know About the Abortion Debate

During the 49 years since the U.S. Supreme Court legalized abortion , the issue has run hot and cold in the political realm, sometimes dominating the national conversation and at other times simmering in the background as conservatives chipped away at reproductive rights and laid the groundwork for the repeal of Roe v. Wade . Now, with the leak of a draft Supreme Court majority opinion that would do just that, the issue has exploded. Pro-choice Americans are bracing for the loss of reproductive rights, and the anti-abortion movement is preparing to celebrate its long-awaited victory — and set its next targets .

If you are new to abortion politics , jumping into the decades-old debate can be overwhelming. Here are the key terms and fault lines you’ll need to know.

What was the legal standard set by Roe v. Wade?

The 1973 Supreme Court decision Roe v. Wade (along with the lesser-known companion case Doe v. Bolton ) codified nationally a woman’s right to have an abortion under certain circumstances. The majority opinion, written by Nixon appointee Harry Blackmun with six other justices concurring, found the right to an abortion is an implied constitutional protection of privacy. It held that women had an absolute right to a first-trimester abortion (up to 14 weeks). In the second trimester (14–27 weeks), the government could impose medical regulations, strictly to protect the woman’s health. Then in the third trimester, abortions could be banned outright, reflecting the state’s interest in protecting the “potential life” of the fetus — but exceptions for physician-defined threats to the life or health of the woman had to be allowed.

The decision swept away state bans on most abortions in 33 states, while liberalizing abortion laws in 13 other states. It is annually commemorated on January 22 by both pro-choice and anti-abortion organizations. (Most notably, the March for Life in D.C. has taken place on this date every year since 1974.)

What is fetal viability?

Fetal viability is the point in the development of the human fetus when it has the capacity to survive outside the womb. The medical rule of thumb (which many states and courts follow) is that viability occurs at the earliest at about 24 weeks of pregnancy. Less than one percent of abortions occur after fetal viability, which is why the anti-abortion movement has been determined to shift the line back to earlier stages of pregnancy.

In all the Supreme Court precedents on abortion, women have a very clear right to an abortion prior to viability, subject to limited regulations. However, in 2021 the Court refused a petition to put a hold Texas law that bans on abortions performed after 6 weeks of pregnancy, which blatantly ignores this precedent. Idaho and Oklahoma passed copycat laws in 2022.

How did Planned Parenthood v. Casey change the legal standard set by Roe v. Wade ?

The currently prevailing Supreme Court precedent was set in 1992 by Planned Parenthood v. Casey , a 5-4 decision that both reaffirmed and modified Roe v. Wade . Authored jointly by three Republican-appointed justices (Anthony Kennedy, Sandra Day O’Connor, and David Souter), with two other Republican-appointed justices concurring (Harry Blackmun and John Paul Stevens), Casey scrapped the trimester system, replacing it with a simple right to pre-viability abortions. However, Casey also allowed states to regulate abortions that occurred pre-viability, as long as those regulations did not “unduly burden” a woman’s right to an abortion. ( Roe had barred all government interference in the first trimester.)

Reproductive rights advocates feared the very subjective “undue burden” standard would create a big opening for abortion restrictions, but at the time, most were relieved that the Court had not, as many expected, simply reversed Roe . For the same reason, it was perceived as a bitter defeat for anti-abortion advocates, although it opened up new avenues for abortion restrictions much earlier in pregnancy.

What is fetal personhood?

Many, and perhaps most, anti-abortion activists embrace the idea that from the moment of conception (or fertilization) the fetus is morally and metaphysically a “person” who deserves full citizenship rights that should be constitutionally protected. In other words, while the anti-abortion movement’s immediate goal is reversal of Roe v. Wade and a state-controlled landscape of abortion laws, it generally favors a national law (or constitutional amendment) entrenching fetal rights. A Human Life Amendment to the Constitution has been endorsed in national Republican platforms dating back to 1980.

A state-based “personhood movement” has aimed to enshrine fetal rights in state constitutions, leading to unsuccessful ballot initiatives in Colorado, Mississippi, and North Dakota, and a successful (if vaguer) initiative in Alabama . The “personhood movement” tends to take particularly extreme positions on fetal and embryonic life, often opposing IV-fertilization practices that lead to the destruction of unused embryos, along with birth control methods (e.g., IUDs and morning-after pills) it regards as abortifacient rather than contraceptive. Significantly, the “sanctuary city for the unborn” movement in Texas, which led to the state’s abortion ban, often sought local ordinances banning the sale of morning-after pills and all abortions.

What are pain-capable abortion bans?

One type of state law (and congressional proposal ) has aimed to chip away at abortion rights by shifting the dividing line between legal and potentially illegal abortions from fetal viability to some earlier point in pregnancy — most popularly a scientifically unsubstantiated point at which a fetus is alleged to be capable of experiencing pain (typically 20 or 22 weeks into pregnancy).

Why are some states banning abortion when a heartbeat can be detected?

The most popular current model for state abortion bans is an even more dubious proposition: prohibiting abortion when, in theory, a fetal heartbeat can be detected. (Though cardiac activity — or pulsing cells — can be detected via ultrasound as early as six weeks, this term is misleading because embryos don’t have hearts.) Typically these “heartbeat bills” ban abortion after six weeks of pregnancy, which is before many women know they are pregnant. Like the fetal-pain bans, these laws are intended to supply agitprop to the anti-abortion cause, and provide a suggested new standard for future abortion restrictions. So far eleven states have enacted “heartbeat” laws.

Why do many abortion bans include exceptions for rape and incest?

Within the anti-abortion movement, there is a perpetually raging debate over whether it’s immoral to accept exceptions to proposed abortion bans for pregnancies resulting from rape and incest. Such exceptions are extremely popular, and Republican politicians (including Ronald Reagan and Donald Trump) tend to support them. There’s so much talk about these exceptions in conservative circles that those who embrace them have been able to cultivate a “moderate” image despite supporting bans on the estimated 98.5 percent of abortions that do not involve rape or incest.

Several recently passed state laws – including the Texas 6-week ban that the Supreme Court allowed to take effect, and the Mississippi 15-week ban at issue in Dobbs – have no rape or incest exceptions .

What are TRAP laws?

Largely frustrated in their efforts to directly ban or restrict abortions after Casey , Republican-controlled states increasingly focused their efforts on making abortion services unavailable. The idea behind TRAP (Targeted Regulation of Abortion Providers) laws was to devise ostensibly reasonable-sounding requirements, usually rationalized as being for the benefit of the women involved, that had the effect of shutting down abortion clinics. As the Guttmacher Institute explains :

Most TRAP laws apply a state’s standards for ambulatory surgical centers (ASCs) to abortion clinics, even though surgical centers tend to provide riskier, more invasive procedures and use higher levels of sedation. In some cases, TRAP laws also extend to physicians’ offices where abortions are performed and even to sites where only medication abortion is administered. TRAP regulations often include minimum measurements for room size and corridor width — requirements that may necessitate relocation or costly changes to a clinic’s physical layout and structure. Some regulations also mandate that clinicians performing abortions have admitting privileges at a local hospital, even though complications from abortion that require hospital admission are rare, so abortion providers are unlikely to meet minimum annual patient admissions that some hospitals require. TRAP requirements set standards that are intended to be difficult, if not impossible, for providers to meet. Instead of improving patient care, these laws endanger patients by reducing the total number of abortion facilities that are able to stay open under these financial and administrative constraints, thus making safe services harder to obtain.

In 2016, with Justice Kennedy supplying the key vote, the Supreme Court put up a stop sign to TRAP laws in a Texas case by challenging the states’ right to mischaracterize restrictions that were transparently intended to reduce access to abortion services (a textbook case of “undue burden”). After Justice Kennedy was replaced by Brett Kavanaugh, a nearly identical law enacted by Louisiana was invalidated by the Court in a 5-4 decision in 2020, with Chief Justice John Roberts joining the liberal minority, pretty clearly because he thought it would be disruptive to reverse course so abruptly.

The vigilante enforcement scheme in the new Texas abortion law (private citizens are given a civil right of action and even bonuses for successful litigation against abortion providers who violate the 6-week ban) is reminiscent of TRAP laws insofar as it is aimed at intimidating and imposing prohibitive costs on providers. But the anti-abortion movement’s focus shifted from indirect to direct attacks on legalized abortion in recent years, especially once the Court said it would review Dobbs .

What is partial-birth abortion?

This is a political, not a medical, term for abortions involving a technique (intact dilation and extraction) in which the fetus is temporarily outside the woman before the pregnancy is terminated. After striking down a state “partial-birth abortion ban” for its failure to provide an exception for the health of a woman, in 2007 the Supreme Court upheld a similar federal ban in a surprise 5-4 decision , Gonzalez v. Carhart . The Court held that the ban did not constitute an “undue burden,” as alternative abortion methods were still available, and cited a congressional “finding” that the procedure was never medically necessary. (This contradicted the medical community’s consensus, and did away with the traditional deference to the judgement of a woman’s physician).

What is late-term abortion?

The anti-abortion movement has long sought to undermine support for abortion rights generally by focusing on and demonizing late-term abortions — though, as noted above, less than one percent of abortions occur after fetal viability, and these cases typically involve threats to the health of the mother or severe fetal abnormalities.

The latest impetus for an attack on late-term abortions arose when New York sought to codify abortion rights in case Roe v. Wade is reversed, passing a law in 2019 that allows for late-term abortions under strict medical circumstances (as did a proposed law in Virginia). Anti-abortion advocates, including then- President Trump , began describing such abortions as a form of “infanticide,” making lurid and wildly inaccurate claims about what the procedure entails.

What is the Hyde Amendment?

This congressional appropriations rider , which has been in effect since 1980, prohibits the use of federal funding for abortion services (which means abortions are not covered by Medicaid, the federal-and-state-funded health-insurance program for low-income Americans). It originally drew significant Democratic support, not just from anti-abortion Democrats but from those who viewed a funding ban as a reasonable compromise despite its heavy impact on women who could not otherwise afford abortions.

Calls for the repeal of the Hyde Amendment have now become very common among Democrats (it was a plank in the Democratic platform for the first time in 2016), to the point that 2020 presidential candidate Joe Biden reversed his long-standing position favoring the amendment. He followed through as president by proposing an end to Hyde as part of his Fiscal Year 2022 budget resolution. Meanwhile Republicans, who almost universally support Hyde, rationalize demands for a funding cutoff for Planned Parenthood as a logical extension of the law.

Why is Planned Parenthood such a big target?

The Planned Parenthood Federation is a nonprofit organization that performs more abortion procedures ( 332,000 in 2017 ) than any other single provider. Through its 600 clinics, it also supplies an array of medical services, from cancer screenings to contraceptives to STI treatment to sex education. In many medically underserved areas, Planned Parenthood is the only source of reproductive-health services for poorer people.

The anti-abortion movement has tried, unsuccessfully, to defund Planned Parenthood entirely at the federal and state levels, arguing that providing any government funding just frees up money for abortion services (the Hyde Amendment already bans the use of Medicaid dollars for abortion). A sketchy 2015 “sting” operation producing video purporting to show Planned Parenthood officials discussing sales of fetal tissue (or as the anti-abortion activists called it, “baby parts”) as a profit center helped inflame a fresh round of Republican attacks on Planned Parenthood in the last few years.

What are the other major reproductive rights groups?

The preeminent pro-choice organization in the country is NARAL (National Abortion Rights Action League) Pro-Choice America, which prior to Roe v. Wade was called the National Association for the Repeal of Abortion Laws. Other notable pro-choice groups include EMILY’s List, a political organization that exclusively funds campaigns waged by pro-choice Democratic women; the research-oriented Guttmacher Institute; the Center for Reproductive Rights, a legal organization that handles litigation in abortion and contraception cases; and the National Network of Abortion Funds, which helps pay for abortions for women who cannot otherwise afford them.

What are the major anti-abortion groups?

The movement to restrict abortions has multiple organizing outlets. The National Right to Life Committee is the oldest and broadest-based group, which often promotes pragmatic strategies for gradually eroding abortion rights and focusing public attention on controversial practices like rare late-term abortions and questionable-sounding motives for abortion. A more militant organization, the Susan B. Anthony List, views itself as a counterpart to EMILY’s List. A number of explicitly religious organizations, notably the U.S. Conference of Catholic Bishops (which helped create the NRLC), the Southern Baptist Convention, and the Church of Jesus Christ of Latter-Day Saints, have been active in the fight against legal abortion. Personhood USA is a group dedicated to the radical cause of establishing fetal personhood in the Constitution and laws.

What are the preferred terms for the two sides of the abortion debate?

Arguments over language have long been part of the abortion debate. The most frequently used term for those who want to protect a fundamental right to an abortion has always been “pro-choice.” But more recently, a perceived need to become less defensive about the abortion “choice,” and to frame abortion as a normal health service, has led to the greater use of more straightforward terms like “reproductive rights” or “abortion rights.” (And a push to avoid calling the opposing side “pro-life,” using the terms “anti-abortion” or “anti-choice” instead.) An example of the impact of this more positive point of view was the elimination in 2012 of the Democratic national platform pledge to make abortion (in Bill Clinton’s words) “safe, legal and rare.” “Pro-life” remains the preferred self-designation for virtually all activists who oppose abortion.

This piece has been updated throughout.

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What’s at stake in the Supreme Court abortion pill case

Tuesday’s oral argument is focused on whether to overrule the fda and reimpose some restrictions on getting medication to terminate pregnancy.

Less than two years after the Supreme Court overturned Roe v. Wade , the issue of reproductive rights is returning to the high court on Tuesday as the justices consider whether to limit access to a medication used in more than 60 percent of U.S. abortions .

The Biden administration and the manufacturer of mifepristone are seeking to reverse a lower-court ruling that would make it more difficult to obtain the medication, first approved nearly 25 years ago and shown in multiple studies to be overwhelmingly safe .

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The conservative U.S. Court of Appeals for the 5th Circuit said the Food and Drug Administration failed to follow proper procedures and thoroughly explain its reasoning when it began loosening regulations. The changes made in 2016 and again in 2021 allowed mifepristone to be taken up to 10 weeks into pregnancy, instead of seven weeks , prescribed by a medical professional other than a doctor, and mailed directly to patients without an in-person medical consultation.

The pharmaceutical industry has warned that second-guessing the FDA’s determinations in this case will more broadly disrupt the nation’s drug-approval process and stymie private investment in research.

A decision should come by the end of June or in early July, putting abortion front and center as Democrats campaign on the issue in the 2024 election .

Here’s a look at what’s at stake:

Abortion access

The case could make it harder to get medication abortions even in states where abortion is legal. Allowing medication abortions to proceed without an ultrasound or in-person medical visit has increased access, particularly for women in rural areas and others who struggle to go to a clinic in person, by allowing them to complete the entire process from home.

The Supreme Court could also further impede abortion access for those living in one of the more than a dozen states with strict abortion bans in place. A few telemedicine clinics have started allowing U.S.-based doctors to prescribe and mail pills into restricted states, relying on new “shield laws” passed in several blue states to protect them from prosecution. The largest of these clinics, Aid Access, now mails approximately 6,000 doses of medication abortion into antiabortion states every month, according to founder Rebecca Gomperts.

Many abortion rights advocates say they will continue to send abortion pills through the mail no matter how the Supreme Court rules. Some are ready to switch to a misoprostol-only protocol, a method of medication abortion that uses only the second drug in the current two-step regimen. That option is also highly effective but causes significantly more cramping and bleeding.

A narrowed time window for accessing abortion pills would have major implications nationwide. In 2021, 56 percent of all abortions occurred beyond seven weeks of pregnancy. Just 20 percent occurred after 10 weeks, the FDA’s current mifepristone limit.

The drug-approval process

For the FDA and the pharmaceutical industry, the legal battle over mifepristone casts a shadow over all drugs, medical devices and diagnostics that the agency approves. If the 5th Circuit’s decision is upheld, industry and former government officials say, it would undercut the FDA’s stature as the global gold standard of regulating medicine — as well as the ability of drugmakers to raise money from investors. That, in turn, could deprive patients of innovative therapies.

Pharmaceutical companies denied approval for a drug could use the courts to reverse the agency’s scientific judgments — or challenge the approval of a competitor’s drug, former FDA commissioners said in a brief to the high court. Advocates for patients who suffer side effects from a drug could ask judges to bar other patients from taking an otherwise safe and effective medication.

A brief signed by hundreds of biotech executives said allowing a court to override the FDA’s process for approving drugs “will create intolerable risks and undermine the incentives for investment regardless of the drug at issue.”

A group of former Trump-era Department of Health and Human Services officials, however, sided with the challengers in a separate brief that says the FDA failed to properly assess the broader effects of lifting restrictions on mifepristone. James R. Lawrence III, an FDA chief counsel under President Donald Trump , said a ruling in favor of the agency could embolden other drugmakers to demand fewer restrictions.

A ruling against the FDA also could broaden who can sue the agency. In the mifepristone case, the four doctors suing the FDA claimed they had legal standing not because their patients were directly harmed by the drug, but because women suffering adverse effects crowding into emergency rooms would take away resources needed to treat other patients.

“Basically, any physician could sue the agency over any drug approval they disagree with,” said Holly Fernandez Lynch, an attorney and assistant professor of medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania.

The Supreme Court

When the court’s conservative majority overturned Roe in June 2022 with its ruling in Dobbs v. Jackson Women’s Health Organization , Justice Samuel A. Alito Jr. wrote that it was time to “return the issue of abortion to the people’s elected representatives.” Justice Brett M. Kavanaugh wrote separately, saying questions about the basic legality of abortion “will be resolved by the people and their representatives in the democratic process in the states or Congress” — not by the nine members of the Supreme Court.

Instead, the court has two abortion-related cases before it this term, the mifepristone case and one involving whether emergency room physicians must terminate pregnancies in some cases even in states where abortion is banned.

Supreme Court 2024 decisions

This is not the first time the court has considered the FDA’s regulation of mifepristone. During the pandemic, doctors and abortion providers sued the FDA , trying to remove the requirement that patients obtain the drug in person. A lower court judge agreed, saying in-person visits imposed unnecessary health risks due to covid-19.

But the Trump administration appealed, and the Supreme Court’s conservative majority reversed the lower-court decision , reinstating the in-person pickup requirement even though most patients take the medication at home.

The majority has generally been skeptical of the power of federal agencies and is reviewing several other challenges this term to the so-called administrative state, long a target of conservative criticism. But back in 2021, Chief Justice John G. Roberts Jr. sided with the Trump administration because, he said, courts should defer to public health experts.

Roberts’s position will be tested now that the court is being asked by the FDA and the Biden administration to retain full access to mifepristone, including to allow the medication to be sent to patients by mail.

The election

Whatever the Supreme Court decides will further inflame the election-year debate over abortion rights, with Democrats eager to campaign on the issue and Republicans struggling to craft a winning message since the fall of Roe.

President Biden has repeatedly vowed to defend access to mifepristone, part of his broader pledge to protect access to abortion. If the justices side with the White House and allow current regulations for mifepristone to stand, Biden and his allies can claim a legal victory; if the court limits access, Democrats will inevitably use the decision to mobilize voters.

Abortion rights arguably have been Democrats’ strongest advantage this political cycle, with voters repeatedly siding with the party on ballot measures and candidates in states such as Kansas, Kentucky and Ohio. Voters also say they trust Democrats to handle abortion more than Republicans by a 14-point margin, according to a February poll by KFF, a nonpartisan health-care research organization.

Voters also favor access to abortion medication. Two-thirds of Americans said that mifepristone should remain on the market, according to a Washington Post-ABC News poll in May 2023. GOP leaders, meanwhile, have continued to stake out opposition to the medication. A proposal released last week by the Republican Study Committee, an influential congressional caucus that represents most House Republicans, called for rolling back access to mifepristone. Conservative policy groups such as the Heritage Foundation have also said that Trump should use executive authority to crack down on the drug if he is elected again.

At stake for the antiabortion movement

The abortion pill has in many ways thwarted the antiabortion movement’s vision for a post- Dobbs America, allowing tens of thousands of abortions to continue in states where abortion is illegal. And while antiabortion advocates have scrambled to imagine new laws that might crack down on the flow of pills through the mail system, any legislation of that kind would be very difficult to get through Congress and hard to enforce at the state level.

Many antiabortion advocates have instead pinned their hopes on changing the culture around abortion pills — hoping to make women skeptical of obtaining the pills through the mail without an ultrasound or a doctor’s visit , even though studies show it is overwhelmingly safe to do so. Antiabortion arguments about the risks of abortion pills are based largely on studies that have recently been retracted by the journal that published them.

A Supreme Court ruling that compels the FDA to reinstate old restrictions would be an important step toward changing how the pills are perceived, antiabortion advocates said.

“Many women … are taking these drugs in unsafe ways because they’re hearing from the FDA that they’re safe to take in this way,” said Christina Francis, chief executive of the American Association of Pro-Life Obstetricians and Gynecologists. “The [FDA’s] stamp of approval still carries a lot of weight.”

A large body of research shows mifepristone is safe and effective . The FDA points to published studies of tens of thousands of women showing that serious adverse events after mifepristone use occur in fewer than 1 percent of cases.

Daniel Gilbert, David Ovalle and Dan Diamond contributed to this report .

U.S. abortion access, reproductive rights

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

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

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

Abortion and the 2024 election: Voters in a dozen states in 2024 could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. The Biden administration announced new steps intended to ensure access to contraception, abortion medication and emergency abortions at hospitals. Here’s what the moves on reproductive health mean for consumers. See where the 2024 presidential candidates stand on abortion bans .

• The biggest 2024 Supreme Court rulings so far, and what’s still to come March 27, 2024 The biggest 2024 Supreme Court rulings so far, and what’s still to come March 27, 2024
• 5 key moments from Supreme Court arguments on the abortion pill case March 26, 2024 5 key moments from Supreme Court arguments on the abortion pill case March 26, 2024
• What’s at stake in the Supreme Court abortion pill case March 24, 2024 What’s at stake in the Supreme Court abortion pill case March 24, 2024

Abortion Access:

Supreme Court Rekindles Abortion Debate as Election Fight Looms

• Cases involve access to abortion pill, state limits on doctors
• Abortion becoming key campaign topic before November vote

The US Supreme Court in Washington, DC.

Two years after promising to get out of the abortion-regulation business, the US Supreme Court is again in the middle of the fray, with potentially far-reaching implications for reproductive rights and the November election.

The court’s 2022 ruling overturning Roe v. Wade transformed the legal and political landscape. It cleared the way for tougher restrictions or bans on the procedure in Republican-led states and gave Democrats a potent political issue as abortion-rights advocates battle to prevent access from eroding further.

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A concise history of the US abortion debate

Originally published in, by  treva b. lindsey.

Professor of Women's, Gender, and Sexuality Studies, The Ohio State University

Screenshot from ‘Maude’s Dilemma.’ Amazon Prime Video

On Nov. 14, 1972, a controversial two-part episode of the groundbreaking television show, “Maude” aired.

Titled “Maude’s Dilemma,” the episodes chronicled the decision by the main character to have an abortion.

The landmark Supreme Court ruling in Roe v. Wade was issued two months after these episodes. The ruling affirmed the right to have an abortion during the first 12 weeks of pregnancy. “Maude’s Dilemma” brought the battle over abortion from the streets and courthouses to prime-time television.

Responses to the episodes ranged from celebration to fury , which mirrored contemporary attitudes about abortion.

In the almost 50 years since Roe v. Wade, the debate over abortion has pervaded politics in the U.S.

While many may think that the political arguments over abortion now are fresh and new, scholars of women’s, medical and legal history note that this debate has a long history in the U.S.

It began at more than a century before Roe v. Wade.

The era of ‘The Pill’

Less than 10 years before “Maude’s Dilemma” aired, the Food and Drug Administration approved the first commercially produced birth control pill , Envoid-10.

Although various forms of birth control predate the birth control pill, the FDA’s approval of Envoid-10 was a watershed in the national debate around family planning and reproductive choice.

Commonly known as “The Pill,” the wider accessibility of birth control is seen as an early victory of the nascent women’s liberation movement.

Abortion also emerged as a prominent issue within this burgeoning movement. For many feminist activists of the 1960s and 1970s, women’s right to control their own reproductive lives became inextricable from the larger platform of gender equality.

19th-century advertisements for abortion-inducing items and abortion services. The Library Company of Philadelphia , CC BY-NC

From unregulated to criminalized

From the nation’s founding through the early 1800s, pre-quickening abortions – that is, abortions before a pregnant person feels fetal movement – were fairly common and even advertised.

Women from various backgrounds sought to end unwanted pregnancies before and during this period both in the U.S. and across the world. For example, enslaved black women in the U.S. developed abortifacients – drugs that induce abortions – and abortion practices as means to stop pregnancies after rapes by, and coerced sexual encounters with, white male slave owners.

In the mid- to late-1800s, an increasing number of states passed anti-abortion laws sparked by both moral and safety concerns. Primarily motivated by fears about high risks for injury or death, medical practitioners in particular led the charge for anti-abortion laws during this era.

By 1860, the American Medical Association sought to end legal abortion. The Comstock Law of 1873 criminalized attaining, producing or publishing information about contraception, sexually transmitted infections and diseases, and how to procure an abortion.

A spike in fears about new immigrants and newly emancipated black people reproducing at higher rates than the white population also prompted more opposition to legal abortion.

There’s an ongoing dispute about whether famous women’s activists of the 1800s such as Elizabeth Cady Stanton and Susan B. Anthony opposed abortion.

The anti-abortion movement references statements made by Anthony that appear to denounce abortion. Abortion rights advocates reject this understanding of Stanton, Anthony and other early American women’s rights activists’ views on abortion. They assert that statements about infanticide and motherhood have been misrepresented and inaccurately attributed to these activists.

These differing historical interpretations offer two distinct framings for both historical and contemporary abortion and anti-abortion activism.

Abortion in the sixties

By the turn of the 20th century, every state classified abortion as a felony , with some states including limited exceptions for medical emergencies and cases of rape and incest.

Despite the criminalization, by the 1930s , physicians performed almost a million abortions every year. This figure doesn’t account for abortions performed by non-medical practitioners or through undocumented channels and methods.

Nevertheless, the commonality of abortions didn’t become a hotly contested political issue until the women’s liberation movement and the sexual revolution of the 1960s and 1970s. These movements brought renewed interest in public discussions about reproductive rights, family planning, and access to legal and safe abortion services.

In 1962, the story of Sherri Finkbine , the local Phoenix, Arizona host of the children’s program, “Romper Room,” became national news.

Finkbine had four children, and had taken a drug, thalidomide, before she realized she was pregnant with her fifth child. Worried that the drug could cause severe birth defects, she tried to get an abortion in her home state, Arizona, but could not. She then traveled to Sweden for a legal abortion. Finkbine’s story is credited with helping to shift public opinion on abortion and was central to a growing, national call for abortion reform laws.

Two years after Finkbine’s story made headlines, the death of Gerri Santoro , a woman who died seeking an illegal abortion in Connecticut, ignited a renewed fervor among those seeking to legalize abortion.

Santoro’s death, along with many other reported deaths and injuries also sparked the founding of underground networks such as The Jane Collective to offer abortion services to those seeking to end pregnancies.

In Washington, D.C., March 10, 1986, thousands participated in the March for Women’s Lives, where they pressed for women’s right to birth control and legal abortion. AP/Tom Reed

In 1967, Colorado became the first state to legalize abortion in cases of rape, incest, or if the pregnancy would cause permanent physical disability to the birth parent.

By the time “Maude’s Dilemma” aired, abortion was legal under specific circumstances in 20 states. A rapid growth in the number of pro- and anti-abortion organizations occurred in the 1960s and 1970s.

On Jan. 22, 1973, the Supreme Court’s ruling in Roe v. Wade nullified existing state laws that banned abortions and provided guidelines for abortion availability based upon trimesters and fetal viability. This ruling remains the most important legal statute for abortion access in modern U.S. history.

With numerous states recently passing bills banning abortions after six to eight weeks – a challenge to Roe’s legalization of abortions up to 12 weeks of pregnancy – it is unsurprising that many people are asking questions about both the history and future of abortion in the U.S. Due to current legal challenges , these bills are not yet in effect.

Treva B. Lindsey , Professor of Women's, Gender, and Sexuality Studies, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article .

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The fight over US abortion rights in the year without Roe – photo essay

A look back on the year since the US supreme court overturned Roe v Wade with the Dobbs decision, and the advocates who aren’t giving up

While the supreme court’s decision to overturn Roe v Wade sent shockwaves around the country, many activists, physicians and advocacy groups closely engaged in the fight over abortion in the US were not surprised.

Since Roe’s establishment of the federal right to abortion in 1973, anti-abortion advocates and conservative lawmakers have been chipping away at it. Restrictions on abortion increased over the last decade, and by the mid-2010s, seven states had just one abortion clinic left. In Mississippi, where the Dobbs v Jackson Women’s Health Organization case that ultimately ended Roe originated, the state’s one clinic did not provide abortions beyond 16 weeks of pregnancy, meaning many people already had to travel to find care.

For residents in a state with the highest poverty rate in the nation, where there is no guaranteed childcare, and where elected officials have refused to expand Medicaid to cover low-income workers, that often meant obtaining an abortion was unlikely. For those who do move forward with pregnancies, the state doesn’t make that easy either. The states like Mississippi that have now passed the strictest abortion laws are also typically the ones with the lowest minimum wages , the least generous policies that support families, least access to education and to health care. In many southern states, the rates of maternal and infant mortality and morbidity are among the highest in the country. The US has the highest maternal death rate of any wealthy country, and Black women suffer most – they’re three to four times as likely to die from pregnancy-related complications as white women.

The ways the US healthcare system has treated Black people continues to affect their health in profound ways, says Dr Nina Ragunanthan, an OB-GYN who serves the largely low-income Black community in Mississippi’s Delta region.

“You take a group of people that have been so abused for generations,” she says, “the essential stress from that passes down.” Ragunanthan and other doctors say these inherited health challenges combined with ongoing racism mean that abortion bans and their subsequent effects, from medical providers moving away from states with restrictive laws to the potential of criminal penalties, have a disproportionate impact on Black Americans.

In the days after the Dobbs decision, protesters flooded the Pink House, as the Jackson Women’s Health Organization clinic was known. The Pink House Defenders, the group of volunteers who escorted patients to and from the clinic, were used to seeing regular, sometimes heated demonstrations outside, and so tried to keep things as normal as possible for patients, said Derenda Hancock, the group’s founder. “We are just trying to be here for the patients until the last moment.”

Destiny Buchauau had her son at 14 and had her daughter a few months before the Dobbs ruling. She dropped out of school and lives in Rolling Fork, Mississippi, with her children and extended family.

Activist Linda Nicole Stringfellow always has condoms, emergency contraception, and pregnancy tests in her office in Cleveland, Mississippi. Whenever someone arrives, she also provides basic sexual education.

Ebony Jones became pregnant by rape at 17 and miscarried. She later got pregnant again, but the fetus was not developing correctly. Jones had to continue to term because it was illegal to terminate at her stage. When her son was born, she held him as he was dying for 10 hours.

Shantana Stamps, has a four-month-old son at 16. She lives with her mother and aunts in Anguilla, Mississippi. While she knew that contraception existed, she did not know where to find it or who to ask.

Cathy Dolley delivered her daughter prematurely by emergency cesarean section. Years earlier, she had a miscarriage and had to keep the fetus in her uterus for 21 days because of trap laws on abortion.

Dolley has three children and has been pregnant six times. Her first daughter, T’lana La’Faith Davis, died the day she was born in 2018.

Dolley is a certified nurse. Throughout the whole miscarriage and hospital experience she understood completely what are the risks and what was happening to her body.

Many abortion clinics stopped providing care the moment the Dobbs decision came down as they scrambled to interpret what the ruling meant for their state. The Pink House closed its doors for good on 6 July, and as the summer stretched on, more abortion bans took effect. Sixty-six clinics across 15 states stopped offering abortions in the first 100 days after Roe fell, according to the Guttmacher Institute, a research form that supports abortion rights.

Clinics in states where abortion remains legal saw huge increases in patients seeking care, and they tried to expand hours and staffing to meet those needs.

I went home with his birth certificate and an empty box with a black flower on it. – Ebony Jones

Doctors, patients and activists spoke out, drawing attention to the ripple effects that new abortion laws were having not only on those who sought abortions, but also on people experiencing pregnancy complications, miscarriages and on those who used medications that were caught up in the uncertainty around the new legislation. Anti-abortion doctors and advocates, meanwhile, argued that the laws were clear and doctors were at fault for any confusion about when the laws applied.

In August, the new era of abortion restrictions faced its first test at the ballot box when Kansas voters decisively rejected a measure that would have opened the state to future abortion bans. The surprising win for abortion rights supporters served as a symbol of a brewing backlash to the supreme court’s decision, and added fuel to debates within the Republican party about how far it should go with its new ability to restrict abortion.

Senator Lindsay Graham proposed a national 15-week abortion ban in September, but other conservative states faltered as they tried to agree on limits for abortion without the constraints of Roe.

The intensity of these fights increased as the country headed toward the midterm elections, where abortion was suddenly at the forefront of nearly every campaign. Members of Congress held hearings on the topic. Advocates flooded into states where more ballot measures addressed abortion, and where voters were now acutely aware of the power that state and local elected officials have over their lives.

Meanwhile, reproductive justice advocates, who had been warning for years that Roe was not enough to guarantee abortion access, ramped up their plans to help people find care. Some clinics that stopped offering abortions remained open in states with bans to provide other reproductive health services, gender-affirming care and follow-up appointments for people who terminated their pregnancies out of state.

While performing an ultrasound for a patient who was preparing for an abortion, Dr. Cheryl Hamlin saw signs of an ectopic pregnancy, which would make taking abortion pills dangerous for the patient.

Her patient had traveled multiple hours to reach the clinic and needed to return home that night, so Hamlin worked to verify the diagnosis as soon as possible with other specialists.

While some people prefer to take abortion pills on their own, Hamlin believes everyone should have medical support if they desire. Now that many states have outlawed abortion, many people are going without that support.

Kate works at the Hope Clinic for Women in Illinois, where she received an abortion in 2021. After a complicated pregnancy, she was told a future pregnancy would be dangerous but the Catholic hospital where she gave birth refused to tie her tubes.

Kate became pregnant again despite taking birth control. She experienced complications after taking abortion pills and had to have three blood transfusions. The Hope Clinic asked Kate to return to ensure the abortion was safely completed.

Many abortion clinic workers choose these jobs because they have personal experience with the topic or believe strongly in the clinics’ missions.

Grassroots groups known as abortion funds raised money to help people afford abortions and the travel, lodging, childcare and extra costs that come with seeking medical assistance far from home. People like Michelle Colon, founder of Shero in Mississippi, organized volunteers to drive more than 50 women at least 10 hours north to Illinois to obtain abortions. Colon herself drove at least 20 times between the end of June and the fall, sometimes bringing more than one patient in her car and paying for travel costs herself. She is now among the very few individuals left providing such help in Mississippi.

With the country focused on abortion in a way it hadn’t been for years, advocates tried to cut through the stigma around the topic. They held conferences, speakouts and encouraged politicians to talk about the issue on the campaign trail leading up to the November midterm elections.

Angela Michael, an anti-abortion activist and former nurse performs an ultrasound on Ashley in a recreational vehicle outside the Hope Clinic. Michael convinced Ashley not to have an abortion several years ago.

On 8 November 2022, voters delivered a ringing endorsement of abortion rights in key states, establishing new abortion protections in Michigan, California and Vermont, while rejecting efforts to restrict abortion or criminalize providers in Kentucky and Montana. Elsewhere, voters supported governors and other state level candidates who backed abortion rights in places like Wisconsin, Michigan, Pennsylvania, Kansas and Arizona.

As the post-Roe reality set in, abortion pills, which have been on the World Health Organization’s list of “essential medicines” for years and now account for more than half of US abortions, proved a key flash point.

Abortion rights activists see the pills, a two-drug regimen also known as medication abortion, as a key way to help people get care privately and take some of the load off brick-and-mortar clinics. Telehealth services like Hey Jane, Choix and Abortion on Demand expanded in states where abortion remains legal. The number of abortions provided by virtual-only telehealth providers increased from an average of 4,025 abortions a month (or 5% of all abortions) before Dobbs to 7,461 a month (9% of all abortions) in the first nine months after the decision, according to the Society of Family Planning’s new WeCount report . For people who couldn’t or didn’t want to use official channels, activists expanded underground networks run by groups like Las Libres and Red Necesito Arbortar that are delivering abortion pills to Americans from as far away as Mexico and India.

Michelle Colon, founder of Shero, an abortion fund in Mississippi, works with other activists to find ways to continue helping women in the south access abortion.

Plan A mobile clinic provides free basic reproductive healthcare and pre- and postnatal checkups for patients without health insurance. The clinic also refers patients to health centers that provide post-abortion checkups.

Valencia Robinson leads Mississippi in Action, a group that does advocacy and education about sexual and reproductive health issues. Robinson started this work after her own emergency c-section years ago.

April Jackson already had two kids when she got pregnant again. She went to a pregnancy center and was convinced not to have an abortion. Her youngest daughter was born with a heart defect that now needs to be constantly monitored.

April is raising her seven children on her own without any substantial support from any organizations or the state of Mississippi, where she is from and currently lives.

As a teenager, Amanda Furdge had two abortions. She never received sex education growing up in Mississippi. She later got married and had a son but escaped back home after her husband became violent. She soon learned she was pregnant again and was misled by a crisis pregnancy center after she went to them for an abortion.

Several years later she married another man, and though she did not want to have more children, she had another baby. After her second husband also became violent, Furdge got a tubal ligation and left her spouse to raise her children on her own.

Those who oppose abortion see pills as enabling a way around their favored laws. While the vast majority of Americans did not want to see Roe overturned and public opinion has only solidified in favor of abortion rights since last summer, the anti-abortion movement does not care if its positions are not widely popular. This year, Christian legal advocacy group Alliance Defending Freedom filed a lawsuit aiming to force the FDA to take mifepristone, one of the two drugs used for medication abortions, off the market nationwide.

After a Trump-appointed federal judge in Texas agreed with the group, the supreme court eventually blocked the restrictions and maintained access for now. But the case is likely to end up back at the supreme court, where it could still upend abortion access in every state.

She asked me to show her a photo of my oldest son. And then she asked ‘what if I kill him? – Amanda Furdge

The 2023 legislative session brought a number of new state abortion bans and restrictions, though some of these have now been blocked by courts. Democratic-leaning states pushed back by allocating funding and passing new protections for abortion seekers and providers within their borders. In other places, conservative lawmakers sought to limit ballot measures related to abortion. A group of patients in Texas who say they were denied medically necessary abortions despite risks to their lives and their fetuses, sued the state seeking to clarify exceptions to its abortion bans and as physicians in other states highlighted similar situations also arguing for more health-based exceptions, lawmakers often proved skeptical and anti-abortion advocates encouraged them to hold strong.

Alejandra had an abortion in 2018. She remembers how lonely she felt during her experience. Now Alejandra provides help to other women in Arizona and talks about her story publicly to fight abortion stigma.

Throughout the spring, abortion funds continued to help people access care. But while many groups in places as diverse as Louisiana, Arizona and Colorado doubled and tripled their fundraising from before Dobbs, they are now warning that funding is lagging as the public’s attention wanes. The New York Abortion Access Fund, which has helped patients from 29 states, Washington DC and six countries access abortions in the last year, says it is on pace to run out of money by October if it does not receive more support.

Over 3,000 abortion pills were donated to Red Necesito Abortar, an activist group in Mexico so that they can be transported across the border for American women to use.

Misa (pseudonym) is an activist from a feminist collective in Matamoros, Mexico. Since the abortion laws have changed in the US, she has crossed the border multiple times to bring abortion pills to Texas.

In Mississippi, health problems continue and people like Colon, one of the few people helping residents in her state find the resources to travel and obtain abortions, says the situation feels almost like Jenga, the children’s game that involves precariously removing wooden blocks from a tower until they collapse. “They’re just pulling away everything,” she says. “There’s only a couple more blocks left. You’ve got these other blocks just kind of teetering.”

We never thought that we would be the ones who would be able to provide abortion access to women in the US. – Veronica Cruz

It’s not clear what will happen when the last block is gone. More lawsuits and legal attacks are coming, OB-GYNs are leaving states with abortion bans, and training for the next generation of medical residents in states with restrictions remains uncertain.

But for now, abortion rights advocates are not giving up.

Colon says she feels like she is fighting back against the new laws every time she gets someone to an appointment to terminate their pregnancy if that’s what they want. “You may have put up all of these hurdles, but we’re still getting folks there,” she says. “We’re basically crawling over fucking glass, we’re climbing mountains, yet we’re still getting people there.

Lola, an undocumented immigrant from Mexico who has been living in California for over 20 years, prepares abortion pills provided by a Mexican organization for clandestine distribution around the US.

When Lola had an abortion a few years ago, she was alone. She is now part of a network distributing them to people in the states where abortion has been illegal since more laws started changing in June 2022.

• A year without Roe
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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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Key Arguments From Both Sides of the Abortion Debate

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Many points come up in the abortion debate . Here's a look at abortion from both sides : 10 arguments for abortion and 10 arguments against abortion, for a total of 20 statements that represent a range of topics as seen from both sides.

Pro-Life Arguments

• Since life begins at conception,   abortion is akin to murder as it is the act of taking human life. Abortion is in direct defiance of the commonly accepted idea of the sanctity of human life.
• No civilized society permits one human to intentionally harm or take the life of another human without punishment, and abortion is no different.
• Adoption is a viable alternative to abortion and accomplishes the same result. And with 1.5 million American families wanting to adopt a child, there is no such thing as an unwanted child.
• An abortion can result in medical complications later in life; the risk of ectopic pregnancies is increased if other factors such as smoking are present, the chance of a miscarriage increases in some cases,   and pelvic inflammatory disease also increases.  
• In the instance of rape and incest, taking certain drugs soon after the event can ensure that a woman will not get pregnant.   Abortion punishes the unborn child who committed no crime; instead, it is the perpetrator who should be punished.
• Abortion should not be used as another form of contraception.
• For women who demand complete control of their body, control should include preventing the risk of unwanted pregnancy through the responsible use of contraception or, if that is not possible, through abstinence .
• Many Americans who pay taxes are opposed to abortion, therefore it's morally wrong to use tax dollars to fund abortion.
• Those who choose abortions are often minors or young women with insufficient life experience to understand fully what they are doing. Many have lifelong regrets afterward.
• Abortion sometimes causes psychological pain and stress.  

Pro-Choice Arguments

• Nearly all abortions take place in the first trimester when a fetus is attached by the placenta and umbilical cord to the mother.   As such, its health is dependent on her health, and cannot be regarded as a separate entity as it cannot exist outside her womb.
• The concept of personhood is different from the concept of human life. Human life occurs at conception,   but fertilized eggs used for in vitro fertilization are also human lives and those not implanted are routinely thrown away. Is this murder, and if not, then how is abortion murder?
• Adoption is not an alternative to abortion because it remains the woman's choice whether or not to give her child up for adoption. Statistics show that very few women who give birth choose to give up their babies; less than 3% of White unmarried women and less than 2% of Black​ unmarried women.
• Abortion is a safe medical procedure. The vast majority of women who have an abortion do so in their first trimester.   Medical abortions have a very low risk of serious complications and do not affect a woman's health or future ability to become pregnant or give birth.  
• In the case of rape or incest, forcing a woman made pregnant by this violent act would cause further psychological harm to the victim.   Often a woman is too afraid to speak up or is unaware she is pregnant, thus the morning after pill is ineffective in these situations.
• Abortion is not used as a form of contraception . Pregnancy can occur even with contraceptive use. Few women who have abortions do not use any form of birth control, and that is due more to individual carelessness than to the availability of abortion.  
• The ability of a woman to have control of her body is critical to civil rights. Take away her reproductive choice and you step onto a slippery slope. If the government can force a woman to continue a pregnancy, what about forcing a woman to use contraception or undergo sterilization?
• Taxpayer dollars are used to enable poor women to access the same medical services as rich women, and abortion is one of these services. Funding abortion is no different from funding a war in the Mideast. For those who are opposed, the place to express outrage is in the voting booth.
• Teenagers who become mothers have grim prospects for the future. They are much more likely to leave school; receive inadequate prenatal care; or develop mental health problems.  
• Like any other difficult situation, abortion creates stress. Yet the American Psychological Association found that stress was greatest prior to an abortion and that there was no evidence of post-abortion syndrome.  

Additional References

• Alvarez, R. Michael, and John Brehm. " American Ambivalence Towards Abortion Policy: Development of a Heteroskedastic Probit Model of Competing Values ." American Journal of Political Science 39.4 (1995): 1055–82. Print.
• Armitage, Hannah. " Political Language, Uses and Abuses: How the Term 'Partial Birth' Changed the Abortion Debate in the United States ." Australasian Journal of American Studies 29.1 (2010): 15–35. Print.
• Gillette, Meg. " Modern American Abortion Narratives and the Century of Silence ." Twentieth Century Literature 58.4 (2012): 663–87. Print.
• Kumar, Anuradha. " Disgust, Stigma, and the Politics of Abortion ." Feminism & Psychology 28.4 (2018): 530–38. Print.
• Ziegler, Mary. " The Framing of a Right to Choose: Roe V. Wade and the Changing Debate on Abortion Law ." Law and History Review 27.2 (2009): 281–330. Print.

“ Life Begins at Fertilization with the Embryo's Conception .”  Princeton University , The Trustees of Princeton University.

“ Long-Term Risks of Surgical Abortion .”  GLOWM, doi:10.3843/GLOWM.10441

Patel, Sangita V, et al. “ Association between Pelvic Inflammatory Disease and Abortions .”  Indian Journal of Sexually Transmitted Diseases and AIDS , Medknow Publications, July 2010, doi:10.4103/2589-0557.75030

Raviele, Kathleen Mary. “ Levonorgestrel in Cases of Rape: How Does It Work? ”  The Linacre Quarterly , Maney Publishing, May 2014, doi:10.1179/2050854914Y.0000000017

Reardon, David C. “ The Abortion and Mental Health Controversy: A Comprehensive Literature Review of Common Ground Agreements, Disagreements, Actionable Recommendations, and Research Opportunities .”  SAGE Open Medicine , SAGE Publications, 29 Oct. 2018, doi:10.1177/2050312118807624

“ CDCs Abortion Surveillance System FAQs .” Centers for Disease Control and Prevention, 25 Nov. 2019.

Bixby Center for Reproductive Health. “ Complications of Surgical Abortion : Clinical Obstetrics and Gynecology .”  LWW , doi:10.1097/GRF.0b013e3181a2b756

" Sexual Violence: Prevalence, Dynamics and Consequences ." World Health Organizaion.

Homco, Juell B, et al. “ Reasons for Ineffective Pre-Pregnancy Contraception Use in Patients Seeking Abortion Services .”  Contraception , U.S. National Library of Medicine, Dec. 2009, doi:10.1016/j.contraception.2009.05.127

" Working With Pregnant & Parenting Teens Tip Sheet ." U.S. Department of Health and Human Services.

Major, Brenda, et al. " Abortion and Mental Health: Evaluating the Evidence ." American Psychological Association, doi:10.1037/a0017497

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The Anti-Abortion Endgame That Erin Hawley Admitted to the Supreme Court

Somewhat lost in the debate around abortion pills and oral arguments that took place at the Supreme Court in FDA v. Alliance for Hippocratic Medicine on Tuesday was one deeply uncomfortable truth: The very notion of what it means to practice emergency medicine is in dispute, with anti-abortion doctors insisting upon a right to refuse treatment for any patient who doesn’t meet their test of moral purity. Indeed, the right asserted is that in the absence of certainty about which patients are morally pure, the doctors want to deny medication to all patients, nationwide.

In public, the plaintiffs in this case—a group of doctors and dentists seeking to ban medication abortion—have long claimed they object to ending “unborn life” by finishing an “incomplete or failed” abortion at the hospital. But in court, they went much further. Their lawyer, Erin Hawley, admitted at oral argument that her clients don’t merely oppose terminating a pregnancy—they are pursuing the right to turn away a patient whose pregnancy has already been terminated . Indeed, they appear to want to deny even emergency care to patients whose fetus is no longer “alive,” on the grounds that the patient used an abortion drug earlier in the process. And they aim to deploy this broad fear of “complicity” against the FDA, to demand a nationwide prohibition on the abortion pill to ensure that they need never again see (and be forced to turn away) patients who’ve previously taken it. This is not a theory of being “complicit” in ending life. It is a theory that doctors can pick and choose their patients based on the “moral distress” they might feel in helping them.

It should come as no surprise that the same judge who tried to ban mifepristone in this case, Matthew Kacsmaryk, has also attempted to legalize anti-LGBTQ+ discrimination in health care nationwide. This is the ballgame: weaponize subjective religious beliefs against secular society to degrade the quality of care for everyone. If you can’t persuade Americans to adopt hardcore evangelical views, exploit the legal system to coerce them into it anyway.

Alliance for Hippocratic Medicine is at once embarrassingly frivolous and existentially important. Don’t let the jokes about how silly the Comstock Act seems , or how speculative the theory of standing is, get in the way of taking a serious look at the claims on offer. The plaintiffs say they are terrified that one day, a patient may walk into their emergency room suffering complications from a medication abortion prescribed by some other doctor. This patient may need their assistance completing the abortion or simply recovering from the complete abortion, which these plaintiffs deem “complicity” in sin. And they say the solution is either a total, nationwide ban on mifepristone, the first drug in the medication abortion sequence, or a draconian (and medically unnecessary) set of restrictions that would place mifepristone out of reach for many patients. (The U.S. Court of Appeals for the 5 th Circuit ruled to reinstate those restrictions at their behest.)

It is a twisted line of logic, one that should never have reached the Supreme Court in the first place. But it is also a product of the court’s past indulgence of outlandish claims about moral “complicity.” As was made plain in the oral arguments and briefing, activist doctors are no longer satisfied with personal conscience exemptions already granted under state and federal law; they now insist that nobody, anywhere, should have access to the abortion pill, in order to ensure that they themselves won’t have to treat patients who took one. At a minimum, they say, they should be able to radically roll back access to the pill in all 50 states to reduce the odds that one of these handful of objectors might someday encounter a patient who took it. This extremist argument lays bare the transformation of the idea of “complicity” from a shield for religious dissenters to a sword for ideologues desperate to seize control over other people’s lives and bodies.

At oral arguments, several justices pressed Hawley, who argued on behalf of Alliance for Hippocratic Medicine, with an obvious retort: Why can’t her clients simply refuse to treat these hypothetical someday patients on the grounds that they cannot help end the “life” of a fetus or embryo? After all, federal law guarantees doctors the right not to have to provide an abortion if doing so is “contrary to his religious beliefs or moral convictions.” Justices Amy Coney Barrett and Brett Kavanaugh secured assurances from Solicitor General Elizabeth Prelogar, early in the arguments, that under no circumstances could the government force any health care provider to ever participate in an abortion in violation of their conscience. Justice Elena Kagan asked Prelogar: “Suppose somebody has bled significantly, needs a transfusion, or, you know, any of a number of other things that might happen.” Would the plaintiffs object to treating them? Prelogar said the record was unclear.

Hawley, who is married to far-right Republican Sen. Josh Hawley, then approached the lectern and cleared up any confusion: Yes, she insisted, treating a patient who has undergone a medication abortion violates the conscience of the plaintiff physicians even if there is no “live” fetus or embryo to terminate anymore. “Completing an elective abortion means removing an embryo fetus, whether or not they’re alive, as well as placental tissue,” Hawley told Kagan. So the plaintiffs don’t object just to taking a “life.” They also object to the mere act of removing leftover tissue, even from the placenta.

Of course, these doctors must remove “dead” fetal tissue and placentas all the time—from patients who experienced a spontaneous miscarriage. By their own admission, the plaintiffs regularly help women complete miscarriages through surgery or medication. Those women they will gladly treat. Other women, though—the ones who induced their own miscarriage via medication—are too sinful to touch. Before the plaintiffs can administer even lifesaving emergency treatment, they need to know the circumstances of this pregnancy loss: Spontaneous miscarriages are OK; medication abortions are not.

Justice Ketanji Brown Jackson, too, zeroed in on this admission. She told Hawley that she had thought the objection was to “participating in a procedure that is ending the life [of the fetus].” Hawley told her no: Any participation in an abortion, even through the indirect treatment of a patient without a “live” fetus, violated the doctors’ conscience. So, wait. What about “handing them a water bottle?” Jackson asked. Hawley dodged the question, declining to say whether helping a patient hydrate would constitute impermissible complicity in sin.

All this is reminiscent of Little Sisters of the Poor , a case about a Catholic charitable group that was afforded an exemption from the Affordable Care Act’s contraception mandate. The Little Sisters were asked to check a box signaling to the government that they could not comply with the mandate, at which point the government would step in to cover their employees. But the Little Sisters refused, viewing this action—the checking of a box to opt out of coverage—as “complicity” in abortion because it would in turn trigger government payment for contraception (which they viewed as abortifacients). The Supreme Court and the Trump administration ultimately indulged the Little Sisters’ claim .

Here, we have emergency room physicians asserting that they will not participate in lifesaving medical intervention unless they approve of the reason for the pregnancy loss. Presumably, if the pregnant patient is an unwed mother, or a gay or transgender person, the doctor would be similarly complicit in sin and decline service. Seen through this lens, since one can never know which sins one is enabling in the ER, each and every day, a narrow conscience exemption becomes a sweeping guarantee that absolutely nobody in the country can ever have access to basic health care, let alone miscarriage management. (Of course, these plaintiffs might focus only on one set of “sins” they see as relevant.) In a country effectively governed by Kacsmaryk and his plaintiff friends, a gay person suffering a stroke could be turned away from any hospital because of his sexual orientation, all to spare a doctor from a glancing encounter with prior sin. As Tobias Barrington Wolff, a professor of law at the University of Pennsylvania Law School, put it to us in an email, this unbounded view of complicity “is part of enacting the social death of people and practices you abhor, which in turn can contribute to the material death of people and practices you abhor.”

One of the most exhausting lessons of post- Roe America is that being “pro-life” definitively means privileging the life of the presumptively sin-free unborn—or even their “dead” remains—over the life of the sin-racked adults who carry them. This is why women are left to go septic or to hemorrhage in hospital parking lots; it is why C-sections are performed in nonviable pregnancies, at high risk to mothers; it’s why the women who sued in Texas to secure exceptions to that state’s abortion ban are condemned by the state as sinners and whores . And it’s why—in the eyes of the Alliance for Hippocratic Medicine — it is a greater hardship for a physician to “waste precious moments scrubbing in, scrubbing out” of emergency surgery, as Hawley put it, so long as they don’t believe that the emergency warrants their professional services, than it is for a pregnant person, anywhere in the country, including in states that permit abortion, to be forced to give birth.

At oral argument, Hawley explained that her clients have “structured [their] medical practice to bring life into the world. When they are called from their labor and delivery floor down to the operating room to treat a woman suffering from abortion drug harm, that is diametrically opposed to why they entered the medical profession. It comes along with emotional harm.” The emotional harm alleged here is that unless these doctors approve of the specific circumstances of the ER visit, they violate not only their own medical preference but also their religious convictions. But they will never truly know enough about the sins of their patients to be able to shield themselves against being a link in a chain of subjective lifelong sin. And to be a doctor, especially an emergency physician, should be to understand that your patients’ private choices and spiritual life are not really open to your pervasive and vigilant medical veto. This deep-rooted suspicion of patients deemed insufficiently pure for lifesaving treatment didn’t begin with the availability of medication abortion. It will assuredly not end there.

The small city of Bristol is now the frontline of the abortion debate | The Excerpt

On a special episode of The Excerpt podcast: Bristol is a small Appalachian city that has  become a microcosm of the national abortion debate . That’s because Bristol has a state line running through it – Virginia to the north, where abortion is legal, and Tennessee to the south, where it was outlawed after Roe v. Wade was overturned. USA TODAY Health Reporter Adrianna Rodriguez visited the city after the ban in Tennessee went into effect to document the impact on its residents.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it.  This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

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Dana Taylor:

Hello and welcome to The Excerpt. I'm Dana Taylor. Today is Wednesday, March 27th, 2024, and this is a special episode of The Excerpt. Bristol is a small Appalachian city that's become a microcosm of the national abortion debate. That's because Bristol has a state line running through it, Virginia to the north where abortion is legal, Tennessee to the south where it was outlawed after Roe v. Wade was overturned. Our guest today, USA Today health reporter Adrianna Rodriguez, visited the city after the ban in Tennessee went into effect to document the impact on its residents. Thanks for being on The Excerpt Adrianna.

Adrianna Rodriguez:

Thank you for having me.

Can you please start us out by describing Bristol? What kind of city is it and how did it change after abortion was banned in Tennessee?

Yeah, so Bristol is a town, it's a small town, quaint town in sort of the Appalachian Mountains. It has a very rich history. It is the birthplace of country music. People like to go there and visit to hike and to see the beautiful scenery. They like to visit downtown. They like to go onto State Street. That marks the divide between the two states and sort of hop across the street to be in two different states, right? People like to go there to retire because it's more of like a slower pace of life. And so before Roe fell, I feel like Bristol was Virginia and Tennessee's best kept secret. But that changed in 2022 because what happened was after Dobbs decision and Roe fell, Tennessee had decided to ban abortion. And so that wanted to affect shortly after Roe fell. And having different laws between the two states isn't really that... it's not a new concept of Bristol.

Tennessee has different gun laws than Virginia, they also have different marijuana laws. But what makes this different is that now there was this vacuum of abortion care in the area, and providers decided to open a new clinic on the Virginia side where abortion was still legal called Bristol Women's Health. And so that became the destination for people who are seeking abortion services. And while they thought, "Okay, this would be the destination for that sort of Appalachian area for Tennessee," they didn't realize at the time that so many states below Virginia were also going to ban abortion, or at least severely restrict it like the Carolinas, Kentucky, West Virginia, Louisiana, Mississippi, Alabama. All of those states had severely restricted or banned abortion shortly after Roe fell. And so people in those states began traveling to Bristol, Virginia, and that sort of put Bristol in the forefront or on the map really, of this national debate.

It's been less than two years since that health clinic opened on the Virginia side. Adrianna, can you give us a sense by the increase in patients, changes in services, pressures on city council of what this shift has been like for the people who live and work in Bristol?

Yeah, I mean, with every abortion clinic you're going to have protesters, but I think what made this different was that it attracted a lot of national players, a lot of big national players, both on the anti-abortion and the abortion activist side that decided to take arms really in Bristol and fight this national battle within this small town.

So what have you heard specifically from anti-abortion activists about how they're challenging the clinic and its services?

So a lot of those big national players that are coming from outside of Bristol began challenging abortion through the city council, trying to introduce zoning ordinances that we had seen in other places in the country to limit and restrict abortions. So there was this one zoning ordinance specifically that basically prohibited the existing abortion clinic, the new one from expanding, and then also prohibited other new abortion clinics from coming into the area.

How about the pro-abortion activists? How has the city changed for them?

For residents who are abortion rights activists, they saw these national big players with a lot of money coming into the town and trying to push their agenda, and they decided they wanted to form sort of their own alliance and fight within the city council as well, against the zoning ordinance.

You wrote that the Guttmacher Institute, a research organization that supports abortion rights, found that since 2020, Virginia has seen a 75% increase in abortions. That was obviously before Roe was overturned. Why do you think this happened?

So I think that increase is largely due to the people that are traveling out of state and are traveling from states that banned or severely restricted abortion and came to Bristol or any other places in Virginia to be able to get an abortion. Bristol Women's Health in particular has said that they've seen an increase since they opened. They now see about 150 patients a month, and they also started opening their services during off hours, during evening hours, on weekends to be able to accommodate all those people that are traveling and don't have as much flexibility as somebody nearby.

Can you share some of the conversations regarding abortion that you heard both at Bristol Women's Health Clinic and with other people you spoke with for the story that really stood out to you?

Something that really stood out to me was really this pushback against the national players that have come to Bristol. Like I said before, Bristol was sort of Virginia's best kept secret for a lot of good and in a positive reasons. And now that it's been sort of pushed into this national stage, and especially on a topic that southern etiquette dictates you don't really talk about has ruffled feathers. People are not happy about being this geographic case study, especially local government and some locals, but the players that really have a stake in it are very passionate about it. The clinic is very passionate about providing these services or an area where there really isn't abortion services or abortion care available. I think the closest one is about two hour drive away in Roanoke, and then the anti-abortion activists are very passionate about getting these services out of the area.

That's really where the town stands is that if you've been impacted by abortion or you know somebody who's been impacted by abortion, you're really in this fight. But the majority of people, local residents of Bristol who really don't want anything to do with it and don't want so many people coming in. Pro-abortion activists are not strangers to conflict because of the nature of abortion in general, in terms of how emotionally charged it is and how divisive it is. They're used to protesters, they're used to people outside of abortion clinics. But I think because there is this national pressure on Bristol that's really heightened the tension in Bristol and for those activists that volunteer as escorts escorting women and pregnant people into the health clinic and stuff like that. I know there was this one woman who had told me about an incident where a man was, I guess so angry with her that he started driving towards her almost threatening to run her over with his pickup truck.

And obviously that's very scary. Obviously that is not the everyday sort of conflict and protest that you see at an abortion clinic, but I think because there is this pressure, this national pressure, it's really heightened emotions. It's really put both sides on alert. I know also the clinic, there's been over 50 calls to the police at the site of the clinic since it first opened, and when I talked to police, they confirmed that it's mostly been calls from either the clinic or the protestors regarding disturbances, protests, security. So just based on that data, it seems like there is a lot of conflict, at least on a weekly basis.

Adrianna, thank you so much for being on The Excerpt.

Thanks to our senior producer Shannon Rae Green and Bradley Glanzrock. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.

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What Does ‘Abortion’ Mean? Even the Word Itself Is Up for Debate.

In medical terms, the definition is clear. But when disputes arise, opponents argue that not every termination is an abortion.

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By Kate Zernike

Even after five decades of argument about abortion in the United States, the most contentious question newly at the forefront is a very basic one: What is abortion?

Major medical societies, and medical billing codes , define abortion as any procedure that terminates a pregnancy — whether that pregnancy is wanted or unwanted, whether a woman is seeking the procedure to clean out her uterus after a miscarriage, or because of a dire fetal diagnosis, or to terminate a pregnancy that she had not expected.

“An abortion is an abortion is an abortion,” said Dr. Louise King, an obstetrician-gynecologist and bioethicist at Harvard Medical School.

Anti-abortion lawmakers and groups disagree, arguing that it’s an abortion only if the woman or her medical provider elects to end the pregnancy. This generally means that terminating a pregnancy in a dire medical situation is acceptable, while terminating an unwanted pregnancy is not.

During the five decades that Roe v. Wade established a constitutional right to abortion, this was mostly a semantic dispute. But in the aftermath of the Supreme Court’s decision to overturn Roe, simply defining the word abortion has taken on new political, legal and medical consequences.

States are struggling to define what they will and will not allow. Doctors, too, are grappling : those in states that now ban abortion say they have stopped providing the procedures because violations of the law can result in lengthy prison terms, large fines and the loss of a medical license.

Most laws allow for exceptions to save the life of the pregnant woman. But uncertainty about what qualifies as life-threatening has resulted in what the president of the American Medical Association called “chaos,” as medical professionals try to decide what conditions fall under those exceptions. Women are being denied abortions for miscarriages and to end pregnancies that have little or no chance of survival, or left to become sicker before they can have an abortion deemed to be lifesaving.

That has put politicians who helped enact those laws, largely Republicans, on the defensive in midterm election campaigns. Under fire, they have tried to carve out new definitions of abortion and blame doctors for misunderstanding.

Anti-abortion politicians in Louisiana faced outrage in August when a hospital denied an abortion to a woman carrying a fetus that doctors said would be born without a skull. One of the state’s three bans allowed abortion to end “medically futile” pregnancies. But the fetus’s condition, acrania, was not specifically included on a list of exceptions allowed under the law.

Jeff Landry, the state’s attorney general, blamed doctors, saying, “it is the hospital that has created ambiguity where there is none.”

“Assuming such a diagnosis was properly certified, the removal of the unborn child is ‘not an abortion,’” he wrote in a letter to the hospital’s general counsel.

Katrina Jackson, a Democrat who sponsored one of the state’s abortion bans, told a local television station that the procedure the woman had been seeking was not an abortion: “This woman is seeking a medical procedure for a pregnancy that is not viable outside of the womb.”

The woman ended up traveling roughly 1,400 miles to a Planned Parenthood clinic in New York, where she terminated her pregnancy with an abortion.

Medical societies and doctors who support abortion rights say defining abortion by intent is a distinction without a difference, because any termination proceeds with the intent to end that pregnancy. And the procedures are the same regardless of whether a woman has had a miscarriage or seeks to end an unwanted pregnancy: Surgically, an abortion involves dilation and curettage, or dilation and evacuation; a medical abortion is done with pills.

They accuse anti-abortion activists of trying to add a value judgment, one intended to suggest that abortion is something only promiscuous women get.

“When something sad or devastating happens, you’re always going to hear the anti-abortion movement saying, ‘That is not abortion,’ because they can’t come to terms with the fact that that is also an abortion,” said Jenny Ma, who has litigated against abortion bans as senior staff attorney for the Center for Reproductive Rights.

“You can add all sorts of different words, you can say induced delivery, you can say quote-unquote elective, but it’s the same,” she said. “It’s all part of how abortion has been stigmatized.”

Soon after Roe was overturned, Ohio doctors denied an abortion to a 10-year-old girl who had become pregnant by rape, because the state’s ban on abortions after detection of fetal cardiac activity — generally around six weeks of pregnancy — does not include any exception for rape victims.

However, Catherine Glenn Foster, the president of the anti-abortion group Americans United for Life, testified in Congress that “it would probably impact her life and so therefore it would fall under any exception and would not be an abortion.”

Anti-abortion groups argue that states have carefully crafted bans to make sure that anyone who needs an abortion for medical reasons receives one.

“That’s not the same as elective abortion, abortion that is done for the primary purpose of producing a dead baby,” said Dr. Donna Harrison, the chief executive of the American Association of Pro-Life Obstetricians and Gynecologists.

Still, only some state bans — Texas, for example — specify that the procedure is “not abortion” if it is done to treat a miscarriage; others, including Arizona and Wisconsin , make no exception for that. (The terms for abortion and miscarriage are so intertwined that in those laws, written in the 19th century, abortion is defined as “procuring a miscarriage.”)

The language around pregnancy has long been subject to fierce debate. In the early 2000s, anti-abortion groups successfully pushed for a federal ban on an extremely rare termination procedure that is typically done in the second trimester — known medically as intact dilation and evacuation — by rebranding it “partial birth abortion.”

But in the new debate over defining abortion, abortion-rights groups say they themselves may have unintentionally created confusion.

Even when Roe was the law of the land, hospitals often set up committees to decide whether abortion was ethical, or justified as “therapeutic.” So the abortion-rights groups set up free-standing clinics to try to expand access. Dr. Jamila Perritt, an obstetrician-gynecologist and the president of Physicians for Reproductive Health, said that encouraged the belief that abortions done at clinics were not the same as those done in doctors’ offices or hospitals where a woman was ending a pregnancy because of cancer treatment, or because of a fetal abnormality.

“I had patients tell me, ‘I’m not like the rest of them, they were careless,’” Dr. Perritt said.

Doctors often soften language when speaking to patients, especially women who are devastated by a miscarriage or a dire fetal diagnosis, both of which carry their own stigmas. Rather than saying “termination,” they may talk about miscarriage and evacuation, or helping along a natural process, even as they note it as “abortion” in the medical chart.

Dr. King, at Harvard, compared it to discussions of other sensitive topics: talking with patients about body mass index rather than morbid obesity, or a “mass” instead of a tumor for cancer diagnoses.

“But then weaponizing and politicizing language is highly inappropriate, and unethical,” she said.

“We don’t want patients to have to be mired in politics when they’re going through an incredibly difficult time in their lives,” she added, “but when you write a law, the law has to use the accepted terminology, and when I make sure I’m adhering to that law, I can only use that accepted terminology.”

Even women who have had abortions may draw a distinction between a procedure after a miscarriage and an abortion. Some are now reconsidering their own medical histories.

Chrissy Teigen, the model and television personality, announced at a conference and on social media in September that discussions after the Supreme Court decision made her realize that a miscarriage she publicized in 2020 had in fact been an abortion. Her fetus, in the second trimester, “had absolutely no chance” and her own life was at risk. Her announcement — The Hollywood Reporter said she “confessed” it — inspired the actress Jenny Mollen to announce that she, too, had abortions to treat two miscarriages.

Anti-abortion groups and lawmakers argued that Ms. Teigen was wrong to call the procedure an abortion, and accused her of changing her words for political gain .

LifeNews.com wrote that doctors did not “purposefully kill her unborn son,” and Ms. Teigen and her family “did not want him to die and mourned his death even though he never lived outside the womb.”

Anti-abortion groups don’t always agree on the definition of acceptable abortion. Dr. Harrison, for example, said she does not believe that the procedure is the right response to rape, or for a fetus diagnosed with a deadly anomaly. While the pregnancy of the 10-year-old Ohio girl was “a horrible social disaster,” Dr. Harrison said, “that pregnancy was not a threat to her life.” Similarly, she said, fetuses with what she termed a “life-limiting diagnosis” can be carried to term in perinatal hospice care.

Abortion-rights supporters say the debate should not be about what exceptions to allow in state laws, because those carve-outs can’t account for every possibility; they may even aggravate the stigma around abortion and pregnancy loss.

“We’re creating this narrative that some people deserve care and some people don’t,” said Dr. Kristyn Brandi, the Darney-Landy fellow at the American College of Obstetricians and Gynecologists. “In medicine, we don’t have that divide based on reason or the divide based on situation. It’s more, the pregnancy needs to end for whatever reason, and we will provide that care because that’s what the person in front of us needs.”

Kate Zernike is a national correspondent. She was a member of the team that shared a 2002 Pulitzer Prize for a series of stories about Al Qaeda and the terrorist attacks of Sept. 11. Her book “The Exceptions: Nancy Hopkins, MIT, and the Fight for Women in Science” will be published in February. More about Kate Zernike