The Laws Of Abortion: Who Decides?

Abortion laws vary widely around the world. In some countries, such as the United States, abortion is a highly divisive and politicized issue, with a vocal minority of anti-abortion activists often dominating the narrative. In the US, abortion was legalized in 1973, but individual states have introduced various laws regulating abortions, with some states seeking to prohibit abortion at earlier points in pregnancy. In 2022, the Supreme Court overturned Roe v. Wade, allowing states to set their own policies on abortion access and establish limits. This has resulted in a patchwork of abortion laws across the country, with some states banning abortion almost entirely while others protect abortion access. Public opinion polls show that a majority of Americans believe abortion should be legal in all or most cases, but many are open to some restrictions.

The majority of Americans believe abortion should be legal in all or most cases

The public's attitudes towards abortion are nuanced and contingent upon specific circumstances. For example, nearly three-quarters of adults (73%) believe that abortion should be legal if the woman's life or health is endangered by the pregnancy. About seven-in-ten say abortion should be legal if the pregnancy is a result of rape, and a smaller majority (53%) say abortion should be legal if the baby is likely to be born with severe disabilities or health problems.

At the same time, large numbers of Americans favor certain restrictions on access to abortions. For instance, seven-in-ten say doctors should be required to notify a parent or legal guardian of minors seeking abortions. And a majority of Americans (56%) believe that how long a woman has been pregnant should be a factor in determining the legality of abortion.

While most Americans do not hold absolutist views about abortion, there is a clear consensus that abortion should be legal in certain situations. For example, in cases where the woman's life or health is endangered by the pregnancy, or when the pregnancy is a result of rape, nearly three-quarters of adults (73%) and about seven-in-ten adults (70%), respectively, believe that abortion should be legal.

The legality of abortion has been a highly debated topic in the United States, with some states moving to protect abortion access while others have imposed stricter regulations or banned it altogether. The Supreme Court's decision in June 2022 to overturn Roe v. Wade, which guaranteed the constitutional right to abortion for nearly fifty years, has further polarized the country on this issue.

The Dobbs ruling overturned Roe v. Wade, allowing states to set abortion policies

The Dobbs ruling, or Dobbs v. Jackson Women's Health Organization, was a landmark decision by the U.S. Supreme Court in 2022 that overturned Roe v. Wade (1973) and Planned Parenthood v. Casey (1992). The ruling held that the U.S. Constitution does not confer a right to abortion and returned the power to regulate abortion to federal and state legislatures.

The case centred on the constitutionality of a 2018 Mississippi state law that banned most abortion operations after the first 15 weeks of pregnancy. The Jackson Women's Health Organization, Mississippi's only abortion clinic at the time, sued Thomas E. Dobbs, a state health officer. Lower courts had blocked enforcement of the law, citing the ruling in Planned Parenthood v. Casey, which prevented states from banning abortion before fetal viability, generally within the first 24 weeks.

The Supreme Court's decision, written by Justice Samuel Alito, argued that abortion was neither a constitutional right mentioned in the Constitution nor a fundamental right implied by the concept of ordered liberty. Alito based his argument on the criterion that a right must be "deeply rooted" in the nation's history and tradition. He wrote that "abortion couldn't be constitutionally protected" and that "when the Fourteenth Amendment was adopted, three-quarters of the States made abortion a crime at all stages of pregnancy."

The Dobbs ruling overturned nearly five decades of precedent set by Roe v. Wade, which established a constitutional right to abortion and allowed abortions up to fetal viability, typically around 24 weeks. The ruling in Dobbs allowed states to set their own policies regarding the legality of abortions, leading to a patchwork of varying abortion laws across the country. Some states have passed laws protecting abortion rights, while many others have made abortion illegal or introduced restrictions.

The impact of the Dobbs ruling has been significant, with profound cultural and social changes surrounding abortion in the U.S. The decision sparked protests and counter-protests across the country and led to a surge in political activism around abortion rights. It also had practical consequences, with abortion rates increasing in states that allowed abortion and decreasing in states that banned it. Additionally, there are concerns about the impact on maternal and infant health, with studies suggesting a rise in infant mortality and maternal deaths following the ruling.

The Dobbs ruling also raised broader questions about other rights that are not explicitly mentioned in the Constitution, such as the right to contraception and same-sex marriage. Justice Clarence Thomas, in a concurring opinion, argued that the Court should reconsider past decisions that granted these rights based on substantive due process. This sparked fears that other established rights could be at risk, contributing to a broader debate about the role of the Supreme Court and its legitimacy.

Abortion is a common medical service that many women obtain

Abortion is a safe and simple health care intervention when carried out by someone with the necessary skills and using a method recommended by the World Health Organization (WHO). However, around 45% of abortions worldwide are unsafe, with more than half of these unsafe abortions occurring in Asia, and three-quarters in Latin America and Africa. In the US, abortion is a highly regulated medical service, with many states imposing limitations such as waiting periods, ultrasound requirements, and gestational age limits. These restrictions can delay access to abortion services and make them less safe.

There are different types of abortion methods, which can be broadly categorized into medication abortion and procedural abortion. Medication abortion involves taking oral medications to terminate a pregnancy, and it can be done at home in the early stages of pregnancy. Procedural abortion, on the other way, is a nonsurgical way to terminate a pregnancy and typically involves aspiration or dilation and evacuation procedures.

Abortion is an essential component of women's health care and is included in the medical training, clinical practice, and continuing medical education of obstetricians and gynecologists. It is a highly personal decision, and factors that influence a woman's decision to have an abortion include contraceptive failure, barriers to contraceptive use and access, rape, incest, intimate partner violence, fetal anomalies, and illness during pregnancy. Additionally, pregnancy complications may be severe enough that abortion becomes the only measure to preserve a woman's health or save her life.

Abortion laws vary by state in the US, with some states banning almost all abortions, while others protect abortion access. Restrictive abortion laws can lead to unsafe abortions, as women may resort to unsafe means to end unwanted pregnancies when abortion is illegal or highly restricted.

Restrictive abortion laws disproportionately affect marginalised communities

The overturning of Roe v. Wade has further exacerbated these injustices. As of January 12, 2023, abortion is banned in 12 US states with very limited exceptions and is unavailable in two additional states. This means that 29% of women of reproductive age in the US are living in states where abortion is either unavailable or severely restricted. The impact of these restrictions is felt most acutely by marginalised communities, including people of colour, low-income people, trans men, non-binary people, immigrants, adolescents, and people living with disabilities.

For example, among reproductive-age women who are ineligible for Medicaid because their state has refused to expand the program, nearly two-thirds are women of colour. Non-citizen US residents are also barred from Medicaid eligibility for their first five years in the country. Similarly, immigrants living without documentation face restrictions when trying to purchase health insurance. These disparities contribute to the inequitable access to abortion care for marginalised communities.

Additionally, Black women living with low incomes are more likely than White women in the same situation to report being pressured by a clinician to use a contraceptive. Studies have also documented experiences of race-based discrimination and pressure to use contraceptive methods that do not align with their preferences during contraceptive counselling among Latina and Black women. Furthermore, Latina and Black women living with low incomes are more likely than middle-class White women to report being advised by healthcare professionals to limit their childbearing. These forms of discrimination and denial of resources uniquely shape abortion access for people subject to intersecting forms of discrimination.

The overturning of Roe v. Wade has also exacerbated inequities in abortion access at the intersection of race and geography. The South and Midwest, which have the largest proportions of Black people, also have the most states that have banned abortion or are expected to do so. These regions are also more likely to lack geographic access to maternity care, have worse maternal and infant health outcomes, and lack basic social family policies such as paid family leave. As a result, the cost of being denied abortion care is incredibly high for people in these regions.

Restrictive abortion laws also have inequitable effects on specific groups of abortion patients. For instance, the Hyde Amendment bans people covered by Medicaid health insurance from using it for abortion care. Gestational age bans that arbitrarily cut off access to abortion care after a certain number of weeks disproportionately affect those who recognise their pregnancy near or past the ban's limit, often before many people even know they are pregnant. Parental involvement laws in states where abortion is still available create additional barriers for pregnant people under 18, especially for Latino adolescents who may face cultural and linguistic barriers in seeking judicial bypass.

The criminalisation of abortion and restrictive laws also have a "chilling effect" on healthcare providers, deterring them from providing the best care options for their patients. This further contributes to the inequitable impact of restrictive abortion laws on marginalised communities, who already face barriers in accessing quality healthcare.

In conclusion, restrictive abortion laws disproportionately affect marginalised communities by compounding the injustices they face due to systemic racism and economic inequality. These laws create additional barriers to accessing safe and timely abortion care, exacerbating existing inequities and violating the human rights of those who are most vulnerable.

Abortion is a human rights issue

The right to privacy entails an individual's decision to pursue a voluntary termination of pregnancy and must be protected by the State and from third-party interference. Restricting access to safe and legal abortions violates the human rights of women and people who can get pregnant, especially those from marginalized communities. These include people on fixed or lower incomes, refugees and migrants, adolescents, lesbian and bisexual women and girls, transgender and gender non-conforming individuals, and minority or Indigenous women.

The criminalization of abortion is a form of discrimination and jeopardizes a range of human rights. Where safe and legal abortion services are unreasonably restricted or not fully available, many other internationally protected human rights may be at risk, including the right to life, health, information, nondiscrimination and equality, privacy and bodily autonomy and integrity, liberty, freedom of conscience and religion, and freedom from torture and cruel, inhuman and degrading treatment.

Abortion restrictions do not prevent abortions. Research has shown that when abortion is banned or restricted, the number of abortions does not decrease. Instead, abortions move underground, increasing the risk of unsafe procedures and police involvement. The rate of unsafe abortions is nearly 45 times higher in countries with highly restrictive abortion laws than in countries where abortion is legal and unrestricted.

Abortion is a common medical service that many women obtain at some point in their lives. It is a basic healthcare need for millions of women, girls, and people who can become pregnant. An estimated 1 in 4 pregnancies worldwide end in abortion each year.

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