abortion articles for research paper 2022

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v.19(7); 2022 Jul

Why restricting access to abortion damages women’s health

The plos medicine editors.

Public Library of Science, San Francisco, California, United States of America

Dr. Caitlin Moyer discusses the implications, for women globally, of restricting access to abortion care.

In late June, the landmark Roe v . Wade ruling was overturned by the United States Supreme Court, a decision, decried by human rights experts at the United Nations [ 1 ], that leaves many women and girls without the right to obtain abortion care that was established nearly 50 years ago. The consequences of limited or nonextant access to safe abortion services in the US remain to be seen; however, information gleaned from abortion-related policies worldwide provides insight into the likely health effects of this abrupt reversal in abortion policy. The US Supreme Court’s decision should serve to amplify the global call for strategies to mitigate the inevitable repercussions for women’s health.

Upholding reproductive rights is crucial for the health of women and girls worldwide, and access to a safe abortion is central to this, yet policies in several countries either severely limit or actively prevent access to appropriate abortion care and services [ 2 ]. However, there is little to suggest that those countries and jurisdictions with abortion bans or heavily restrictive laws see fewer abortions performed. According to a modeling study of pregnancy intentions and abortion from the 1990s to 2019, rates of unintended pregnancies ending in abortion are broadly similar regardless of a country’s legal status of abortion, and unintended pregnancy rates are higher among countries with abortion restrictions [ 3 ]. Abortion is widely considered to be a low-risk procedure. Abortion-related deaths most likely occur in the context of unsafe abortion practices and are reported to account for 8% (95% UI 4.7–13.2%) of maternal deaths [ 4 ], making them a top direct contributor to maternal deaths globally, alongside hemorrhage, hypertension, and sepsis. Restrictive abortion policies may not lower the overall rates of abortion, but they can drive increasing rates of unsafe abortions, as women resort to seeking abortions covertly. Such abortions are often performed by untrained practitioners or involve harmful methods. Perhaps unsurprisingly, most abortions that take place in countries with restrictive abortion access policies are not considered safe [ 5 ], potentially contributing to maternal morbidity and mortality. A study of 162 countries found that maternal mortality rates are lower in countries with more flexible abortion access laws [ 6 ], suggesting that changes in abortion policies could have grievous implications for maternal deaths.

It is not yet known if the reneging of federal protection of abortion rights will impact maternal deaths in the US; however, in the years following the 1973 Roe v . Wade decision, numbers of reported deaths associated with illegal abortions, defined as those performed by an unlicensed practitioner, declined, hovering between zero and 2 deaths from the 1980s to 2018, down from 35 in 1972 [ 7 ] and 19 reported in 1973 [ 8 ]. It is possible that limits on access to timely and safe abortion care could drive this number back up and add to the already unacceptably high maternal mortality rate in the US, potentially exacerbating the persistent disparities in maternal mortality based on socioeconomic deprivation, race and ethnicity, and other factors [ 9 ].

Legal and social barriers that impede access to safe abortions are detrimental to the health and survival of women and girls; thus, constructing policies ensuring access to safe abortion services should be an urgent priority. Placing undue hurdles between women and access to abortion care is associated with undesirable health outcomes. For example, a 2011 change to medication abortion laws in one US state that involved increased medication costs and restricted the timing and location where abortion services could be provided was associated with an increase in rates of women requiring additional medical interventions [ 10 ]. Lending international weight to this argument, dissolution of barriers to safe abortion access was emphasized in the March 2022 update of WHO guidance on abortion care [ 11 ], echoing a 2018 comment on the International Covenant on Civil and Political Rights released by the United Nations Human Rights Committee [ 12 ] that called on member states to remove existing barriers and not enact new restrictions on provision of safe abortion services so that pregnant women and girls do not need to turn to unsafe abortions.

In jurisdictions where prohibitive policies exist, more could be done to counter the impacts of new barriers by changing how abortion care is delivered and increasing accessibility. Protocols for the safe self-management of abortion can be implemented alongside provision of information and provider support. WHO guidance [ 11 ] suggests expanding the breadth of practitioners authorized to prescribe medical abortions to include nurses, midwives, and other cadres of healthcare workers. The guidelines also mention telemedicine as an approach to circumvent obstacles to seeking safe abortion services [ 11 ]. For those with access to the necessary technology, telemedicine services together with self-management of medication abortion can overcome travel-related barriers and ensure the privacy of those seeking treatment. Demands for telehealth services increased during the COVID-19 pandemic, and, according to one study, remote provision of abortion services in the US may be a promising option to counteract barriers and facilitate access [ 13 ].

In 2022, restrictive policies or outright bans on abortion services are discriminatory against women, obstructing their right to maintain autonomy over their own sexual and reproductive health. A post- Roe legal landscape that renders abortion more difficult or impossible to obtain safely will exacerbate an increasingly bleak picture of maternal health in the US; however, the US is just one example where increased effort is needed to overcome barriers to improving women’s healthcare. The reality is that such barriers continue to represent a threat to the health of women worldwide. Evidence-based changes to policy and practice that break down barriers and build new roads are required to enable women to access the healthcare they need.

Funding Statement

The authors received no specific funding for this work.

The PLOS Medicine editors are Raffaella Bosurgi, Callam Davidson, Philippa Dodd, Louise Gaynor-Brook, Caitlin Moyer, Beryne Odeny, and Richard Turner.

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Abortion research that matters: Using core outcomes to enable systematic review

Affiliations.

1 Planned Parenthood League of Massachusetts, Boston, MA, United States.
2 Cochrane Fertility Regulation Review Group, Portland, OR, United States; Center for Health Research, Kaiser Permanente Evidence-based Practice Center, Portland, OR, United States.
3 Center for Health Research, Kaiser Permanente Evidence-based Practice Center, Portland, OR, United States; Department of OB/GYN, Oregon Health & Science University, Portland, OR, United States.
4 Center for Health Research, Kaiser Permanente Evidence-based Practice Center, Portland, OR, United States; Department of OB/GYN, Oregon Health & Science University, Portland, OR, United States. Electronic address: [email protected].
PMID: 36055361
DOI: 10.1016/j.contraception.2022.05.014

Keywords: Abortion; GRADE; Outcomes; Standard outcomes; Systematic reviews.

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Open Access

Why restricting access to abortion damages women’s health

* E-mail: [email protected]

Affiliation Public Library of Science, San Francisco, California, United States of America

The PLOS Medicine Editors

Published: July 26, 2022

https://doi.org/10.1371/journal.pmed.1004075
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Citation: The PLOS Medicine Editors (2022) Why restricting access to abortion damages women’s health. PLoS Med 19(7): e1004075. https://doi.org/10.1371/journal.pmed.1004075

Copyright: © 2022 The PLOS Medicine Editors. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: The authors’ individual competing interests are at http://journals.plos.org/plosmedicine/s/staff-editors . PLOS is funded partly through manuscript publication charges, but the PLOS Medicine Editors are paid a fixed salary (their salaries are not linked to the number of papers published in the journal).

The PLOS Medicine editors are Raffaella Bosurgi, Callam Davidson, Philippa Dodd, Louise Gaynor-Brook, Caitlin Moyer, Beryne Odeny, and Richard Turner.

1. United Nations, Human Rights Office: UN Human Rights Media Center [Internet]. Geneva: Office of the United Nations High Commissioner for Human Rights (OHCHR); c1996–2022. Joint web statement by UN Human rights experts on Supreme Court decision to strike down Roe v. Wade; 2022 Jun 24 [cited 30 Jun 2022]. Available from: https://www.ohchr.org/en/statements/2022/06/joint-web-statement-un-human-rights-experts-supreme-court-decision-strike-down ]
2. Center for Reproductive Rights. The World’s Abortion Laws [Internet]. New York (NY): Center for Reproductive Rights; c1992–2022. [cited June 30, 2022]. Available from: https://reproductiverights.org/maps/worlds-abortion-laws/
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11. World Health Organization. Abortion Care Guideline. Geneva: World Health Organization; 2022 Mar 8. 170 p. Available from: https://www.who.int/publications/i/item/9789240039483 .
12. United Nations, Human Rights Committee (124th session (8 Oct– 2 Nov 2018). General comment no. 36, Article 6, Right to life. Geneva: UN Human Rights Committee; 2019 Sep 3. 21 p.

May 5, 2022

Abortion Rights Are Good Health Care and Good Science

Restricting access to abortion goes against science, safety, and human dignity and portends a dangerous future

By The Editors

Abortion rights demonstrators outside the U.S. Supreme Court in Washington, D.C., U.S., on Wednesday, May 4, 2022.

Valerie Plesch/Bloomberg via Getty Images

The U.S. Supreme Court is about to make a huge mistake.

If the leaked draft opinion in Dobbs v. Jackson Women’s Health Organization is a true indication of the Court’s will, federal abortion rights in this country are about to be struck down. In doing so the Court will not only side against popular opinion on a crucial issue of bodily autonomy, but also signal that politics and religion play a more important role in health care than do science and evidence.

For almost 50 years people in the U.S. who have needed to end a pregnancy have had a legal right to do so. Accessibility and affordability have always been barriers, and anti-abortion lawmakers have chipped away at this right, set forth in Roe v. Wade , but the ability to get a safe and legal abortion before fetal viability was settled law.

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The new decision would strike down Roe and Planned Parenthood v. Casey , an opinion that overturned a Pennsylvania law that required a pregnant married woman to notify her husband in order to obtain abortion services. Many states, mainly governed by conservative lawmakers, have already passed or are planning to introduce laws that either ban abortion outright or put such severe restrictions on this medical procedure that it will be practically impossible to legally end a pregnancy. Some states will make criminals of doctors and other health care providers who perform abortions. Some laws set to go into effect after a Supreme Court ruling would deny people the right to end pregnancies that happen after rape or incest, or that pose grave medical dangers. These laws are contrary to all relevant science, and any health-related claims used to support them are demonstrably wrong.

In passing these laws, anti-abortion legislators often claim that abortion harms people who are pregnant. In a landmark study from the University of California, San Francisco, scientists found the opposite: d enying people abortions led to worse mental and physical health , as well as financial stability. The Turnaway Study looked at about 1,000 women who were seeking abortions, and followed them for five years. Some were just early enough in their pregnancies that they got the procedure, and others were turned away because their pregnancies were slightly past the legal cutoff where they lived. Women who had abortions reported fewer mental health issues, even years later, and their most common reaction was relief . Women denied abortions often experienced brief declines in mental health and higher anxiety.

Women denied abortions were more likely to end up poor, unemployed or receiving government assistance, even though before they asked for an abortion they were in a similar financial place as women who were able to get one. This study, and others, tell us what will happen in a post- Roe world , when people are forced to carry unwanted pregnancies to term because they are denied a most basic form of health care and the ability to make decisions about their own bodies. Access to abortion largely appears to have very positive effects on people’s lives.

The fight against abortion rights is often depicted as a religious mission, but not all religions or religious believers oppose abortion. We note that these political moves are part of a long-standing effort by some conservative Christians, as well as anti-abortion politicians and activists.

By forcing people to have children when they don’t want to, these ideologues strip women of political and earning power, in some cases making them dependent upon men. By forcing people to have children when they are not financially secure, these laws prolong patterns of poverty. And the states with the most restrictive abortion policies often have the worst social safety nets, the worst maternal mortality rates and the greatest health care inequities.

This ideology denies the dangers of pregnancy, despite the fact that in some U.S. states maternal mortality approaches that of some developing nations. Some of the abortion restrictions states have passed are pegged to an early stage of pregnancy. But the biological and genetic problems that lead to complications with pregnancy are too numerous to list, and too variable from person to person to assign a deadline to. Gestational age cutoffs, “heartbeat” laws and total bans go against the basic workings of human biology.

Regardless of how they legally justify their ruling, the justices of the Supreme Court who choose to strike down abortion rights are telling the American public that science doesn’t matter, that evidence can be ignored. High courts have similarly said as much in striking down mask and vaccine mandates during the COVID pandemic. The logic of Alito’s draft—the right to an abortion is not in the Constitution—could apply to all reproductive health, including the Griswold v. Connecticut Supreme Court decision that overturned a law banning birth control. The highest court in the land must value evidence and respect best medical practices, and yet the conservative majority clearly doesn’t.

President Joe Biden and other pro-choice elected officials have said they will work to protect abortion rights. There are legislative means to ensure some degree of abortion access. But with our current federal legislature and the filibuster in place, getting the needed votes to pass measures protecting abortion will be difficult, if not impossible. We hope lawmakers will see abortion rights as an issue that makes it necessary to break through legislative roadblocks.

As our Supreme Court is poised to radically constrain the lives of so many people in the U.S, we applaud those states that are strengthening their abortion protections. We applaud those people who are continuing to fight the legal and practical battles for our right to health care and our right to privacy. And we applaud the health care workers—the doctors, the nurses, the medical assistants—and the volunteers, donors and programs that help people who are pregnant care for themselves and their health. Safe and accessible reproductive health care is a basic right that is supported by science, medicine, and respect for human dignity. Everyone should have access to it.

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Abortion Restrictions and the Threat to Women’s Health

The abortion rights landscape a year after Roe v. Wade was overturned

Annalies Winny

It’s been almost a year since the U.S. Supreme Court overturned Roe v. Wade , dismantling the constitutional right to abortion more than 50 years after the case was decided.

Now, the legal battleground of reproductive rights has grown even more tense. At least a dozen states have banned abortion entirely, and more states are seeking to further restrict access to abortion—making the U.S. an outlier on the global stage: Some 59% of the world's female population currently reside in a country where abortion is broadly allowed.

“And generally over the past several decades, there has been a trend toward increasing liberalization. So this is part of a very unique change in policy happening in the U.S.,” Suzanne Bell , PhD ’18, MPH, said during a May 18 media briefing .

During the briefing, Bell, an assistant professor in Population, Family and Reproductive Health at the Bloomberg School, and Joanne Rosen , JD, MA, a senior lecturer in Health Policy and Management , discussed the state of abortion access in the U.S. and the impact on women’s health—and on physicians—since Roe was overturned. They outlined how abortion restrictions worsen health disparities, how states have responded to Roe’s dismantling, and the potential ramifications of litigation to restrict access to medication abortion for women across the country.

How states have responded

With federal protections for abortion overturned, states were empowered to regulate reproductive health. Rosen noted that some have passed legislation shoring up access to abortion. Fifteen states where abortion remains legal have enacted various additional protections, such as permitting the use of state funds to cover abortion costs; allowing non-physician health professionals to perform abortions; protecting physicians from prosecution, extradition, or other legal action by states that have banned abortion; and prohibiting the disclosure of patients’ medical records without patient permission.

Other states, however, have moved to further erode access, Rosen explained. Even before Dobbs was decided, abortion-hostile states enacted 108 abortion restrictions —in 2021 alone. This is the single highest number of abortion restrictions in any year since Roe was decided in 1973, according to the Guttmacher Institute. In the 11 months since Dobbs was decided, abortion has been banned in 14 states.

Efforts to ban medication abortion nationwide

A Texas case seeking to revoke the FDA’s approval of the safe and effective drug mifepristone—which was used in 53% of abortions in 2020—has “extraordinary” implications that go beyond the possibility of taking mifepristone off the shelves, said Rosen. The litigation also sets a dangerous precedent for court interference in the FDA’s scientific approval process. If the plaintiffs are successful, it “would be the first time a court has abrogated the FDA’s approval of a drug over the objections of the FDA,” Rosen explained. The consequences could be far-reaching, potentially affecting access to any number of drugs for political or ideological reasons.

Other efforts to abolish abortion center on reviving the Comstock Act, an 1873 law banning, among other things, the mailing or transport of products “intended for the prevention of conception or procuring of abortion.” The Comstock Act is one of many “zombie laws”—meaning they’ve long been considered invalid but remain technically on the books—that could see a revival given the precedent set by overturning Roe and invalidating Planned Parenthood v. Casey , the 1992 decision that upheld the right to abortion. Other “zombie laws” in the same legal vein as Comstock, with the same potential for revival, concern same sex marriage and sexual activity and interracial marriage.

Concerns for physicians

The wave of abortion bans have broader implications for the health care workforce.

For one, physicians working in states that ban abortion must contend with “risk management committees” set up by hospitals to determine whether an abortion is warranted in an urgent health care situation where the life of a pregnant person is at risk. “In this context, physicians are finding it difficult to use best medical practices to protect their patients’ well-being”—and they’re concerned about the genuine risk of criminal prosecution, Rosen said.

In this environment, it’s getting harder for hospitals in abortion-hostile states to attract and retain obstetricians and gynecologists, and raising questions about the future of training for these specialties in those states.

“Are they going to entirely leave hostile states and set up their training program elsewhere?” asked Bell. “Or are the people that received training in those states just not going to receive the appropriate training? I think we have yet to see what those full ramifications are.”

Deepening disparities

All of these challenges stand to exacerbate existing disparities in access to quality reproductive health care, Bell added.

Black women are three times as likely, and Hispanic women twice as likely, to seek abortions than white women. And half of all women who get abortions live below the poverty line—many of them in states that limit or are seeking to limit abortions, explained Bell .

Being denied an abortion comes with substantial health risks—especially for vulnerable groups. The risk of maternal death is 15 times higher for carrying a pregnancy to term than it is for abortion, and pregnancy-related complications are 2 to more than 25 times higher for pregnancies ending in birth compared to abortion, Bell explained.

“We have maternal mortality rates that are in some cases twice as high in restrictive states as they are in supportive abortion states,” said Bell—and those restrictions undermine the delivery of basic services, Bell added.

“I want to emphasize that abortion is health care,” Bell said. “Recent state restrictions, coupled with ongoing efforts to curtail access to medication abortion pills nationwide, are an attempt to interfere with the delivery of evidence-based health care and control pregnant people’s bodies, with harmful consequences for individuals and population health.”

Annalies Winny is a producer and writer at the Johns Hopkins Bloomberg School of Public Health.

A Brief History of Abortion in the U.S.
Mifepristone On Trial: An Unprecedented Overreach (podcast)
What’s Happening With Abortion Access Six Months After the SCOTUS Decision (podcast)

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The Most Important Study in the Abortion Debate

Researchers rigorously tested the persistent notion that abortion wounds the women who seek it.

The demographer Diana Greene Foster was in Orlando last month, preparing for the end of Roe v. Wade , when Politico published a leaked draft of a majority Supreme Court opinion striking down the landmark ruling. The opinion, written by Justice Samuel Alito, would revoke the constitutional right to abortion and thus give states the ability to ban the medical procedure.

Foster, the director of the Bixby Population Sciences Research Unit at UC San Francisco, was at a meeting of abortion providers, seeking their help recruiting people for a new study . And she was racing against time. She wanted to look, she told me, “at the last person served in, say, Nebraska, compared to the first person turned away in Nebraska.” Nearly two dozen red and purple states are expected to enact stringent limits or even bans on abortion as soon as the Supreme Court strikes down Roe v. Wade , as it is poised to do. Foster intends to study women with unwanted pregnancies just before and just after the right to an abortion vanishes.

Read: When a right becomes a privilege

When Alito’s draft surfaced, Foster told me, “I was struck by how little it considered the people who would be affected. The experience of someone who’s pregnant when they do not want to be and what happens to their life is absolutely not considered in that document.” Foster’s earlier work provides detailed insight into what does happen. The landmark Turnaway Study , which she led, is a crystal ball into our post- Roe future and, I would argue, the single most important piece of academic research in American life at this moment.

The legal and political debate about abortion in recent decades has tended to focus more on the rights and experience of embryos and fetuses than the people who gestate them. And some commentators—including ones seated on the Supreme Court—have speculated that termination is not just a cruel convenience, but one that harms women too . Foster and her colleagues rigorously tested that notion. Their research demonstrates that, in general, abortion does not wound women physically, psychologically, or financially. Carrying an unwanted pregnancy to term does.

In a 2007 decision , Gonzales v. Carhart , the Supreme Court upheld a ban on one specific, uncommon abortion procedure. In his majority opinion , Justice Anthony Kennedy ventured a guess about abortion’s effect on women’s lives: “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained,” he wrote. “Severe depression and loss of esteem can follow.”

Was that really true? Activists insisted so, but social scientists were not sure . Indeed, they were not sure about a lot of things when it came to the effect of the termination of a pregnancy on a person’s life. Many papers compared individuals who had an abortion with people who carried a pregnancy to term. The problem is that those are two different groups of people; to state the obvious, most people seeking an abortion are experiencing an unplanned pregnancy, while a majority of people carrying to term intended to get pregnant.

Foster and her co-authors figured out a way to isolate the impact of abortion itself. Nearly all states bar the procedure after a certain gestational age or after the point that a fetus is considered viable outside the womb . The researchers could compare people who were “turned away” by a provider because they were too far along with people who had an abortion at the same clinics. (They did not include people who ended a pregnancy for medical reasons.) The women who got an abortion would be similar, in terms of demographics and socioeconomics, to those who were turned away; what would separate the two groups was only that some women got to the clinic on time, and some didn’t.

In time, 30 abortion providers—ones that had the latest gestational limit of any clinic within 150 miles, meaning that a person could not easily access an abortion if they were turned away—agreed to work with the researchers. They recruited nearly 1,000 women to be interviewed every six months for five years. The findings were voluminous, resulting in 50 publications and counting. They were also clear. Kennedy’s speculation was wrong: Women, as a general point, do not regret having an abortion at all.

Researchers found, among other things, that women who were denied abortions were more likely to end up living in poverty. They had worse credit scores and, even years later, were more likely to not have enough money for the basics, such as food and gas. They were more likely to be unemployed. They were more likely to go through bankruptcy or eviction. “The two groups were economically the same when they sought an abortion,” Foster told me. “One became poorer.”

Read: The calamity of unwanted motherhood

In addition, those denied a termination were more likely to be with a partner who abused them. They were more likely to end up as a single parent. They had more trouble bonding with their infants, were less likely to agree with the statement “I feel happy when my child laughs or smiles,” and were more likely to say they “feel trapped as a mother.” They experienced more anxiety and had lower self-esteem, though those effects faded in time. They were half as likely to be in a “very good” romantic relationship at two years. They were less likely to have “aspirational” life plans.

Their bodies were different too. The ones denied an abortion were in worse health, experiencing more hypertension and chronic pain. None of the women who had an abortion died from it. This is unsurprising; other research shows that the procedure has extremely low complication rates , as well as no known negative health or fertility effects . Yet in the Turnaway sample, pregnancy ended up killing two of the women who wanted a termination and did not get one.

The Turnaway Study also showed that abortion is a choice that women often make in order to take care of their family. Most of the women seeking an abortion were already mothers. In the years after they terminated a pregnancy, their kids were better off; they were more likely to hit their developmental milestones and less likely to live in poverty. Moreover, many women who had an abortion went on to have more children. Those pregnancies were much more likely to be planned, and those kids had better outcomes too.

The interviews made clear that women, far from taking a casual view of abortion, took the decision seriously. Most reported using contraception when they got pregnant, and most of the people who sought an abortion after their state’s limit simply did not realize they were pregnant until it was too late. (Many women have irregular periods, do not experience morning sickness, and do not feel fetal movement until late in the second trimester.) The women gave nuanced, compelling reasons for wanting to end their pregnancies.

Afterward, nearly all said that termination had been the right decision. At five years, only 14 percent felt any sadness about having an abortion; two in three ended up having no or very few emotions about it at all. “Relief” was the most common feeling, and an abiding one.

From the May 2022 issue: The future of abortion in a post- Roe America

The policy impact of the Turnaway research has been significant, even though it was published during a period when states have been restricting abortion access. In 2018, the Iowa Supreme Court struck down a law requiring a 72-hour waiting period between when a person seeks and has an abortion, noting that “the vast majority of abortion patients do not regret the procedure, even years later, and instead feel relief and acceptance”—a Turnaway finding. That same finding was cited by members of Chile’s constitutional court as they allowed for the decriminalization of abortion in certain circumstances.

Yet the research has not swayed many people who advocate for abortion bans, believing that life begins at conception and that the law must prioritize the needs of the fetus. Other activists have argued that Turnaway is methodologically flawed; some women approached in the clinic waiting room declined to participate, and not all participating women completed all interviews . “The women who anticipate and experience the most negative reactions to abortion are the least likely to want to participate in interviews,” the activist David Reardon argued in a 2018 article in a Catholic Medical Association journal.

Still, four dozen papers analyzing the Turnaway Study’s findings have been published in peer-reviewed journals; the research is “the gold standard,” Emily M. Johnston, an Urban Institute health-policy expert who wasn’t involved with the project, told me. In the trajectories of women who received an abortion and those who were denied one, “we can understand the impact of abortion on women’s lives,” Foster told me. “They don’t have to represent all women seeking abortion for the findings to be valid.” And her work has been buttressed by other surveys, showing that women fear the repercussions of unplanned pregnancies for good reason and do not tend to regret having a termination. “Among the women we spoke with, they did not regret either choice,” whether that was having an abortion or carrying to term, Johnston told me. “These women were thinking about their desires for themselves, but also were thinking very thoughtfully about what kind of life they could provide for a child.”

The Turnaway study , for Foster, underscored that nobody needs the government to decide whether they need an abortion. If and when America’s highest court overturns Roe , though, an estimated 34 million women of reproductive age will lose some or all access to the procedure in the state where they live. Some people will travel to an out-of-state clinic to terminate a pregnancy; some will get pills by mail to manage their abortions at home; some will “try and do things that are less safe,” as Foster put it. Many will carry to term: The Guttmacher Institute has estimated that there will be roughly 100,000 fewer legal abortions per year post- Roe . “The question now is who is able to circumvent the law, what that costs, and who suffers from these bans,” Foster told me. “The burden of this will be disproportionately put on people who are least able to support a pregnancy and to support a child.”

Ellen Gruber Garvey: I helped women get abortions in pre- Roe America

Foster said that there is a lot we still do not know about how the end of Roe might alter the course of people’s lives—the topic of her new research. “In the Turnaway Study, people were too late to get an abortion, but they didn’t have to feel like the police were going to knock on their door,” she told me. “Now, if you’re able to find an abortion somewhere and you have a complication, do you get health care? Do you seek health care out if you’re having a miscarriage, or are you too scared? If you’re going to travel across state lines, can you tell your mother or your boss what you’re doing?”

In addition, she said that she was uncertain about the role that abortion funds —local, on-the-ground organizations that help people find, travel to, and pay for terminations—might play. “We really don’t know who is calling these hotlines,” she said. “When people call, what support do they need? What is enough, and who falls through the cracks?” She added that many people are unaware that such services exist, and might have trouble accessing them.

People are resourceful when seeking a termination and resilient when denied an abortion, Foster told me. But looking into the post- Roe future, she predicted, “There’s going to be some widespread and scary consequences just from the fact that we’ve made this common health-care practice against the law.” Foster, to her dismay, is about to have a lot more research to do.

Open access
Published: 28 June 2021

Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol

Foluso Ishola ORCID: orcid.org/0000-0002-8644-0570 1 ,
U. Vivian Ukah 1 &
Arijit Nandi 1

Systematic Reviews volume 10 , Article number: 192 ( 2021 ) Cite this article

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A country’s abortion law is a key component in determining the enabling environment for safe abortion. While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, with the majority of them moving away from an absolute ban. However, the implications of these reforms on women’s access to and use of health services, as well as their health outcomes, is uncertain. First, there are methodological challenges to the evaluation of abortion laws, since these changes are not exogenous. Second, extant evaluations may be limited in terms of their generalizability, given variation in reforms across the abortion legality spectrum and differences in levels of implementation and enforcement cross-nationally. This systematic review aims to address this gap. Our aim is to systematically collect, evaluate, and synthesize empirical research evidence concerning the impact of abortion law reforms on women’s health services and outcomes in LMICs.

We will conduct a systematic review of the peer-reviewed literature on changes in abortion laws and women’s health services and outcomes in LMICs. We will search Medline, Embase, CINAHL, and Web of Science databases, as well as grey literature and reference lists of included studies for further relevant literature. As our goal is to draw inference on the impact of abortion law reforms, we will include quasi-experimental studies examining the impact of change in abortion laws on at least one of our outcomes of interest. We will assess the methodological quality of studies using the quasi-experimental study designs series checklist. Due to anticipated heterogeneity in policy changes, outcomes, and study designs, we will synthesize results through a narrative description.

This review will systematically appraise and synthesize the research evidence on the impact of abortion law reforms on women’s health services and outcomes in LMICs. We will examine the effect of legislative reforms and investigate the conditions that might contribute to heterogeneous effects, including whether specific groups of women are differentially affected by abortion law reforms. We will discuss gaps and future directions for research. Findings from this review could provide evidence on emerging strategies to influence policy reforms, implement abortion services and scale up accessibility.

Systematic review registration

PROSPERO CRD42019126927

Peer Review reports

An estimated 25·1 million unsafe abortions occur each year, with 97% of these in developing countries [ 1 , 2 , 3 ]. Despite its frequency, unsafe abortion remains a major global public health challenge [ 4 , 5 ]. According to the World health Organization (WHO), nearly 8% of maternal deaths were attributed to unsafe abortion, with the majority of these occurring in developing countries [ 5 , 6 ]. Approximately 7 million women are admitted to hospitals every year due to complications from unsafe abortion such as hemorrhage, infections, septic shock, uterine and intestinal perforation, and peritonitis [ 7 , 8 , 9 ]. These often result in long-term effects such as infertility and chronic reproductive tract infections. The annual cost of treating major complications from unsafe abortion is estimated at US$ 232 million each year in developing countries [ 10 , 11 ]. The negative consequences on children’s health, well-being, and development have also been documented. Unsafe abortion increases risk of poor birth outcomes, neonatal and infant mortality [ 12 , 13 ]. Additionally, women who lack access to safe and legal abortion are often forced to continue with unwanted pregnancies, and may not seek prenatal care [ 14 ], which might increase risks of child morbidity and mortality.

Access to safe abortion services is often limited due to a wide range of barriers. Collectively, these barriers contribute to the staggering number of deaths and disabilities seen annually as a result of unsafe abortion, which are disproportionately felt in developing countries [ 15 , 16 , 17 ]. A recent systematic review on the barriers to abortion access in low- and middle-income countries (LMICs) implicated the following factors: restrictive abortion laws, lack of knowledge about abortion law or locations that provide abortion, high cost of services, judgmental provider attitudes, scarcity of facilities and medical equipment, poor training and shortage of staff, stigma on social and religious grounds, and lack of decision making power [ 17 ].

An important factor regulating access to abortion is abortion law [ 17 , 18 , 19 ]. Although abortion is a medical procedure, its legal status in many countries has been incorporated in penal codes which specify grounds in which abortion is permitted. These include prohibition in all circumstances, to save the woman’s life, to preserve the woman’s health, in cases of rape, incest, fetal impairment, for economic or social reasons, and on request with no requirement for justification [ 18 , 19 , 20 ].

Although abortion laws in different countries are usually compared based on the grounds under which legal abortions are allowed, these comparisons rarely take into account components of the legal framework that may have strongly restrictive implications, such as regulation of facilities that are authorized to provide abortions, mandatory waiting periods, reporting requirements in cases of rape, limited choice in terms of the method of abortion, and requirements for third-party authorizations [ 19 , 21 , 22 ]. For example, the Zambian Termination of Pregnancy Act permits abortion on socio-economic grounds. It is considered liberal, as it permits legal abortions for more indications than most countries in Sub-Saharan Africa; however, abortions must only be provided in registered hospitals, and three medical doctors—one of whom must be a specialist—must provide signatures to allow the procedure to take place [ 22 ]. Given the critical shortage of doctors in Zambia [ 23 ], this is in fact a major restriction that is only captured by a thorough analysis of the conditions under which abortion services are provided.

Additionally, abortion laws may exist outside the penal codes in some countries, where they are supplemented by health legislation and regulations such as public health statutes, reproductive health acts, court decisions, medical ethic codes, practice guidelines, and general health acts [ 18 , 19 , 24 ]. The diversity of regulatory documents may lead to conflicting directives about the grounds under which abortion is lawful [ 19 ]. For example, in Kenya and Uganda, standards and guidelines on the reduction of morbidity and mortality due to unsafe abortion supported by the constitution was contradictory to the penal code, leaving room for an ambiguous interpretation of the legal environment [ 25 ].

Regulations restricting the range of abortion methods from which women can choose, including medication abortion in particular, may also affect abortion access [ 26 , 27 ]. A literature review contextualizing medication abortion in seven African countries reported that incidence of medication abortion is low despite being a safe, effective, and low-cost abortion method, likely due to legal restrictions on access to the medications [ 27 ].

Over the past two decades, many LMICs have reformed their abortion laws [ 3 , 28 ]. Most have expanded the grounds on which abortion may be performed legally, while very few have restricted access. Countries like Uruguay, South Africa, and Portugal have amended their laws to allow abortion on request in the first trimester of pregnancy [ 29 , 30 ]. Conversely, in Nicaragua, a law to ban all abortion without any exception was introduced in 2006 [ 31 ].

Progressive reforms are expected to lead to improvements in women’s access to safe abortion and health outcomes, including reductions in the death and disabilities that accompany unsafe abortion, and reductions in stigma over the longer term [ 17 , 29 , 32 ]. However, abortion law reforms may yield different outcomes even in countries that experience similar reforms, as the legislative processes that are associated with changing abortion laws take place in highly distinct political, economic, religious, and social contexts [ 28 , 33 ]. This variation may contribute to abortion law reforms having different effects with respect to the health services and outcomes that they are hypothesized to influence [ 17 , 29 ].

Extant empirical literature has examined changes in abortion-related morbidity and mortality, contraceptive usage, fertility, and other health-related outcomes following reforms to abortion laws [ 34 , 35 , 36 , 37 ]. For example, a study in Mexico reported that a policy that decriminalized and subsidized early-term elective abortion led to substantial reductions in maternal morbidity and that this was particularly strong among vulnerable populations such as young and socioeconomically disadvantaged women [ 38 ].

To the best of our knowledge, however, the growing literature on the impact of abortion law reforms on women’s health services and outcomes has not been systematically reviewed. A study by Benson et al. evaluated evidence on the impact of abortion policy reforms on maternal death in three countries, Romania, South Africa, and Bangladesh, where reforms were immediately followed by strategies to implement abortion services, scale up accessibility, and establish complementary reproductive and maternal health services [ 39 ]. The three countries highlighted in this paper provided unique insights into implementation and practical application following law reforms, in spite of limited resources. However, the review focused only on a selection of countries that have enacted similar reforms and it is unclear if its conclusions are more widely generalizable.

Accordingly, the primary objective of this review is to summarize studies that have estimated the causal effect of a change in abortion law on women’s health services and outcomes. Additionally, we aim to examine heterogeneity in the impacts of abortion reforms, including variation across specific population sub-groups and contexts (e.g., due to variations in the intensity of enforcement and service delivery). Through this review, we aim to offer a higher-level view of the impact of abortion law reforms in LMICs, beyond what can be gained from any individual study, and to thereby highlight patterns in the evidence across studies, gaps in current research, and to identify promising programs and strategies that could be adapted and applied more broadly to increase access to safe abortion services.

The review protocol has been reported using Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines [ 40 ] (Additional file 1 ). It was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database CRD42019126927.

Eligibility criteria

Types of studies.

This review will consider quasi-experimental studies which aim to estimate the causal effect of a change in a specific law or reform and an outcome, but in which participants (in this case jurisdictions, whether countries, states/provinces, or smaller units) are not randomly assigned to treatment conditions [ 41 ]. Eligible designs include the following:

Pretest-posttest designs where the outcome is compared before and after the reform, as well as nonequivalent groups designs, such as pretest-posttest design that includes a comparison group, also known as a controlled before and after (CBA) designs.

Interrupted time series (ITS) designs where the trend of an outcome after an abortion law reform is compared to a counterfactual (i.e., trends in the outcome in the post-intervention period had the jurisdiction not enacted the reform) based on the pre-intervention trends and/or a control group [ 42 , 43 ].

Differences-in-differences (DD) designs, which compare the before vs. after change in an outcome in jurisdictions that experienced an abortion law reform to the corresponding change in the places that did not experience such a change, under the assumption of parallel trends [ 44 , 45 ].

Synthetic controls (SC) approaches, which use a weighted combination of control units that did not experience the intervention, selected to match the treated unit in its pre-intervention outcome trend, to proxy the counterfactual scenario [ 46 , 47 ].

Regression discontinuity (RD) designs, which in the case of eligibility for abortion services being determined by the value of a continuous random variable, such as age or income, would compare the distributions of post-intervention outcomes for those just above and below the threshold [ 48 ].

There is heterogeneity in the terminology and definitions used to describe quasi-experimental designs, but we will do our best to categorize studies into the above groups based on their designs, identification strategies, and assumptions.

Our focus is on quasi-experimental research because we are interested in studies evaluating the effect of population-level interventions (i.e., abortion law reform) with a design that permits inference regarding the causal effect of abortion legislation, which is not possible from other types of observational designs such as cross-sectional studies, cohort studies or case-control studies that lack an identification strategy for addressing sources of unmeasured confounding (e.g., secular trends in outcomes). We are not excluding randomized studies such as randomized controlled trials, cluster randomized trials, or stepped-wedge cluster-randomized trials; however, we do not expect to identify any relevant randomized studies given that abortion policy is unlikely to be randomly assigned. Since our objective is to provide a summary of empirical studies reporting primary research, reviews/meta-analyses, qualitative studies, editorials, letters, book reviews, correspondence, and case reports/studies will also be excluded.

Our population of interest includes women of reproductive age (15–49 years) residing in LMICs, as the policy exposure of interest applies primarily to women who have a demand for sexual and reproductive health services including abortion.

Intervention

The intervention in this study refers to a change in abortion law or policy, either from a restrictive policy to a non-restrictive or less restrictive one, or vice versa. This can, for example, include a change from abortion prohibition in all circumstances to abortion permissible in other circumstances, such as to save the woman’s life, to preserve the woman’s health, in cases of rape, incest, fetal impairment, for economic or social reasons, or on request with no requirement for justification. It can also include the abolition of existing abortion policies or the introduction of new policies including those occurring outside the penal code, which also have legal standing, such as:

National constitutions;

Supreme court decisions, as well as higher court decisions;

Customary or religious law, such as interpretations of Muslim law;

Medical ethical codes; and

Regulatory standards and guidelines governing the provision of abortion.

We will also consider national and sub-national reforms, although we anticipate that most reforms will operate at the national level.

The comparison group represents the counterfactual scenario, specifically the level and/or trend of a particular post-intervention outcome in the treated jurisdiction that experienced an abortion law reform had it, counter to the fact, not experienced this specific intervention. Comparison groups will vary depending on the type of quasi-experimental design. These may include outcome trends after abortion reform in the same country, as in the case of an interrupted time series design without a control group, or corresponding trends in countries that did not experience a change in abortion law, as in the case of the difference-in-differences design.

Outcome measures

Primary outcomes.

Access to abortion services: There is no consensus on how to measure access but we will use the following indicators, based on the relevant literature [ 49 ]: [ 1 ] the availability of trained staff to provide care, [ 2 ] facilities are geographically accessible such as distance to providers, [ 3 ] essential equipment, supplies and medications, [ 4 ] services provided regardless of woman’s ability to pay, [ 5 ] all aspects of abortion care are explained to women, [ 6 ] whether staff offer respectful care, [ 7 ] if staff work to ensure privacy, [ 8 ] if high-quality, supportive counseling is provided, [ 9 ] if services are offered in a timely manner, and [ 10 ] if women have the opportunity to express concerns, ask questions, and receive answers.

Use of abortion services refers to induced pregnancy termination, including medication abortion and number of women treated for abortion-related complications.

Secondary outcomes

Current use of any method of contraception refers to women of reproductive age currently using any method contraceptive method.

Future use of contraception refers to women of reproductive age who are not currently using contraception but intend to do so in the future.

Demand for family planning refers to women of reproductive age who are currently using, or whose sexual partner is currently using, at least one contraceptive method.

Unmet need for family planning refers to women of reproductive age who want to stop or delay childbearing but are not using any method of contraception.

Fertility rate refers to the average number of children born to women of childbearing age.

Neonatal morbidity and mortality refer to disability or death of newborn babies within the first 28 days of life.

Maternal morbidity and mortality refer to disability or death due to complications from pregnancy or childbirth.

There will be no language, date, or year restrictions on studies included in this systematic review.

Studies have to be conducted in a low- and middle-income country. We will use the country classification specified in the World Bank Data Catalogue to identify LMICs (Additional file 2 ).

Search methods

We will perform searches for eligible peer-reviewed studies in the following electronic databases.

Ovid MEDLINE(R) (from 1946 to present)

Embase Classic+Embase on OvidSP (from 1947 to present)

CINAHL (1973 to present); and

Web of Science (1900 to present)

The reference list of included studies will be hand searched for additional potentially relevant citations. Additionally, a grey literature search for reports or working papers will be done with the help of Google and Social Science Research Network (SSRN).

Search strategy

A search strategy, based on the eligibility criteria and combining subject indexing terms (i.e., MeSH) and free-text search terms in the title and abstract fields, will be developed for each electronic database. The search strategy will combine terms related to the interventions of interest (i.e., abortion law/policy), etiology (i.e., impact/effect), and context (i.e., LMICs) and will be developed with the help of a subject matter librarian. We opted not to specify outcomes in the search strategy in order to maximize the sensitivity of our search. See Additional file 3 for a draft of our search strategy.

Data collection and analysis

Data management.

Search results from all databases will be imported into Endnote reference manager software (Version X9, Clarivate Analytics) where duplicate records will be identified and excluded using a systematic, rigorous, and reproducible method that utilizes a sequential combination of fields including author, year, title, journal, and pages. Rayyan systematic review software will be used to manage records throughout the review [ 50 ].

Selection process

Two review authors will screen titles and abstracts and apply the eligibility criteria to select studies for full-text review. Reference lists of any relevant articles identified will be screened to ensure no primary research studies are missed. Studies in a language different from English will be translated by collaborators who are fluent in the particular language. If no such expertise is identified, we will use Google Translate [ 51 ]. Full text versions of potentially relevant articles will be retrieved and assessed for inclusion based on study eligibility criteria. Discrepancies will be resolved by consensus or will involve a third reviewer as an arbitrator. The selection of studies, as well as reasons for exclusions of potentially eligible studies, will be described using a PRISMA flow chart.

Data extraction

Data extraction will be independently undertaken by two authors. At the conclusion of data extraction, these two authors will meet with the third author to resolve any discrepancies. A piloted standardized extraction form will be used to extract the following information: authors, date of publication, country of study, aim of study, policy reform year, type of policy reform, data source (surveys, medical records), years compared (before and after the reform), comparators (over time or between groups), participant characteristics (age, socioeconomic status), primary and secondary outcomes, evaluation design, methods used for statistical analysis (regression), estimates reported (means, rates, proportion), information to assess risk of bias (sensitivity analyses), sources of funding, and any potential conflicts of interest.

Risk of bias and quality assessment

Two independent reviewers with content and methodological expertise in methods for policy evaluation will assess the methodological quality of included studies using the quasi-experimental study designs series risk of bias checklist [ 52 ]. This checklist provides a list of criteria for grading the quality of quasi-experimental studies that relate directly to the intrinsic strength of the studies in inferring causality. These include [ 1 ] relevant comparison, [ 2 ] number of times outcome assessments were available, [ 3 ] intervention effect estimated by changes over time for the same or different groups, [ 4 ] control of confounding, [ 5 ] how groups of individuals or clusters were formed (time or location differences), and [ 6 ] assessment of outcome variables. Each of the following domains will be assigned a “yes,” “no,” or “possibly” bias classification. Any discrepancies will be resolved by consensus or a third reviewer with expertise in review methodology if required.

Confidence in cumulative evidence

The strength of the body of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system [ 53 ].

Data synthesis

We anticipate that risk of bias and heterogeneity in the studies included may preclude the use of meta-analyses to describe pooled effects. This may necessitate the presentation of our main findings through a narrative description. We will synthesize the findings from the included articles according to the following key headings:

Information on the differential aspects of the abortion policy reforms.

Information on the types of study design used to assess the impact of policy reforms.

Information on main effects of abortion law reforms on primary and secondary outcomes of interest.

Information on heterogeneity in the results that might be due to differences in study designs, individual-level characteristics, and contextual factors.

Potential meta-analysis

If outcomes are reported consistently across studies, we will construct forest plots and synthesize effect estimates using meta-analysis. Statistical heterogeneity will be assessed using the I 2 test where I 2 values over 50% indicate moderate to high heterogeneity [ 54 ]. If studies are sufficiently homogenous, we will use fixed effects. However, if there is evidence of heterogeneity, a random effects model will be adopted. Summary measures, including risk ratios or differences or prevalence ratios or differences will be calculated, along with 95% confidence intervals (CI).

Analysis of subgroups

If there are sufficient numbers of included studies, we will perform sub-group analyses according to type of policy reform, geographical location and type of participant characteristics such as age groups, socioeconomic status, urban/rural status, education, or marital status to examine the evidence for heterogeneous effects of abortion laws.

Sensitivity analysis

Sensitivity analyses will be conducted if there are major differences in quality of the included articles to explore the influence of risk of bias on effect estimates.

Meta-biases

If available, studies will be compared to protocols and registers to identify potential reporting bias within studies. If appropriate and there are a sufficient number of studies included, funnel plots will be generated to determine potential publication bias.

This systematic review will synthesize current evidence on the impact of abortion law reforms on women’s health. It aims to identify which legislative reforms are effective, for which population sub-groups, and under which conditions.

Potential limitations may include the low quality of included studies as a result of suboptimal study design, invalid assumptions, lack of sensitivity analysis, imprecision of estimates, variability in results, missing data, and poor outcome measurements. Our review may also include a limited number of articles because we opted to focus on evidence from quasi-experimental study design due to the causal nature of the research question under review. Nonetheless, we will synthesize the literature, provide a critical evaluation of the quality of the evidence and discuss the potential effects of any limitations to our overall conclusions. Protocol amendments will be recorded and dated using the registration for this review on PROSPERO. We will also describe any amendments in our final manuscript.

Synthesizing available evidence on the impact of abortion law reforms represents an important step towards building our knowledge base regarding how abortion law reforms affect women’s health services and health outcomes; we will provide evidence on emerging strategies to influence policy reforms, implement abortion services, and scale up accessibility. This review will be of interest to service providers, policy makers and researchers seeking to improve women’s access to safe abortion around the world.

Abbreviations

Cumulative index to nursing and allied health literature

Excerpta medica database

Low- and middle-income countries

Preferred reporting items for systematic review and meta-analysis protocols

International prospective register of systematic reviews

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tuncalp O, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model. Lancet. 2017;390(10110):2372–81. https://doi.org/10.1016/S0140-6736(17)31794-4 .

Article PubMed PubMed Central Google Scholar

Guttmacher Institute. Induced Abortion Worldwide; Global Incidence and Trends 2018. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide . Accessed 15 Dec 2019.

Singh S, Remez L, Sedgh G, Kwok L, Onda T. Abortion worldwide 2017: uneven progress and unequal access. NewYork: Guttmacher Institute; 2018.

Book Google Scholar

Fusco CLB. Unsafe abortion: a serious public health issue in a poverty stricken population. Reprod Clim. 2013;2(8):2–9.

Google Scholar

Rehnstrom Loi U, Gemzell-Danielsson K, Faxelid E, Klingberg-Allvin M. Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health. 2015;15(1):139. https://doi.org/10.1186/s12889-015-1502-2 .

Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):E323–E33. https://doi.org/10.1016/S2214-109X(14)70227-X .

Article PubMed Google Scholar

Benson J, Nicholson LA, Gaffikin L, Kinoti SN. Complications of unsafe abortion in sub-Saharan Africa: a review. Health Policy Plan. 1996;11(2):117–31. https://doi.org/10.1093/heapol/11.2.117 .

Abiodun OM, Balogun OR, Adeleke NA, Farinloye EO. Complications of unsafe abortion in South West Nigeria: a review of 96 cases. Afr J Med Med Sci. 2013;42(1):111–5.

CAS PubMed Google Scholar

Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2016;123(9):1489–98. https://doi.org/10.1111/1471-0528.13552 .

Article CAS PubMed Google Scholar

Vlassoff M, Walker D, Shearer J, Newlands D, Singh S. Estimates of health care system costs of unsafe abortion in Africa and Latin America. Int Perspect Sex Reprod Health. 2009;35(3):114–21. https://doi.org/10.1363/3511409 .

Singh S, Darroch JE. Adding it up: costs and benefits of contraceptive services. Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund; 2012.

Auger N, Bilodeau-Bertrand M, Sauve R. Abortion and infant mortality on the first day of life. Neonatology. 2016;109(2):147–53. https://doi.org/10.1159/000442279 .

Krieger N, Gruskin S, Singh N, Kiang MV, Chen JT, Waterman PD, et al. Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010. SSM Popul Health. 2016;2:277–93. https://doi.org/10.1016/j.ssmph.2016.03.007 .

Banaem LM, Majlessi F. A comparative study of low 5-minute Apgar scores (< 8) in newborns of wanted versus unwanted pregnancies in southern Tehran, Iran (2006-2007). J Matern Fetal Neonatal Med. 2008;21(12):898–901. https://doi.org/10.1080/14767050802372390 .

Bhandari A. Barriers in access to safe abortion services: perspectives of potential clients from a hilly district of Nepal. Trop Med Int Health. 2007;12:87.

Seid A, Yeneneh H, Sende B, Belete S, Eshete H, Fantahun M, et al. Barriers to access safe abortion services in East Shoa and Arsi Zones of Oromia Regional State, Ethiopia. J Health Dev. 2015;29(1):13–21.

Arroyave FAB, Moreno PA. A systematic bibliographical review: barriers and facilitators for access to legal abortion in low and middle income countries. Open J Prev Med. 2018;8(5):147–68. https://doi.org/10.4236/ojpm.2018.85015 .

Article Google Scholar

Boland R, Katzive L. Developments in laws on induced abortion: 1998-2007. Int Fam Plan Perspect. 2008;34(3):110–20. https://doi.org/10.1363/3411008 .

Lavelanet AF, Schlitt S, Johnson BR Jr, Ganatra B. Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion. BMC Int Health Hum Rights. 2018;18(1):44. https://doi.org/10.1186/s12914-018-0183-1 .

United Nations Population Division. Abortion policies: A global review. Major dimensions of abortion policies. 2002 [Available from: https://www.un.org/en/development/desa/population/publications/abortion/abortion-policies-2002.asp .

Johnson BR, Lavelanet AF, Schlitt S. Global abortion policies database: a new approach to strengthening knowledge on laws, policies, and human rights standards. Bmc Int Health Hum Rights. 2018;18(1):35. https://doi.org/10.1186/s12914-018-0174-2 .

Haaland MES, Haukanes H, Zulu JM, Moland KM, Michelo C, Munakampe MN, et al. Shaping the abortion policy - competing discourses on the Zambian termination of pregnancy act. Int J Equity Health. 2019;18(1):20. https://doi.org/10.1186/s12939-018-0908-8 .

Schatz JJ. Zambia’s health-worker crisis. Lancet. 2008;371(9613):638–9. https://doi.org/10.1016/S0140-6736(08)60287-1 .

Erdman JN, Johnson BR. Access to knowledge and the Global Abortion Policies Database. Int J Gynecol Obstet. 2018;142(1):120–4. https://doi.org/10.1002/ijgo.12509 .

Cleeve A, Oguttu M, Ganatra B, Atuhairwe S, Larsson EC, Makenzius M, et al. Time to act-comprehensive abortion care in east Africa. Lancet Glob Health. 2016;4(9):E601–E2. https://doi.org/10.1016/S2214-109X(16)30136-X .

Berer M, Hoggart L. Medical abortion pills have the potential to change everything about abortion. Contraception. 2018;97(2):79–81. https://doi.org/10.1016/j.contraception.2017.12.006 .

Moseson H, Shaw J, Chandrasekaran S, Kimani E, Maina J, Malisau P, et al. Contextualizing medication abortion in seven African nations: A literature review. Health Care Women Int. 2019;40(7-9):950–80. https://doi.org/10.1080/07399332.2019.1608207 .

Blystad A, Moland KM. Comparative cases of abortion laws and access to safe abortion services in sub-Saharan Africa. Trop Med Int Health. 2017;22:351.

Berer M. Abortion law and policy around the world: in search of decriminalization. Health Hum Rights. 2017;19(1):13–27.

PubMed PubMed Central Google Scholar

Johnson BR, Mishra V, Lavelanet AF, Khosla R, Ganatra B. A global database of abortion laws, policies, health standards and guidelines. B World Health Organ. 2017;95(7):542–4. https://doi.org/10.2471/BLT.17.197442 .

Replogle J. Nicaragua tightens up abortion laws. Lancet. 2007;369(9555):15–6. https://doi.org/10.1016/S0140-6736(07)60011-7 .

Keogh LA, Newton D, Bayly C, McNamee K, Hardiman A, Webster A, et al. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. J Fam Plann Reprod Health Care. 2017;43(1):18–24. https://doi.org/10.1136/jfprhc-2016-101541 .

Levels M, Sluiter R, Need A. A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010. Health Policy. 2014;118(1):95–104. https://doi.org/10.1016/j.healthpol.2014.06.008 .

Serbanescu F, Morris L, Stupp P, Stanescu A. The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania. Stud Fam Plann. 1995;26(2):76–87. https://doi.org/10.2307/2137933 .

Henderson JT, Puri M, Blum M, Harper CC, Rana A, Gurung G, et al. Effects of Abortion Legalization in Nepal, 2001-2010. PLoS ONE. 2013;8(5):e64775. https://doi.org/10.1371/journal.pone.0064775 .

Goncalves-Pinho M, Santos JV, Costa A, Costa-Pereira A, Freitas A. The impact of a liberalisation law on legally induced abortion hospitalisations. Eur J Obstet Gynecol Reprod Biol. 2016;203:142–6. https://doi.org/10.1016/j.ejogrb.2016.05.037 .

Latt SM, Milner A, Kavanagh A. Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries. BMC Women’s Health. 2019;19(1). https://doi.org/10.1186/s12905-018-0705-y .

Clarke D, Muhlrad H. Abortion laws and women’s health. IZA discussion papers 11890. Bonn: IZA Institute of Labor Economics; 2018.

Benson J, Andersen K, Samandari G. Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh. Reprod Health. 2011;8(39). https://doi.org/10.1186/1742-4755-8-39 .

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj-Brit Med J. 2015;349.

William R. Shadish, Thomas D. Cook, Donald T. Campbell. Experimental and quasi-experimental designs for generalized causal inference. Boston, New York; 2002.

Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55. https://doi.org/10.1093/ije/dyw098 .

Bernal JL, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. Int J Epidemiol. 2018;47(6):2082–93. https://doi.org/10.1093/ije/dyy135 .

Meyer BD. Natural and quasi-experiments in economics. J Bus Econ Stat. 1995;13(2):151–61.

Strumpf EC, Harper S, Kaufman JS. Fixed effects and difference in differences. In: Methods in Social Epidemiology ed. San Francisco CA: Jossey-Bass; 2017.

Abadie A, Diamond A, Hainmueller J. Synthetic control methods for comparative case studies: estimating the effect of California’s Tobacco Control Program. J Am Stat Assoc. 2010;105(490):493–505. https://doi.org/10.1198/jasa.2009.ap08746 .

Article CAS Google Scholar

Abadie A, Diamond A, Hainmueller J. Comparative politics and the synthetic control method. Am J Polit Sci. 2015;59(2):495–510. https://doi.org/10.1111/ajps.12116 .

Moscoe E, Bor J, Barnighausen T. Regression discontinuity designs are underutilized in medicine, epidemiology, and public health: a review of current and best practice. Journal of Clinical Epidemiology. 2015;68(2):132–43. https://doi.org/10.1016/j.jclinepi.2014.06.021 .

Dennis A, Blanchard K, Bessenaar T. Identifying indicators for quality abortion care: a systematic literature review. J Fam Plan Reprod H. 2017;43(1):7–15. https://doi.org/10.1136/jfprhc-2015-101427 .

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4 .

Jackson JL, Kuriyama A, Anton A, Choi A, Fournier JP, Geier AK, et al. The accuracy of Google Translate for abstracting data from non-English-language trials for systematic reviews. Ann Intern Med. 2019.

Reeves BC, Wells GA, Waddington H. Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels. J Clin Epidemiol. 2017;89:30–42. https://doi.org/10.1016/j.jclinepi.2017.02.016 .

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD .

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186 .

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We thank Genevieve Gore, Liaison Librarian at McGill University, for her assistance with refining the research question, keywords, and Mesh terms for the preliminary search strategy.

The authors acknowledge funding from the Fonds de recherche du Quebec – Santé (FRQS) PhD doctoral awards and Canadian Institutes of Health Research (CIHR) Operating Grant, “Examining the impact of social policies on health equity” (ROH-115209).

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Ishola, F., Ukah, U.V. & Nandi, A. Impact of abortion law reforms on women’s health services and outcomes: a systematic review protocol. Syst Rev 10 , 192 (2021). https://doi.org/10.1186/s13643-021-01739-w

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Abortion is an issue that has ethical, moral, and religious considerations for many people, making it a topic that impacts all of society. Read the overview below to gain a balanced understanding of the issue and explore the previews of opinion articles that showcase many perspectives on reproductive rights.

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Abortion topic overview.

"Abortion" Opposing Viewpoints Online Collection , Gale, 2024.

Abortion is a medical or surgical procedure to deliberately end a pregnancy. In 1973 the US Supreme Court decision in Roe v. Wade ruled that the Constitution protects the right to an abortion prior to the viability of a fetus. Until the 2022 ruling in Dobbs v. Jackson Women's Health Organization, Roe v. Wade allowed a person living in any US state to exercise the right to an abortion at their own discretion through the end of the first trimester, around the twelfth week of pregnancy. States were allowed some power to regulate abortion access during the second and third trimesters. The Dobbs ruling, however, ended the federal protections for abortion rights and returned to the states the authority to determine abortion law.

In the decades between Roe and Dobbs , activists and policy makers in many states sought to change legal protections for reproductive rights. In 2020 lawmakers in twelve states tried to use the COVID-19 pandemic as justification to temporarily ban abortion as a "nonessential service." In 2021 several states introduced new restrictions on abortion, implementing over one hundred new abortion restrictions. Though the public has consistently indicated opposition to bans on abortion, several state legislatures passed bans in anticipation of the conservative Supreme Court majority overturning the nearly fifty-year-old Roe decision. Since the decision, new abortion laws have been passed across the country, some restricting and some easing access to abortion.

Main Ideas

Abortion refers to a procedure to terminate a pregnancy. The term is typically applied to a planned medical or surgical procedure.
People who support legal access to abortion typically identify as pro-choice , while those who support bans and heavy restrictions identify as pro-life .
Medical abortions can take place during the first trimester of a pregnancy. In these procedures, the patient takes a combination of drugs to induce an abortion.
In 1973 the US Supreme Court ruled in Roe v. Wade that state laws banning abortion during the first trimester of pregnancy were unconstitutional. Reproductive rights advocates challenged subsequent restrictions placed on abortion in federal court.
Passed in 1976, the Hyde Amendment forbids the use of federal funds for abortions except under cases of rape, incest, or in which continuing the pregnancy would threaten the woman's health.
In 2022 the US Supreme Court ruled in Dobbs v. Jackson Women's Health Organization that the US Constitution did not guarantee the right to abortion. The decision overturned the court's previous ruling in Roe v. Wade .
After the Dobbs ruling, many states passed or implemented abortion bans or restrictions, despite continuing US public support for legal abortion. Bans have increased travel to obtain abortions to states where it remains legal and resulted in increased maternal and infant deaths in states where abortion was banned.

SUPPORT FOR AND OPPOSITION TO ABORTION

Opponents of abortion, who generally refer to themselves as pro-life , typically object to the practice for religious or ethical reasons, contending that the procedure amounts to the killing of what they consider to be a human life. Supporters of abortion rights, who typically identify as pro-choice , consider it an issue of human rights, asserting that individuals should be able to make medical decisions about their own bodies and lives. Both movements encompass a range of opinions on the subject. Some pro-life activists may condone abortions in cases of rape or incest, while others argue that all abortion is murder. Within the pro-choice movement, some activists contend that no restrictions should be placed on abortion, while others support laws requiring a waiting period before abortions can be performed or that minors obtain permission from their parents.

The majority of Americans oppose banning abortion altogether, with just 13 percent of respondents to a May 2022 Gallup poll indicating a belief that abortion should be illegal under all circumstances. However, the public has remained divided on the extent to which the government should be allowed to impose restrictions. A 2023 Pew Research Center poll found that 64 percent of US adults believed abortion should be legal in all or most cases, compared to 34 percent who said it should be prohibited in all or most cases. Poll results also showed a partisan divide on abortion that has widened over time, with almost 90 percent of Democrats believing abortion should be legal in all or most cases in 2022 compared to 21 percent of Republicans. According to an April 2023 report from the Pew Research Center, 54 percent of Americans said it would be very or somewhat easy to get an abortion in their area, compared to 65 percent in 2019. A further 34 percent of respondents told Pew it should be easier to have an abortion in their area, up from 26 percent in 2019.

After Roe was overturned, protest marches and demonstrations erupted across the United States and lasted for days, with some commentators noting the wide discrepancy between popular support for Roe and the court's rejection of it. While abortion has long been considered a feminist or women's rights issue, the protests highlighted its effects on all Americans regardless of gender. The Dobbs ruling removed precedents related to the right to privacy and the right to bodily autonomy, neither of which is specifically stated in the Constitution. However, these assumed rights have been foundational to rulings decriminalizing interracial marriage, contraception, nonprocreative sex, and same-sex marriage.

Surgical and Medical Abortions

Most abortions take place within the first trimester of pregnancy. The two types of abortion are surgical and medication . The most commonly performed surgical abortion procedure is suction abortion , also referred to as vacuum aspiration , which involves removing tissue from the uterus through a thin tube. The procedure is less invasive than surgeries at later stages of pregnancy, which require labor to be induced. First-trimester surgical abortions performed by trained medical professionals are among the safest and simplest forms of surgery. Data from the US Centers for Disease Control and Prevention (CDC) suggests that many fewer women die from legal abortions than from childbirth or many other common procedures, leading many medical experts to conclude that abortion is safer than giving birth in the United States.

Abortions achieved with drugs instead of surgery are called medication abortions and are considered safe and effective until between nine and eleven weeks after the last menstrual period. The most commonly used drugs for medication abortions in the United States are mifepristone and misoprostol, taken in sequence as prescribed by a health care provider. Patients first take mifepristone (previously called RU-486), which blocks the body's natural production of progesterone, an essential pregnancy hormone. The patient takes the second pill, misoprostol, two days later. This drug causes the uterus to contract and expel the embryo. Medication abortions are different from emergency contraception, a type of birth control pill used after unprotected sexual intercourse that prevents pregnancy.

The number of medication abortions surpassed the number of surgical abortions for the first time in 2020, accounting for an estimated 54 percent of all abortions that year, according to the Guttmacher Institute. In April 2021, due in part to COVID-19's impact on providing and accessing health care services, the US Food and Drug Administration (FDA) lifted a ban on dispensing abortion medication through the mail. The decision enabled patients to access abortion without risking COVID exposure and allowed abortion providers that operate online to mail pills to more states. The FDA made this change permanent in December 2021.

Roe V. Wade

Abortions were commonly performed in the United States at the time of its founding and were not restricted by law until Connecticut passed the first anti-abortion law in 1821. Until the Roe v. Wade ruling in 1973 there was no federal standard for abortion laws, which were left to the discretion of state legislatures. By 1967 forty-nine states and the District of Columbia had classified abortion as a felony crime in most cases. That same year, however, Colorado passed a law that allowed women to seek voluntary abortions. Several states followed Colorado in liberalizing their abortion laws. By 1973 laws prohibiting abortions had been repealed in four states and loosened in fourteen. In states where abortions were prohibited by law, women who wished to terminate their pregnancies sought out illegal abortions provided by health care workers who risked jeopardizing their careers or by individuals without the proper skills or tools to perform the procedure safely.

In Roe v. Wade , the Supreme Court ruled that restrictive abortion laws are unconstitutional and violate a woman's right to privacy, as implied by the due process clause of the Fourteenth Amendment. The court's decision also determined that an embryo or unviable fetus is not a person in the legal sense. The ruling established that the decision to terminate a pregnancy during the first trimester was the sole decision of the pregnant person and their physician but permitted state governments to regulate abortion during the second trimester. States could ban abortion after the fetus had reached viability, except in cases where the pregnant person's health is endangered. Viability refers to a fetus's ability to survive outside of the womb. The point at which viability is achieved during a pregnancy remains a topic of debate, though it is usually accepted as near the end of the second trimester, at around twenty-four weeks.

In Doe v. Bolton , a companion case to Roe v. Wade decided on the same day, the Supreme Court reaffirmed its decision in Roe v. Wade by prohibiting laws that require admission to a hospital, approval by a hospital abortion committee, a second and third medical opinion, or legal residence in a state before an abortion can be performed. The decision also extended the definition of what posed a health threat to the pregnant person when performing a post-viability abortion by allowing a health care provider to consider such factors as the woman's age and emotional and psychological health. These two court decisions contributed to a notable decrease in mortality rates among pregnant women.

After Roe , the Supreme Court heard several cases that challenged the ruling. In Planned Parenthood v. Danforth (1976), the court ruled against several restrictions imposed by Missouri's abortion laws, thus expanding access to abortion. One year later, however, the court ruled in Maher v. Roe that state governments could choose to deny public funds for an abortion, granting the government additional control over reproductive health care. The Maher v. Roe decision took advantage of the Hyde Amendment, legislation passed by Congress in 1976 that excluded abortion from the list of medical services provided and covered through Medicaid, the federal and state government program that subsidizes medical costs for patients with limited financial means.

CAMPAIGN TO OVERTURN ROE V. WADE

Responding first to a trend in the states toward liberalizing abortion laws and later to the court's decision in Roe v. Wade , activists founded several organizations in the late 1960s and 1970s, giving rise to a network of fervent pro-life groups. On the one-year anniversary of the Roe decision, approximately twenty thousand activists in Washington, DC, participated in the first March for Life, which became an annual event for anti-abortion activists. Activists also commonly hold public demonstrations outside abortion clinics, brandishing signs with disturbing images of fetuses and shouting condemnations toward people entering the buildings. In 1994 the Freedom of Access to Clinic Entrances (FACE) Act made blocking the entrances of places providing abortion counseling or services a federal offense punishable by fines and imprisonment.

Some anti-abortion activists have taken more extreme, surreptitious, or violent measures. Members of groups such as Project Veritas, for instance, have posed as patients and secretly filmed abortion providers, using the footage to create misinformation campaigns alleging unethical and criminal behavior. Anti-abortion groups also operate crisis pregnancy centers (CPCs), nonprofit organizations that seek to deter women from terminating unintended pregnancies. CPCs have been accused of using misleading and deceptive advertising and purposefully providing inaccurate information to stop individuals from accessing abortion services. Members of militant pro-life organizations such as Operation Rescue have committed acts of domestic terrorism, including the bombing of clinics and waging of aggressive harassment campaigns. Several doctors who provided abortions have been murdered by pro-life activists.

Meanwhile, in states where pro-life conservatives hold power, legislatures passed laws that placed additional regulations on abortion providers and had the effect of making abortion services more difficult to obtain. Some of these laws included provisions that required the examination rooms in which the procedure would be performed to be a certain size. Other laws required abortion providers and facilities to be affiliated with a hospital or located within a certain distance from a hospital. Pro-choice groups refer to these laws as Targeted Regulation (or Restriction) for Abortion Providers (TRAP) laws. The Supreme Court ruled against TRAP bills from Texas and Louisiana in Whole Woman's Health v. Hellerstedt (2016) and June Medical Services, LLC v. Russo (2020), determining that such requirements did not produce sufficient medical benefit to justify the imposition placed on women seeking abortions.

Many anti-abortion activists celebrated the election of President Donald Trump in 2016, as he had committed during his campaign to nominating pro-life judges. Anticipating a conservative majority in the Supreme Court, lawmakers in several states began advancing more restrictive anti-abortion legislation, including many laws intended to prohibit abortions before the end of the first trimester. For example, some states passed legislation outlawing abortion after a "fetal heartbeat" is detected. Reproductive health doctors consider this terminology misleading, as they describe the noise heard as the electrical activity of the ultrasound machine rather than a heartbeat produced by a functioning heart. Texas' "fetal heartbeat" law prohibited abortions after six weeks and relied on private citizens for enforcement by allowing anyone in any state to file a civil suit against any person who helps someone get an abortion in Texas. Out of fear of possible litigation, most providers in the state had ceased operations months before the Supreme Court issued its ruling in Dobbs .

In the courts, pro-life attorneys brought challenges to Roe in the hopes the Supreme Court would eventually strike it down, while pro-life activists built an organized pipeline of judicial nominees. In 1982 a group of conservatives and libertarians founded the Federalist Society as a professional network that would support and promote judges who shared a similar legal vision, including the overturning of Roe v. Wade . The Trump administration nominated several Federalist Society members as federal judges, including Supreme Court justices Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. As of 2023, six of the nine Supreme Court justices were members of the Federalist Society.

CRITICAL THINKING QUESTIONS

What factors do you think prevented federal lawmakers from adding a constitutional amendment or passing a federal law establishing a national standard regarding abortion rights?
Under what circumstances, if any, do you think state governments should restrict a person's access to abortion services? Explain your answer.
How has the Supreme Court's 2022 overturning of abortion rights affected abortion access in the country? What do you consider to be the most significant effect of those changes?

ABORTION RIGHTS POST- ROE

The Dobbs ruling, which denied that the Constitution ever recognized or implied a right to abortion in the US Constitution, has had a significant impact on abortion access throughout the country. In the late 2010s, in anticipation of a conservative majority on the court, lawmakers in some states began passing legislation to safeguard the right to legal and safe abortions in the event Roe v. Wade was overturned. In 2019, for example, New York passed the Reproductive Health Act, which removed several restrictions, decriminalized abortion, and limited government interference with the decisions of women and their health care providers. Before Roe 's overturning, ten states—Alaska, Arizona, California, Florida, Kansas, Massachusetts, Minnesota, Montana, New Jersey, and New Mexico—had state constitutions protecting abortion rights. As of October 2023, twenty-two states had expanded or protected access to abortion, though the governments of some of these states were challenging those protections.

Before the Dobbs ruling, thirteen US states had passed trigger laws that would outlaw abortion in all or most cases, but not all went into effect immediately after the decision. Some triggered the beginning of a process to ban abortion, while others triggered the ban going into effect. Some laws were blocked from taking effect while lawsuits against them moved through the courts. In some states nearly all abortions became illegal, with some not allowing exceptions in instances of rape and incest or when continuing the pregnancy could be fatal.

President Joe Biden issued an executive order aimed at protecting reproductive rights in July 2022, following the Dobbs ruling. The order directed federal agencies, including the FDA and the Federal Trade Commission (FTC), to develop plans to protect patient privacy, safety, and security, as well as ensure access to comprehensive and reliable medical information and medical services, including abortion and contraception. Additionally, the order created a reproductive health care task force. Despite the sweeping intentions of the executive order, the Biden administration's ability to affect abortion rights remains limited without congressional action.

Since Dobbs , states have passed new laws either protecting or restricting abortion. State legislatures introduced 563 abortion restriction provisions, fifty of which were signed into law, and 369 abortion protection provisions, seventy-seven of which were passed. Six states also held ballot initiatives in which voters chose to protect abortion rights, reflecting the 64 percent majority of Americans who reported supporting abortion rights. As of October 2023, the Guttmacher Institute categorized six US states as "very protective" of abortion rights, with Oregon's laws identified as "most protective." An additional nine states, plus Washington, DC, had policies that protected the right to abortion but imposed some restrictions. Eight states were characterized as "restrictive" and three as "very restrictive." Fifteen states—Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, and West Virginia—had the "most restrictive" abortion policies, a significant increase from the five states with the designation in 2022.

One major point of contention between states is the ability of people to travel in order to access abortion. As of June 2023, twenty-five million people who can become pregnant had less access to legal abortion in their state than they did before the ruling, resulting in significant numbers of people traveling across state borders for the procedure. In response, so-called shield laws , which protect abortion patents and providers from prosecution in states where abortion is illegal, have been passed in fourteen states since Dobbs , bringing the total to fifteen states. In September 2023, lawmakers in Texas began passing measures restricting access to roadways for people on their way to an abortion appointment. In response to a federal rule allowing military personnel stationed in states where access to abortion is restricted to travel to states where abortion is legal, Senator Tommy Tuberville (R–AL) blocked the Senate from voting on military promotions, leaving several crucial high-level posts vacant for months. As of October 2023, despite pressure to relent from both sides of the aisle, Tuberville's blockade continued.

With the FDA allowing delivery of pills for medication abortion through the mail, pro-choice lawmakers and reproductive rights activists hoped that expanding access to medication abortion through telemedicine would mitigate some of the travel burden. However, in states where abortion is restricted, anti-abortion lawmakers began to explore ways of preventing the use of medication abortion. Despite a lack of medical or scientific evidence, several states passed legislation requiring doctors to inform patients that medical abortions can be interrupted or "reversed" by replacing the second pill with a dose of progesterone. Conservative states and legal groups have also pursued overturning the FDA's approval of mifepristone, one of the two drugs used in medication abortions. In April 2023 the Supreme Court ruled that mifepristone could continue to be prescribed while lawsuits continued.

In the year following Dobbs , the US maternal death rate, already the highest among industrialized countries, rose in states where abortion access was illegal or highly restricted. According to a January 2023 report by the Gender Equity Policy Institute, pregnant people in states where abortion is banned were up to three times more likely to die during pregnancy or labor or soon after than pregnant people in less restrictive states. Of these deaths, one in seven occurred in Texas. Babies were 30 percent likelier to die during their first month of life in states with abortion bans, and teen birth rates were twice as high in abortion restriction states.

The number of abortions performed in the United States increased after the Dobbs decision, according to the Guttmacher Institute, which found about 511,000 abortions performed between January and June 2023, compared to 465,000 in the same period of 2020. Less restrictive states bordering more restrictive states experienced most of the increase, with Illinois providers reporting a 69 percent increase and New Mexico reporting a 220 percent increase. States with total bans or six-week bans had an estimated 114,590 fewer abortions performed within their borders, according to the research group WeCount. Experts have raised concerns that the country's remaining abortion clinics are experiencing unsustainable demand for the procedure.

Parental involvement laws can impose harmful burdens on pregnant minors.

"They talked about making sure they did really well in school from now on, so that their abortions weren't in vain."

Francie Diep is a staff writer at Pacific Standard . In the following viewpoint, Diep argues that parental involvement laws for minors seeking abortions can be detrimental to young women's physical and mental health. Discussing a study of minors who sought a judge's approval, a process commonly referred to as judicial bypass, in lieu of obtaining parental consent, the author reveals wide variation among experiences with the process. Diep notes that judicial bypass frequently delays a minor's abortion by several weeks. Citing the experiences of study participants, the author characterizes securing judicial bypass as a humiliating experience and provides several examples of a judge or a minor's guardian ad litem demonstrating anti-abortion bias. Despite these negative experiences, the author maintains, many of the minors subjected to parental involvement laws support such restrictions on minors seeking abortions.

Parental Consent Laws Protect Teens

“According to a national study conducted by researchers associated with Guttmacher, disappointment is the most common response of parents who learn that their teen daughter is pregnant, and almost no parent responds with violence.”

Teresa S. Collett is a professor of law at the University of St. Thomas School of Law in Minneapolis.

In the following viewpoint, Collett contends that parental consent laws are constitutional and in the best interest of girls seeking abortion. Citing the likelihood that adult men are most often the fathers of school-age pregnancies, parental involvement ensures that cases of coercion and statutory rape do not go unreported. Additionally, parents are in the best position to provide health information and care for their daughters during a time of acute vulnerability and need.

Late-Term Abortions Are Cruel, Common, and Unjustified

"In one recording taken on May 2, an unidentified woman is able to schedule an abortion at 30 weeks of pregnancy, even after she says there's nothing wrong with the fetus."

Bradford Richardson is a reporter at the Washington Times .

In the following viewpoint, Richardson argues that abortion providers in New Mexico, Louisiana, and Texas frequently terminate pregnancies during the third trimester (twenty-eight to forty weeks) and employ methods that cause the fetus undue harm. Defending comments made by Donald Trump during the 2016 presidential debates, the author disputes assertions made by reproductive rights groups and media outlets that late-term abortions are performed only in special circumstances and that the procedure referred to as partial-birth abortion is not considered legitimate among US medical experts. The author commends the efforts of anti-abortion activists and organizations like the Center for Medical Progress, which made covert recordings of abortion providers, for drawing attention to medical practices employed at reproductive health clinics.

Overregulation Forces Women To Have Late-Term Abortions

"Animal advocates, as well as many scientists, are increasingly questioning the scientific validity and reliability of animal experimentation."

“[A]dding hurdles that force women to obtain an abortion later in pregnancy—or to seek out options on their own, such as online medications of unknown quality—is bad for women’s health.”

Daniel Grossman is a professor in the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, and director of Advancing New Standards in Reproductive Health (ANSIRH) at the Bixby Center for Global Reproductive Health.

In the following viewpoint, Grossman argues that restrictions on abortion access contribute to women delaying abortions. He explains how abortions that take place earlier in a pregnancy tend to be safer for the woman’s health than abortions performed later. He argues that women already encounter significant obstacles to obtaining the procedure without additional regulations. He contends that several restrictions prevent patients from choosing medical abortions, which are significantly less invasive than surgical abortions and could be administered by more health care providers than specific state laws allow.

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

Pew Research Center has conducted many surveys about abortion over the years, providing a lens into Americans’ views on whether the procedure should be legal, among a host of other questions.

In a Center survey conducted nearly a year after the Supreme Court’s June 2022 decision that ended the constitutional right to abortion , 62% of U.S. adults said the practice should be legal in all or most cases, while 36% said it should be illegal in all or most cases. Another survey conducted a few months before the decision showed that relatively few Americans take an absolutist view on the issue .

Find answers to common questions about abortion in America, based on data from the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, which have tracked these patterns for several decades:

How many abortions are there in the U.S. each year?

How has the number of abortions in the u.s. changed over time, what is the abortion rate among women in the u.s. how has it changed over time, what are the most common types of abortion, how many abortion providers are there in the u.s., and how has that number changed, what percentage of abortions are for women who live in a different state from the abortion provider, what are the demographics of women who have had abortions, when during pregnancy do most abortions occur, how often are there medical complications from abortion.

This compilation of data on abortion in the United States draws mainly from two sources: the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, both of which have regularly compiled national abortion data for approximately half a century, and which collect their data in different ways.

The CDC data that is highlighted in this post comes from the agency’s “abortion surveillance” reports, which have been published annually since 1974 (and which have included data from 1969). Its figures from 1973 through 1996 include data from all 50 states, the District of Columbia and New York City – 52 “reporting areas” in all. Since 1997, the CDC’s totals have lacked data from some states (most notably California) for the years that those states did not report data to the agency. The four reporting areas that did not submit data to the CDC in 2021 – California, Maryland, New Hampshire and New Jersey – accounted for approximately 25% of all legal induced abortions in the U.S. in 2020, according to Guttmacher’s data. Most states, though, do have data in the reports, and the figures for the vast majority of them came from each state’s central health agency, while for some states, the figures came from hospitals and other medical facilities.

Discussion of CDC abortion data involving women’s state of residence, marital status, race, ethnicity, age, abortion history and the number of previous live births excludes the low share of abortions where that information was not supplied. Read the methodology for the CDC’s latest abortion surveillance report , which includes data from 2021, for more details. Previous reports can be found at stacks.cdc.gov by entering “abortion surveillance” into the search box.

For the numbers of deaths caused by induced abortions in 1963 and 1965, this analysis looks at reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. In computing those figures, we excluded abortions listed in the report under the categories “spontaneous or unspecified” or as “other.” (“Spontaneous abortion” is another way of referring to miscarriages.)

Guttmacher data in this post comes from national surveys of abortion providers that Guttmacher has conducted 19 times since 1973. Guttmacher compiles its figures after contacting every known provider of abortions – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, and it provides estimates for abortion providers that don’t respond to its inquiries. (In 2020, the last year for which it has released data on the number of abortions in the U.S., it used estimates for 12% of abortions.) For most of the 2000s, Guttmacher has conducted these national surveys every three years, each time getting abortion data for the prior two years. For each interim year, Guttmacher has calculated estimates based on trends from its own figures and from other data.

The latest full summary of Guttmacher data came in the institute’s report titled “Abortion Incidence and Service Availability in the United States, 2020.” It includes figures for 2020 and 2019 and estimates for 2018. The report includes a methods section.

In addition, this post uses data from StatPearls, an online health care resource, on complications from abortion.

An exact answer is hard to come by. The CDC and the Guttmacher Institute have each tried to measure this for around half a century, but they use different methods and publish different figures.

The last year for which the CDC reported a yearly national total for abortions is 2021. It found there were 625,978 abortions in the District of Columbia and the 46 states with available data that year, up from 597,355 in those states and D.C. in 2020. The corresponding figure for 2019 was 607,720.

The last year for which Guttmacher reported a yearly national total was 2020. It said there were 930,160 abortions that year in all 50 states and the District of Columbia, compared with 916,460 in 2019.

How the CDC gets its data: It compiles figures that are voluntarily reported by states’ central health agencies, including separate figures for New York City and the District of Columbia. Its latest totals do not include figures from California, Maryland, New Hampshire or New Jersey, which did not report data to the CDC. ( Read the methodology from the latest CDC report .)
How Guttmacher gets its data: It compiles its figures after contacting every known abortion provider – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, then provides estimates for abortion providers that don’t respond. Guttmacher’s figures are higher than the CDC’s in part because they include data (and in some instances, estimates) from all 50 states. ( Read the institute’s latest full report and methodology .)

While the Guttmacher Institute supports abortion rights, its empirical data on abortions in the U.S. has been widely cited by groups and publications across the political spectrum, including by a number of those that disagree with its positions .

These estimates from Guttmacher and the CDC are results of multiyear efforts to collect data on abortion across the U.S. Last year, Guttmacher also began publishing less precise estimates every few months , based on a much smaller sample of providers.

The figures reported by these organizations include only legal induced abortions conducted by clinics, hospitals or physicians’ offices, or those that make use of abortion pills dispensed from certified facilities such as clinics or physicians’ offices. They do not account for the use of abortion pills that were obtained outside of clinical settings .

(Back to top)

A line chart showing the changing number of legal abortions in the U.S. since the 1970s.

The annual number of U.S. abortions rose for years after Roe v. Wade legalized the procedure in 1973, reaching its highest levels around the late 1980s and early 1990s, according to both the CDC and Guttmacher. Since then, abortions have generally decreased at what a CDC analysis called “a slow yet steady pace.”

Guttmacher says the number of abortions occurring in the U.S. in 2020 was 40% lower than it was in 1991. According to the CDC, the number was 36% lower in 2021 than in 1991, looking just at the District of Columbia and the 46 states that reported both of those years.

(The corresponding line graph shows the long-term trend in the number of legal abortions reported by both organizations. To allow for consistent comparisons over time, the CDC figures in the chart have been adjusted to ensure that the same states are counted from one year to the next. Using that approach, the CDC figure for 2021 is 622,108 legal abortions.)

There have been occasional breaks in this long-term pattern of decline – during the middle of the first decade of the 2000s, and then again in the late 2010s. The CDC reported modest 1% and 2% increases in abortions in 2018 and 2019, and then, after a 2% decrease in 2020, a 5% increase in 2021. Guttmacher reported an 8% increase over the three-year period from 2017 to 2020.

As noted above, these figures do not include abortions that use pills obtained outside of clinical settings.

Guttmacher says that in 2020 there were 14.4 abortions in the U.S. per 1,000 women ages 15 to 44. Its data shows that the rate of abortions among women has generally been declining in the U.S. since 1981, when it reported there were 29.3 abortions per 1,000 women in that age range.

The CDC says that in 2021, there were 11.6 abortions in the U.S. per 1,000 women ages 15 to 44. (That figure excludes data from California, the District of Columbia, Maryland, New Hampshire and New Jersey.) Like Guttmacher’s data, the CDC’s figures also suggest a general decline in the abortion rate over time. In 1980, when the CDC reported on all 50 states and D.C., it said there were 25 abortions per 1,000 women ages 15 to 44.

That said, both Guttmacher and the CDC say there were slight increases in the rate of abortions during the late 2010s and early 2020s. Guttmacher says the abortion rate per 1,000 women ages 15 to 44 rose from 13.5 in 2017 to 14.4 in 2020. The CDC says it rose from 11.2 per 1,000 in 2017 to 11.4 in 2019, before falling back to 11.1 in 2020 and then rising again to 11.6 in 2021. (The CDC’s figures for those years exclude data from California, D.C., Maryland, New Hampshire and New Jersey.)

The CDC broadly divides abortions into two categories: surgical abortions and medication abortions, which involve pills. Since the Food and Drug Administration first approved abortion pills in 2000, their use has increased over time as a share of abortions nationally, according to both the CDC and Guttmacher.

The majority of abortions in the U.S. now involve pills, according to both the CDC and Guttmacher. The CDC says 56% of U.S. abortions in 2021 involved pills, up from 53% in 2020 and 44% in 2019. Its figures for 2021 include the District of Columbia and 44 states that provided this data; its figures for 2020 include D.C. and 44 states (though not all of the same states as in 2021), and its figures for 2019 include D.C. and 45 states.

Guttmacher, which measures this every three years, says 53% of U.S. abortions involved pills in 2020, up from 39% in 2017.

Two pills commonly used together for medication abortions are mifepristone, which, taken first, blocks hormones that support a pregnancy, and misoprostol, which then causes the uterus to empty. According to the FDA, medication abortions are safe until 10 weeks into pregnancy.

Surgical abortions conducted during the first trimester of pregnancy typically use a suction process, while the relatively few surgical abortions that occur during the second trimester of a pregnancy typically use a process called dilation and evacuation, according to the UCLA School of Medicine.

In 2020, there were 1,603 facilities in the U.S. that provided abortions, according to Guttmacher . This included 807 clinics, 530 hospitals and 266 physicians’ offices.

A horizontal stacked bar chart showing the total number of abortion providers down since 1982.

While clinics make up half of the facilities that provide abortions, they are the sites where the vast majority (96%) of abortions are administered, either through procedures or the distribution of pills, according to Guttmacher’s 2020 data. (This includes 54% of abortions that are administered at specialized abortion clinics and 43% at nonspecialized clinics.) Hospitals made up 33% of the facilities that provided abortions in 2020 but accounted for only 3% of abortions that year, while just 1% of abortions were conducted by physicians’ offices.

Looking just at clinics – that is, the total number of specialized abortion clinics and nonspecialized clinics in the U.S. – Guttmacher found the total virtually unchanged between 2017 (808 clinics) and 2020 (807 clinics). However, there were regional differences. In the Midwest, the number of clinics that provide abortions increased by 11% during those years, and in the West by 6%. The number of clinics decreased during those years by 9% in the Northeast and 3% in the South.

The total number of abortion providers has declined dramatically since the 1980s. In 1982, according to Guttmacher, there were 2,908 facilities providing abortions in the U.S., including 789 clinics, 1,405 hospitals and 714 physicians’ offices.

The CDC does not track the number of abortion providers.

In the District of Columbia and the 46 states that provided abortion and residency information to the CDC in 2021, 10.9% of all abortions were performed on women known to live outside the state where the abortion occurred – slightly higher than the percentage in 2020 (9.7%). That year, D.C. and 46 states (though not the same ones as in 2021) reported abortion and residency data. (The total number of abortions used in these calculations included figures for women with both known and unknown residential status.)

The share of reported abortions performed on women outside their state of residence was much higher before the 1973 Roe decision that stopped states from banning abortion. In 1972, 41% of all abortions in D.C. and the 20 states that provided this information to the CDC that year were performed on women outside their state of residence. In 1973, the corresponding figure was 21% in the District of Columbia and the 41 states that provided this information, and in 1974 it was 11% in D.C. and the 43 states that provided data.

In the District of Columbia and the 46 states that reported age data to the CDC in 2021, the majority of women who had abortions (57%) were in their 20s, while about three-in-ten (31%) were in their 30s. Teens ages 13 to 19 accounted for 8% of those who had abortions, while women ages 40 to 44 accounted for about 4%.

The vast majority of women who had abortions in 2021 were unmarried (87%), while married women accounted for 13%, according to the CDC , which had data on this from 37 states.

A pie chart showing that, in 2021, majority of abortions were for women who had never had one before.

In the District of Columbia, New York City (but not the rest of New York) and the 31 states that reported racial and ethnic data on abortion to the CDC , 42% of all women who had abortions in 2021 were non-Hispanic Black, while 30% were non-Hispanic White, 22% were Hispanic and 6% were of other races.

Looking at abortion rates among those ages 15 to 44, there were 28.6 abortions per 1,000 non-Hispanic Black women in 2021; 12.3 abortions per 1,000 Hispanic women; 6.4 abortions per 1,000 non-Hispanic White women; and 9.2 abortions per 1,000 women of other races, the CDC reported from those same 31 states, D.C. and New York City.

For 57% of U.S. women who had induced abortions in 2021, it was the first time they had ever had one, according to the CDC. For nearly a quarter (24%), it was their second abortion. For 11% of women who had an abortion that year, it was their third, and for 8% it was their fourth or more. These CDC figures include data from 41 states and New York City, but not the rest of New York.

A bar chart showing that most U.S. abortions in 2021 were for women who had previously given birth.

Nearly four-in-ten women who had abortions in 2021 (39%) had no previous live births at the time they had an abortion, according to the CDC . Almost a quarter (24%) of women who had abortions in 2021 had one previous live birth, 20% had two previous live births, 10% had three, and 7% had four or more previous live births. These CDC figures include data from 41 states and New York City, but not the rest of New York.

The vast majority of abortions occur during the first trimester of a pregnancy. In 2021, 93% of abortions occurred during the first trimester – that is, at or before 13 weeks of gestation, according to the CDC . An additional 6% occurred between 14 and 20 weeks of pregnancy, and about 1% were performed at 21 weeks or more of gestation. These CDC figures include data from 40 states and New York City, but not the rest of New York.

About 2% of all abortions in the U.S. involve some type of complication for the woman , according to an article in StatPearls, an online health care resource. “Most complications are considered minor such as pain, bleeding, infection and post-anesthesia complications,” according to the article.

The CDC calculates case-fatality rates for women from induced abortions – that is, how many women die from abortion-related complications, for every 100,000 legal abortions that occur in the U.S . The rate was lowest during the most recent period examined by the agency (2013 to 2020), when there were 0.45 deaths to women per 100,000 legal induced abortions. The case-fatality rate reported by the CDC was highest during the first period examined by the agency (1973 to 1977), when it was 2.09 deaths to women per 100,000 legal induced abortions. During the five-year periods in between, the figure ranged from 0.52 (from 1993 to 1997) to 0.78 (from 1978 to 1982).

The CDC calculates death rates by five-year and seven-year periods because of year-to-year fluctuation in the numbers and due to the relatively low number of women who die from legal induced abortions.

In 2020, the last year for which the CDC has information , six women in the U.S. died due to complications from induced abortions. Four women died in this way in 2019, two in 2018, and three in 2017. (These deaths all followed legal abortions.) Since 1990, the annual number of deaths among women due to legal induced abortion has ranged from two to 12.

The annual number of reported deaths from induced abortions (legal and illegal) tended to be higher in the 1980s, when it ranged from nine to 16, and from 1972 to 1979, when it ranged from 13 to 63. One driver of the decline was the drop in deaths from illegal abortions. There were 39 deaths from illegal abortions in 1972, the last full year before Roe v. Wade. The total fell to 19 in 1973 and to single digits or zero every year after that. (The number of deaths from legal abortions has also declined since then, though with some slight variation over time.)

The number of deaths from induced abortions was considerably higher in the 1960s than afterward. For instance, there were 119 deaths from induced abortions in 1963 and 99 in 1965 , according to reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. The CDC is a division of Health and Human Services.

Note: This is an update of a post originally published May 27, 2022, and first updated June 24, 2022.

Jeff Diamant is a senior writer/editor focusing on religion at Pew Research Center .

Besheer Mohamed is a senior researcher focusing on religion at Pew Research Center .

Rebecca Leppert is a copy editor at Pew Research Center .

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Abortion restrictions harm mental health, with low-income women hardest hit

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People living in states that enacted tighter abortion restrictions in the wake of the Dobbs v. Jackson Women’s Health decision, which returned regulation of abortion access to state legislatures , are more likely to report elevated levels of mental distress. This is particularly true for people of lower socioeconomic means.

These are the key takeaways of our July 2024 paper published in Science Advances .

We mined two years’ worth of data from the National Household Pulse Survey and analyzed 21 survey waves, each with more than 60,000 respondents. We were able to trace how newly introduced gestational restrictions and abortion bans affected mental health outcomes such as anxiety, worry, disinterest and depression on a state-by-state basis. The increase in self-reported mental health issues amounts to an approximate 3% relative rise over the pre-Dobbs baseline of 18% to 26% – a troubling increase by any measure.

Why it matters

Two years after the Dobbs decision, the country is still coming to grips with its societal repercussions. Some states have tightened restrictions on abortion , while others have taken measures to preserve access, leading thousands of women to travel across state lines each month to obtain these services. As of July 2024, 21 states have passed abortion bans or enacted more restrictive gestational limits.

The decision to overturn a half-century of legal precedent has deeply affected women’s reproductive care and is altering the legal landscape that governs people’s decisions on whether and when to have children. These decisions are often stressful, as they involve navigating complex emotional, social and legal landscapes.

Accordingly, these sudden changes in access to abortion services may carry significant mental health consequences. Breaking down our results by demographic, we found consistent effects across birth-assigned gender, sexual orientation, age, marital status and race. However, we also found striking differences dependent on respondents’ income level and education.

Put plainly, abortion restrictions had a greater negative impact on the mental health of respondents of lesser economic means and the less educated. Those with more wealth and education, by contrast, were largely insulated.

As more states consider adopting restrictions of their own, with possible federal restrictions on abortion not off the table , it helps to have a more holistic sense of what that might mean for Americans.

In addition, our study underscores the need to think about women’s health across various subgroups of the population, especially as it pertains to sex assigned at birth and socioeconomic class.

What still isn’t known

We do not know exactly why socioeconomic class played such a pivotal role in our study, but we can speculate.

One possible explanation has to do with anticipatory stress about the financial burdens associated with carrying an unwanted pregnancy to term, or traveling out of state for an abortion. Financial concerns of this sort are likely more impactful on the mental health of Americans who are least able to bear these costs.

An alternative theory is that poorer women constitute a disproportionate percentage of the patient base receiving abortion care. According to a 2014 report from the Guttmacher Institute, an advocacy group, 75% of abortion patients qualified as low-income .

What other research is being done

Our work builds on findings from The Turnaway Study, which observed a marked decline in the short-term mental health of women who were denied an abortion because their pregnancy just exceeded the gestational limit. Our unique contribution resides in assessing the effect of abortion restrictions on mental health more broadly.

It’s important to realize that this paper is part of a growing body of work that shows the issues with mental health in the post-Dobbs era. Some studies have looked exclusively at women while others have begun to compare younger men and women . Whereas those works found effects were concentrated primarily among women of childbearing age, our results imply that a broader swath of the population has been affected.

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State Laws Banning Abortion Linked to Increases in Mental Health Issues

Researchers found that state-level restrictions and bans on abortion care led to higher levels of mental distress in the state’s population.

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States that implement abortion bans see an upward tick in mental distress relative to states that don’t restrict abortion, according to new research. Photo via iStock/Mary Long

Jessica Colarossi

Since the US Supreme Court overturned the national right to abortion in June 2022, journalists and abortion advocates have spotlighted the decision’s many repercussions, particularly for people living in states that subsequently banned the procedure . There have been cases of women whose lives were at risk, yet were unable to receive timely care, reports of doctors fearing that providing lifesaving care could result in legal prosecution, and stories of the tens of thousands of people traveling to other states to get abortions or abortion medication, adding time and costs to an already burdensome process.

All of these changes result in an obvious physical toll for people, as well as an economic burden for those who travel for care or stay pregnant. But there is also a notable impact on mental health that has largely gone under the radar, according to a new study coauthored by a Boston University researcher. In a paper published in Science Advances , information systems expert Gordon Burtch and his colleagues found that there is a significant increase in mental distress after state-level abortion restrictions are enacted.

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Their paper says that abortion restrictions have had “broad negative implications for the mental health of people living in the US, particularly those of lower education and personal wealth,” which is likely due to the difficulty in paying for travel out of state or the costs associated with pregnancy. Advocates have pointed out for decades that abortion restrictions are felt disproportionately by people of color and those who are in poverty.

“The mental stress that comes with these policy changes isn’t just due to the policy change itself, but also the ambiguity around the change,” says Burtch, a BU Questrom School of Business Allen and Kelli Questrom Professor in Information Systems and a dean’s research scholar. Bans and restrictions have led to legal gray areas around what doctors are allowed to do under the law, which Burtch says leads to widespread stress and worry for patients, clinicians, and family members. He and his coauthors, Michaela R. Anderson of the University of Pennsylvania and Brad N. Greenwood of George Mason University, used data collected between July 2021 and June 2023 by the nationwide Household Pulse Survey to evaluate how bans and restrictions on abortion access have impacted mental health in broad swaths of the population.

The Brink spoke with Burtch about the findings, the implications of the study, and how the Supreme Court’s recent decision to dismiss a case on Idaho’s attempt to ban emergency abortion care will impact that state’s collective mental health.

With Gordon Burtch

The brink: what motivated the study.

Burtch: Shortly after Roe v. Wade got overturned, my coauthor Brad and I were talking about all kinds of problems that will happen from this decision and how so many things will be disrupted. One of the first changes was likely to be stress. I was aware of the Household Pulse Survey that had been launched by the Census Bureau during the COVID-19 pandemic, and that it also has questions to capture mental health and indicators of distress. We immediately saw patterns in the data, and we brought in Michaela, who helped us understand these results from the clinical perspective. I think this is giving us a baseline about how extensive the consequences are for people broadly.

The Brink: Why is mental health an important measure in regards to abortion restrictions?

Burtch: Obviously, women of childbearing age are most likely to be affected. But these policy changes extend to a much broader population than we typically realize, like family members and caregivers. This could create stress for the entire family, for anybody that’s connected to an individual that is in a position of needing an abortion. There’s also a lot of people worried about what could come next. After Roe was overturned, that led to questions about same-sex marriage rights and other rights that could be impacted by the courts. We have a lot of reasons to expect that these national changes will have a broad influence, beyond the stress that comes with contemplating abortion and going through an abortion.

The Brink: How did you figure out that spikes in mental distress are specifically related to abortion bans, and not something else?

Burtch: We essentially look at the change over time, from before to after policy change. In this case, the institution of an abortion restriction in a given location. We compare those differences in states with abortion restrictions to states where no policy change happened. This means we’re implicitly controlling for natural sources of variation, like seasonality or the economy. In the paper, we show that nothing is systematically different in states that have not adopted bans; in the ones that do adopt abortion bans, we see an upward tick [in mental distress] relative to ones that didn’t make any change. This is all happening at the population level, and the survey collected over a million responses for every question and then weighted the results to be demographically representative.

The Brink: Why are there disparities among people with lower incomes and education?

Burtch: The most plausible explanation is: When an abortion restriction is imposed in a particular state, how do people deal with that? If someone can’t access an abortion and ends up having the child, there’s an economic cost to that which is much harder for people with less money to bear, and they’ll likely experience more stress about this possibility. If the other option requires travel costs, taking time off a job, paying for childcare, and paying for the procedure or medication, that’s a lot of additional costs too. The fact that mental health effects appear larger among people with lesser education is probably correlated to lesser wealth, so that’s probably a single factor—that people of lower socioeconomic status have more difficulty absorbing new costs that come with dealing with an abortion.

The Brink: Do you think the recent court case about the abortion restriction in Idaho will cause more stress?

Burtch: It’s important to note that a lot of the mental stress that comes with these policy changes isn’t just due to the policy change itself, but also the ambiguity around the change. In the recent example in Idaho, where the state challenged the federal government’s rule on providing emergency [abortion] medical care, the Supreme Court didn’t rule in favor of the state—they basically threw it out and said that this challenge shouldn’t have made it to the Supreme Court. So, they didn’t resolve it. As of now, doctors need to keep providing emergency [abortion] care until they say otherwise. But it’s still a legal gray area that impacts medical providers and patients. So long as this remains unresolved, and we don’t have clarity around what’s allowed in different places, that’s linked to so much stress. I hope this paper reaches lawmakers and medical providers, so they can understand that these policies are creating lots of stress for lots of different people and they should be empathetic to that.

This interview was edited and condensed for clarity and length.

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Published: 02 January 2024

Psychological traits and public attitudes towards abortion: the role of empathy, locus of control, and need for cognition

Jiuqing Cheng 1 ,
Ping Xu 2 &
Chloe Thostenson 1

Humanities and Social Sciences Communications volume 11 , Article number: 23 ( 2024 ) Cite this article

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In the summer of 2022, the U.S. Supreme Court overturned the historic Roe v. Wade ruling, prompting various states to put forth ballot measures regarding state-level abortion rights. While earlier studies have established associations between demographics, such as religious beliefs and political ideologies, and attitudes toward abortion, the current research delves into the role of psychological traits such as empathy, locus of control, and need for cognition. A sample of 294 U.S. adults was obtained via Amazon Mechanical Turk, and participants were asked to provide their attitudes on seven abortion scenarios. They also responded to scales measuring empathy toward the pregnant woman and the unborn, locus of control, and need for cognition. Principal Component Analysis divided abortion attitudes into two categories: traumatic abortions (e.g., pregnancies due to rape) and elective abortions (e.g., the woman does not want the child anymore). After controlling for religious belief and political ideology, the study found psychological factors accounted for substantial variation in abortion attitudes. Notably, empathy toward the pregnant woman correlated positively with abortion support across both categories, while empathy toward the unborn revealed an inverse relationship. An internal locus of control was positively linked to support for both types of abortions. Conversely, external locus of control and need for cognition only positively correlated with attitudes toward elective abortion, showing no association with traumatic abortion attitudes. Collectively, these findings underscore the significant and unique role psychological factors play in shaping public attitudes toward abortion. Implications for research and practice were discussed.

Death anxiety as mediator of relationship between renunciation of desire and mental health as predicted by Nonself Theory

The Psychological Science Accelerator’s COVID-19 rapid-response dataset

Conservatives and liberals have similar physiological responses to threats

The U.S. Supreme Court overturned the long-time landmark ruling of Roe v. Wade in 2022 summer. Debates and legal challenges regarding legal abortion in the U.S. have been heated (Felix et al., 2023 ). Furthermore, residents in several states have or will cast their vote on a ballot measure to determine abortion rights at the state level. A Gallup poll released in 2023 summer found that about one third of voters indicated that they would only vote for a candidate who shared their views on abortion (Saad, 2023 ). Therefore, it is imperative to understand people’s attitudes toward abortion. Past research on such attitudes have mainly focused on the role of political ideology and religious belief (e.g., Hess and Rueb, 2005 ); however, to our knowledge, relatively few studies have been done to examine the psychological underpinnings. Here we propose that examining the correlations between psychological factors and attitudes toward abortion has the potential to make contributions from the perspectives of both research and practice.

First, compared to attitudes in everyday life such as attitudes toward a product or brand, attitudes toward abortion are unique because it often elicits strong emotional response and conflict experience (Foster et al., 2012 ; Scott, 1989 ). Moreover, such an attitude goes beyond individual preference as it is deeply intertwined with one’s moral and religious beliefs, cultural background, and societal norms. Debate on abortion is not merely about a personal choice; it is about the definitions of life, rights, and autonomy (Osborne et al., 2022 ; Scott, 1989 ). For abortion, the contrasting views may lead to polarized opinions. In contrast, disagreements about a product or brand preference are typically less emotionally charged and do not carry the same societal weight. Therefore, given the unique nature of attitudes toward abortion as described above, it remains unclear whether psychological factors that correlate with attitudes in other areas still apply and, if so, in what capacity they do so. Additionally, as introduced below, several studies in this area employed a qualitative approach (interview). While the qualitative approach offered valuable insights into individuals’ perspectives on abortion, we aim to expand upon these findings by employing a quantitative approach. Especially, the quantitative approach allows us to explore the unique relationship between psychology and abortion attitudes after statistically controlling for other powerful factors like religious belief and political ideology. Together, a major goal of the present study is to provide initial empirical evidence for the correlations between attitudes toward abortion and certain psychological factors. We will further detail how our study might fill research gaps when introducing specific psychological factors as described below.

Second, examining the correlations between psychological factors and attitudes toward abortion may also offer practical insights. Consider the role of thinking style, for instance. The decision to pursue an abortion is imperative and often a prominently salient one, impacting not just the pregnant woman but also her family and extensive social network. Such a decision is complex and challenging due to intense feelings (e.g., conflict) and the balance between a woman’s bodily autonomy and fetal rights. From this viewpoint, there might be a correlation between attitudes toward abortion and one’s thinking style, especially their willingness to address complex and difficult issues. Past research has highlighted the connection between rational decision-making and the availability of relevant information (Shafir and LeBoeuf, 2002 ). Hence, to facilitate informed decisions, comprehensive knowledge about abortion is both essential and beneficial. The present study will examine the relationship between thinking style and abortion attitudes. Should a correlation be identified, our study would suggest individuals engage more deeply in critical thinking about the issues of abortion to enhance abortion-related education and informed decision-making.

Together, the present study aims to shed more light on the unique role of psychology in abortion attitudes, particularly in the presence of political ideology and religious belief. Specifically, we choose to examine the factors of empathy, locus of control, and thinking style (need for cognition) based on three considerations. Firstly, from a face validity perspective, the psychological constructs are predicted to exhibit a relationship with abortion attitudes. For example, the internal locus of control aligns well with the pro-choice mantra, ‘my body, my choice. Secondly, as detailed below, although these constructs have been explored in previous studies, they have only received limited attention and their relations with abortion attitudes remain inconclusive. Hence, our study aims to fill the gaps from past research by further clarifying their roles in attitudes toward abortion. Thirdly, research has indicated significant intersections between elements like cognitive style, empathy, and locus of control with various decisions, especially in health contexts (Marton et al., 2021 ; Pfattheicher et al., 2020 ; Xu and Cheng, 2021 ). These elements are tied to motivation, information analysis, and make trade-offs (Fischhoff and Broomell, 2020 ). Building on this, our study seeks to explore the applicability of these factors to the deeply sensitive and polarizing decision of abortion. On the other hand, it is worth noting that the psychological factors examined in our study are not exhaustive or driven by theoretical considerations. However, as mentioned in recent publications (Osborne et al., 2022 ; Valdez et al., 2022 ), past research on abortion attitudes with a psychological perspective is still limited. Therefore, our hope is that the present study could provide initial yet meaningful empirical evidence to exhibit the sophisticated role of psychology in attitudes toward abortion. We detail our rationales for each factor below.

Empathy refers to a variety of cognitive and affective responses, including sharing and understanding, toward others’ experiences (Pfattheicher et al., 2020 ). Previous studies have demonstrated a positive association between empathy and prosocial behaviors, such as caring for others (Moudatsou et al., 2020 ; Klimecki et al., 2016 ), as well as a reduction in conflict and stigma (Batson et al., 1997 ; Klimecki, 2019 ). Recently, Pfattheicher et al. ( 2020 ) also demonstrated that inducing empathy for the vulnerable people could promote taking preventative measures during the Covid-19 pandemic. While researchers advocated for incorporating empathy into abortion-related mental health intervention (Brown et al., 2022 ), the role of empathy in attitudes toward abortion remains understudied. Hunt ( 2019 ) investigated the impact of empathy toward pregnant women by presenting testimonial videos in which a pregnant woman described the challenges she faced due to legal abortion restrictions in Arkansas. However, this manipulation did not significantly reduce participants’ support for the abortion restrictions. Research has found that people’s views on abortion tends to be stable over time (Jelen and Wilcox, 2003 ; Pew Research Center, 2022 ). Hence, a short video used in Hunt ( 2019 ) might not be able to change people’s long-held views on abortion. Instead, we here hypothesize that the pre-existing but not temporality induced empathy play a role in abortion attitudes.

Furthermore, in addition to the empathy toward pregnant woman, it is also reasonable to assume that (some) people may feel empathy toward the unborn. For instance, interviews with Protestant religious leaders exhibited empathy toward both pregnant women and unborn (Dozier et al., 2020 ). Embree ( 1998 ) asked participants to indicate their opinions when responding to different scenarios of abortion. As a result, the study found that 64% and 17% of participants showed a moderate and strong level of empathy for the unborn, respectively. Despite the informative findings, the relationship between attitudes toward abortion and empathy toward the unborn remains unclear, particularly when taking empathy toward pregnant woman and other factors (e.g., political ideology) into account.

Together, we raise three hypotheses regarding the role of empathy as shown below.

H1a: Empathy toward pregnant woman and unborn can coexist.

H1b: People’s empathy toward pregnant woman are positively related to the support toward abortion.

H1c: People’s empathy toward unborn are negatively related to the support toward abortion.

As empathy has been highlighted in the intervention process when dealing with abortion-related mental health issues (Brown et al., 2022 ; Whitaker et al., 2015 ), we hope our findings could generate implications for future research and practice.

Locus of control

Locus of control (LOC) refers to people’s beliefs regarding whether their life outcomes are controlled and determined by their own (internal LOC) or external resources (fate, chance and/or powerful people, external LOC) (Levenson, 1981 ). Before delving into details, it is important to note that the internal and external LOC refer to different dimensions and are not mutually exclusive (Levenson, 1981 ; Reknes et al., 2019 ). For example, a person’s success may be determined by both hardworking and support from others. Regarding abortion attitudes, Sundstrom et al. ( 2018 ) analyzed interview contents and found that some women’s thoughts on pregnancy and abortion aligned with an internal locus of control (e.g., “As women, we need to take control as much as possible of our reproductive health”), while others aligned with an external locus of control (e.g., “leave it in God’s hands…we’ll just play it by ear and if I get pregnant, I get pregnant”).

The findings from Sundstrom et al. ( 2018 ) were informative and consistent with common sense. For example, at face value level, the slogan of “my body my choice” well aligns with the concept of internal LOC. However, the role of internal LOC in abortion attitudes may be more complicated. That is, religious belief may complicate the association between internal LOC and abortion attitudes. Past studies, including a meta-analysis and a study with over 20,000 participants, found a positive relationship between internal LOC and religious belief (Coursey et al., 2013 ; Falkowski, 2000 ; Iles-Caven et al., 2020 ). As noted in these articles, there are similarities between internal LOC and religious belief. For instance, religious beliefs often provide individuals with a sense of meaning, purpose, and guidance in life. Meanwhile, people higher in internal LOC are more likely to report higher levels of existential well-being and purpose in life, which can be associated with religious belief and engagement (Kim-Prieto et al., 2005 ; Krause and Hayward, 2013 ). Thus, the relationship between internal LOC and religious belief may complicate how internal LOC is involved in the abortion attitudes. Sundstrom et al. ( 2018 ) used interviews to explore the role of LOC in thoughts about abortion. However, this method might not sufficiently differentiate the influence of religious beliefs. In this study, we adopt a quantitative approach, using a classical scale to measure LOC. We aim to empirically assess the relationship between internal LOC and attitudes toward abortion, especially when accounting for religious belief. Furthermore, considering that the relationship between internal LOC and abortion attitudes might be intertwined with religious beliefs, we refrain from positing a specific hypothesis at this point.

External LOC, on the other hand, does not appear to have a significant relationship with religious belief. Additionally, a few studies found that people higher in external LOC tended to attribute outcomes to external reasons (Falkowski, 2000 ; Reknes et al., 2019 ). Building on this concept, individuals with a higher external locus of control (LOC) may be more inclined to attribute pregnancy to external factors and place less emphasis on personal responsibility. Accordingly, we predict the hypothesis below.

H2: External LOC will be positively related to the support toward abortion.

Need for cognition

Based on face validity, thinking style might pertain to one’s perception of abortion. For instance, individuals who prioritize comprehensive and empirical data might arrive at a different conclusion than those who lean on personal stories and emotional narratives. A few studies have tapped into the relationship between thinking style and attitudes toward abortion. Valdez et al. ( 2022 ) conducted qualitative interviews on abortion and employed natural language processing techniques to analyze the interviews. The study identified analytical thinking, which involved considering abortion from multiple perspectives, had a negative relationship with the number of cognitive distortions (such as polarized and rigid thinking about abortion). However, such a finding conflicted with another study by Hill ( 2004 ) where the concept of cognitive complexity (thinking beyond surface-level observations) did not correlate with attitudes toward abortion. The inconsistency might be due to methodological issues. For example, the correlations described above in Valdez et al. ( 2022 ) were derived from a small sample consisting of 16 participants. A low reliability of the cognitive complexity scale used in Hill ( 2004 ) might (partly) address the non-significant relationship. Thus, the present study will utilize the Need for Cognition scale, a widely recognized and validated instrument that measures thinking style, to examine its correlation with attitudes toward abortion in a larger sample.

Need for cognition (NFC) pertains to the inclination to derive satisfaction from and actively participate in effortful thinking (Cacioppo et al., 1984 ). Consistent with its concept, past research demonstrated that NFC was positively correlated with information seeking (Verplanken et al., 1992 ), academic achievement (Richardson et al., 2012 ), and logical reasoning performance (Ding et al., 2020 ). As for attitudes toward abortion, we hypothesize the following.

H3: There will be a positive correlation between NFC and attitudes toward abortion.

Our prediction is based on two reasons. First, NFC drives individuals to actively seek and update information and knowledge. It was discovered that acquiring a deeper understanding of abortion correlated with increased support for it (Hunt, 2019 ; Mollen et al., 2018 ). Second and relatedly, NFC was found to be negatively associated with various stereotype memories and positively related to non-prejudicial social judgments (Crawford and Skowronski, 1998 ; Curşeu and de Jong, 2017 ).

In sum, the present study aims to provide empirical evidence for the association between attitudes toward abortion and psychology by examining and clarifying the role of empathy, locus of control, and need for cognition. Past research has repeatedly found the involvement of political ideology and religious belief in abortion attitudes (e.g., Hess and Rueb, 2005 ; Holman et al., 2020 ; Jelen, 2017 ; Osborne et al., 2022 ; Prusaczyk and Hodson, 2018 ). Given their powerful and robust effect, it is crucial to gather additional empirical evidence to elucidate the distinct contribution of psychology to attitudes toward abortion, while considering the influence of political ideology and religious beliefs. Additionally, when describing attitudes toward abortion, the dichotomization of “pro-choice” and “pro-life” have been widely used for decades. However, some studies have criticized that the dichotomization oversimplified attitudes toward abortion (Hunt, 2019 ; Osborne et al., 2022 ; Rye and Underhill, 2020 ). That is, people’s views on abortion vary across different scenarios and reasons. For instance, people showed less support toward abortion with elective reasons than with traumatic reasons (Hoffmann and Johnson, 2005 ). With confirmatory analysis, Osborne et al. ( 2022 ) derived two types of abortion: traumatic (e.g., pregnancy due to rape) vs. elective (e.g., the woman does not want the child anymore). Building on prior research, the current study aims exploring potential variations in attitudes across different abortion reasons. Furthermore, we also intend to examine whether the psychological factors described above have varying associations with different types of abortion.

Participants

The study was approved by IRB before data collection. Participants were recruited from Amazon Mechanical Turk (mTurk) on October 20th, 2022. To be eligible for the study, participants must be an adult, a U.S. citizen, and have an approval rating greater than 98% in mTurk. A total of 300 participants were enrolled into the study. Each participant received $3 for compensation. Six participants did not complete at least 80% of the items and were removed from the study. Thus, the effective sample size was 294. Demographics are presented in the Results section.

Materials and procedures

Participants took an online survey developed by Qualtrics. Our study did not set a specific time restriction. Across 294 participants, the average survey completion time was 682.8 s (SD = 286.6 s). The median completion time was 595.0 s (IQR = 344.8 s). The following questionnaires were completed.

Attitudes toward abortion

Hoffmann and Johnson ( 2005 ) and Osborne et al. ( 2022 ) analyzed attitudes toward abortion with six different scenarios (scenarios a-f below) that were measured by the U.S. General Social Survey. We further added an additional item regarding underage pregnancy for two reasons. First, compared to other Western industrialized nations, the U.S. has historically had a higher rate of underage pregnancies. Additionally, underage pregnant individuals tended to have a higher likelihood of seeking abortions compared to their older counterparts (Lantos et al., 2022 ; Kearney and Levine, 2012 ; Sedgh et al., 2015 ). Second, underage pregnancy is linked to various adverse outcomes, such as increased risk during childbirth, heightened stress and depression, disruptions in education, and financial challenges (Eliner et al., 2022 ; Hodgkinson et al., 2014 ; Kearney and Levine, 2012 ). Given the significance and prevalence of underage pregnancy, we chose to include it as a scenario to understand the public’s perception. Additionally, we understood that people might feel conflict or uncertain toward one or more scenarios. Hence, instead of using binary response (yes/no format) adopted in the U.S. General Social Survey, we employed a 1 to 7 Likert scale for each scenario, with a higher score indicating stronger support for a pregnant woman to obtain legal abortion.

The seven scenarios in the present study included: (a) there is a strong chance of serious defect in the baby; (b) the woman’s own health is seriously endangered by the pregnancy; (c) the woman became pregnant as a result of rape; (d) the woman is married and does not want any more children; (e) the family has a very low income and cannot afford any more children; (f) the woman is not married and does not want to marry the man; and (g) the woman is underage.

Following the wording used to measure empathy in Pfattheicher et al. ( 2020 ), we developed six items to measure the empathy toward the pregnant woman and unborn or fetus, respectively. The scale of empathy toward pregnant woman included: (a) I am very concerned about the pregnant woman who may lose access to legal abortion; (b) I feel compassion for the pregnant women who may lose access to legal abortion; and (c) I am quite moved by the pregnant women who may lose access to legal abortion. The scale of empathy toward unborn included: (a) I am very concerned about the fetus or unborn child; (b) I feel compassion for the fetus or unborn child; and (c) I am quite moved by the fetus or unborn child. Participants rated each item on a five-point Likert scale, with 1 being strongly disagree and 5 being strongly agree. Thus, a higher score demonstrated stronger empathy toward the target. The Cronbach’s α for the scale of toward pregnant woman was 0.90 in the present study. The Cronbach’s α for the scale of toward unborn was 0.92.

The need for cognition scale (NFC, Cacioppo et al., 1984 ) intends to measure the tendency to engage into deep thinking. It has 18 items, such as “I only think as hard as I have to” and “I find satisfaction in deliberating hard and for long hours”. Participants rated each item on a five-point Likert scale, with a higher score indicating a greater tendency to enjoy deep thinking. In the present study, the reliability of this scale was 0.93.

The present study adopted Levenson multidimensional locus of control scale (Levenson, 1981 ). Across 24 items, this scale measures three dimensions of locus of control: internality (sample item: Whether or not I get to be a leader depends mostly on my ability); powerful others (sample item: I feel like what happens in my life is mostly determined by powerful people); and chance (sample item: To a great extent my life is controlled by accidental happenings). In the present study, participants rated each item on a 1 to 6 Likert scale, with a higher score indicating a stronger belief that fate was controlled by self, powerful others, or chance. The Cronbach’s α for the subscales of internality, powerful others, and chance was 0.84, 0.91, and 0.93, respectively. As shown below, there was a high agreement between powerful others and chance subscales ( r = 0.87, p < 0.001). Hence, we combined these two subscales to form an external locus of control composite.

Demographics

After completing the scales described above, participants were asked to report their demographic information including race, age, gender, education, annual household income, current relationship status, abortion experience, religious belief, and political ideology. Gender was coded with 1 = male, 2 = female, and 3 = other. Race was coded with 1 = White or Caucasian, 2 = Hispanic or Latinx, 3 = Black or African American, 4 = Asian or Asian American, and 5 = Other. Education was coded with six levels: 1 = Less than high school graduate, 2 = High school graduate or equivalent, 3 = Some college or associate degree, 4 = Bachelor’s degree, 5 = Master’s degree, 6 = Doctoral degree. Annual household income was categorized into 13 levels and ranged between under $9,999 and above $120,000 with increments of $9,999. Current relationship status was coded into six levels: 1 = single and not dating, 2 = single but in a relationship, 3 = married, 4 = divorced, 5 = widowed, 6 = other. For abortion experience participants were asked “For any reason, have you had an abortion?”. For this question, the answer was coded with 1 = yes and 2 = no.

Religious belief was measured with three items. The first item asked “How often do you attend religious services?” Participants selected one option out of the following: 1 = never, 2 = a few times per year, 3 = once a month, 4 = 2–3 times a month, 5 = once a week or more. The second item asked “How important is religion to you personally?” Participants rated this question on a five-point Likert point, with 5 being most important. The third question asked “How would you describe your religious denomination”. The options included 1 = Christian, 2 = Islam, 3 = Judaism, 4 = Buddhism, 5 = Hinduism, 6 = other or atheism. In the present study, the first two items were highly correlated ( r = 0.77, p < 0.001). Following Hunt ( 2019 ), we combined the two items to form a general religiosity composite, with a higher score indicating a stronger religious belief.

Political ideology was measured with two items: (a) Generally, how would you describe your views on most social political issues (e.g., education, religious freedom, death penalty, gender issues, etc.)? and (b) Generally, how would you describe your views on most economic political issues (e.g., minimum wage, taxes, welfare programs, etc.)? Participants rated each item with a five-point Likert scale, with 1 = strongly conservative 2 = conservative 3 = moderate 4 = liberal 5 = strongly liberal. We found a strong correlation between the two political ideology items, r = 0.76, p < 0.001. Hence, we combined the two items to form a general political ideology composite.

SPSS 24.0 was employed to perform all the analyses. Across 294 participants, age ranged from 21 to 79, with a mean of 40.4 and a standard deviation of 12.4. Table 1 displays the descriptive statistics for the variables of gender, race, education, annual household income, current relationship status, religious denomination, and abortion experience.

Table 2 presents the descriptive statistics of attitudes toward abortion in different scenarios, religious belief, political ideology, and the scores of the psychological scales. Similar to the results obtained from the large-scale surveys in the U.S. and New Zealand (Osborne et al., 2022 ), the support toward abortion was strong (neutral = 4) across all scenarios.

To examine the structure of attitudes toward abortion in different scenarios, a Principal Component Analysis (PCA) with a Varimax orthogonal rotation was performed on all seven scenarios. With eigenvalue ≥ 1 as the threshold, two components were generated, accounting for 81.34% of the variability. Table 3 presents the PCA results. As shown, we obtained two distinct components. The first one included the scenarios of baby defection, pregnant woman’s health being endangered, pregnancy caused by rape, and underage pregnancy. The second component included the scenarios of not wanting the child, low income, and not wanting to marry. Such a differentiation between the two components was consistent with the notion in Osborne et al. ( 2022 ). Following this paper and the face validity of the scenarios, we labeled the two components traumatic abortion and elective abortion, respectively. Accordingly, we also computed a composite score for each component by averaging the corresponding items. In line with previous research (Hoffmann and Johnson, 2005 ), the support was significantly stronger toward the traumatic abortion (mean = 5.84, SD = 1.24) than the elective abortion (mean = 4.94, SD = 1.74), t (293) = 11.51, p < 0.001, Cohen’s d = 0.67.

Table 4 presents the zero-order correlations between attitudes toward traumatic and elective abortions, demographics, and scores of the psychological factors. Consistent with the findings from past research (e.g., Hess and Rueb, 2005 ; Holman et al., 2020 ), a stronger religious belief was negatively related to the support toward both types of abortions. A stronger liberal ideology was positively related to the support toward both types of abortions. Additionally, empathy toward the pregnant woman was positively associated with the support toward both types of abortions whereas empathy toward unborn or fetus had an opposite effect. Based on the zero-order correlation, we did not find a significant relationship between internal locus of control and attitudes toward either type of abortion. The external locus of control (either powerful others or chance), on the other hand, was positively related to the support toward elective but not traumatic abortion. As there was a high agreement between the two external locus of control subscales ( r = 0.87, p < 0.001), we formed a general external locus of control composite by averaging the two items in the following regressions. Finally, need for cognition was positively related to attitudes toward elective abortion but not traumatic abortion.

While the zero-order correlations were informative, we were mindful that the Type I error might be greatly inflated due to a vast amount of repeated testing. Moreover, one goal of the study was to examine the role of psychological factors in the presence of religious belief and political ideology. Thus, we performed a hierarchical linear regression on each type of abortion, with age, gender, income, and education in the first block, religious belief and political ideology in the second block, and psychological factors in the third block. We separated the regression between the two types of abortion because the role of predictors might vary. This approach was also employed in Osborne et al. ( 2022 ). Table 5 exhibits the regression results.

As shown in Table 5 , the demographic variables of age, gender, education, and income did not account for a significant portion of the variability in attitudes toward either type of abortion. The present study added to the literature that there might not necessarily be a difference in attitudes toward abortion between males and females (Bilewicz et al., 2017 ; Jelen and Wilcox, 1997 ). By contrast, in the second block, religious belief and political ideology collectively explained a sizable portion of the variability in attitudes toward both types of abortion. In block 3, in the presence of demographic variables including religious belief and political ideology, psychological factors could still account for a significant portion of the variability.

Looking at the individual psychological predictors (for more detailed interpretations please refer to the discussion part), consistent with our hypothesis, empathy toward the pregnant woman was positively associated with the support toward both types of abortion. By contrast, empathy toward the unborn or fetus was negatively associated the support toward abortion. For the factor of locus of control, the internal locus of control was not related to any type of abortion attitudes when zero-order correlation was used (Table 4 ); yet it was positively related to abortion attitudes after all other predictors were taken into account, indicating a suppressing effect. Upon further examination, we identified two suppressors: religious belief and empathy toward the unborn. After removing these two variables, internal locus of control was no longer significant. The observed pattern reflected our previous prediction, indicating that the role of internal locus of control could be complicated by religious beliefs. External locus of control, on the other hand, was positively correlated with the support toward elective abortion. Similarly, need for cognition (NFC) also had a positive relationship with the support toward elective abortion. Neither external locus of control nor NFC had a significant correlation with attituded toward traumatic abortion. Hence, our hypotheses regarding external locus of control and NFC were partially supported. We detailed out interpretation and discussion of the results below.

The present study aimed to provide empirical evidence for the correlations between psychological factors and attitudes toward abortion. As introduced earlier, while it is common to find the involvement of psychology in everyday life attitudes and preferences, attitudes toward abortion are unique and drastically different. Given its unique nature, it lacks empirical evidence regarding whether psychological factors that interplay with attitudes in other areas still apply and, if so, in what capacity they do so. Past research has primarily focused on the role of religious belief and political ideology. Our study demonstrated a substantial involvement ( R 2 change = 0.27 and 0.24 for traumatic and elective abortion, respectively) of the psychological factors, after controlling for religious belief and political ideology. More importantly, these effects were comparable to the variability accounted for by religious belief and political ideology combined, particularly in the elective abortion category. The results highlighted the influential role of psychological factors in shaping attitudes toward abortion.

Additionally, past research has shown the interconnection between psychology and the public’s attitudes toward major societal events. For example, during the Covid-19 pandemic, while the perception of mask-wearing and/or social distancing was highly politicized, studies found that attitudes toward these preventative measures to be related to thinking style, self-control, numeracy, and working memory capacity (Steffen and Cheng, 2023 ; Xie et al., 2020 ; Xu and Cheng, 2021 ). In line with this, our study further underscored the significant influence of psychology on another pressing societal topic: abortion. In the sections below, we detail our findings and relevant implications. We are fully aware that our study was preliminary and hope it could serve as a starting point for future research and practice. We also acknowledge the limitations of our study and address them at the end.

Some past studies on empathy and abortion only considered the empathy toward the pregnant woman (e.g., Brown et al., 2022 ; Homaifar et al., 2017 ; Hunt, 2019 ; Whitaker et al., 2015 ). The present study identified two types of empathy when dealing abortion: empathy toward the pregnant woman and empathy toward the unborn. In the presence of each other, we found that greater empathy toward the pregnant woman was associated with more support toward abortion, whereas greater empathy toward the unborn or fetus was associated with less support toward abortion. Such a pattern suggested that empathy might be a source of conflict feeling. That is, when considering abortion, concerns and care toward pregnant woman and unborn could coexist, potentially leading to conflict and dilemma when people thought about abortion. While the present study examined the public’s attitudes toward abortion with a diverse sample, pregnant women might have a similar pattern of empathy and hence feel conflict and dilemma when thinking about abortion. To cope with such a conflict, it might be beneficial for a counselor to acknowledge conflicting emotions that arise from empathizing with both the unborn and the pregnant individual. Moreover, the counselor could guide the client through the process of reconciling these emotions to alleviate feelings of isolation or confusion the client may experience. Future research in the realms of mental health and counseling should consider integrating these dual empathy perspectives and empirically assess the efficacy of such therapeutic interventions.

Additionally, Hunt ( 2019 ) did not find a significant influence of empathy on abortion attitudes change when participants were exposed to testimonial videos featuring pregnant women discussing the legal obstacles they faced. The disparity between Hunt’s ( 2019 ) findings and our own could potentially be attributed to the inherent stability and longstanding nature of abortion attitudes. Research has found that people’s views on abortion tends to be stable over time (Jelen and Wilcox, 2003 ; Pew Research Center, 2022 ). As a result, it is possible that pre-existing empathy, rather than empathy induced temporarily, was the factor correlated with individuals’ perception and consideration of abortion. Our findings were consistent with this possibility. Together, our findings supported H1a to H1c. Moreover, our study shed more light on empathy by showing its association with distinct views on abortion. The results suggest that future research could investigate how different types of empathy are formed and how they influence the shaping and persuasion of abortion attitudes.

Through qualitative interviews, Sundstrom et al. ( 2018 ) unveiled individual differences in the locus of control when discussing opinions on abortion. However, these interviews might not have fully captured the interplay between internal and external locus of control and other factors involved attitudes toward abortion. To fill the gap, our study employed a quantitative approach to delve deeper into how locus of control correlated with abortion attitudes. Consistent with Levenson ( 1981 ) and Reknes et al. ( 2019 ), we found that the constructs internal locus of control and external locus of control were differentiated but not unidimensional. For internal locus of control, interestingly, we found a suppressing effect. As discussed earlier, the role of internal locus of control in abortion attitudes might be complicated. That is, on the one hand, by face validity, the internal locus of control well aligned with the concept of “my body, my choice” (Sundstrom et al., 2018 ). On the other hand, in line with past research (Coursey et al., 2013 ; Falkowski, 2000 ; Iles-Caven et al., 2020 ), our study found that internal locus of control was positively related to religious belief. Furthermore, as shown in Table 4 , internal locus of control was also positively related to the empathy toward the unborn, and such a relationship was significantly mediated by religious belief (mediation effect = 0.21, SE = 0.5, 95% CI = [0.13, 0.31]). Therefore, when using zero-order correlation, the effect of internal locus of control might be neutralized by the two opposite parts (“my body, my choice” vs. religious belief) discussed above. By contrast, in regression, the “my body, my choice” part stood out because the religiosity part was partialled out by the variables of religious belief and empathy toward the unborn.

In addition to internal locus of control, we also discovered that external locus of control was involved in abortion attitudes. Specifically, we found a positive relationship between external locus of control and support toward elective abortion (H2 was partially supported). Past research has found that locus of control is related to attribution (Falkowski, 2000 ; Reknes et al., 2019 ). Thus, our finding was in line with the notion that those with a greater level of external locus of control might be more likely to attribute unwanted pregnancy to external reasons (not personal responsibility), and hence showed more support toward abortion.

Our findings regarding locus of control suggest that individuals might simultaneously believe in personal autonomy (“my body, my choice”) while also feeling that certain life events, like unwanted pregnancies, are influenced by external factors beyond their control. This is particularly true when thinking about elective abortion. Education and counseling practices might be designed to reflect this duality. For example, materials and discussions could simultaneously emphasize the importance of personal choices and responsibilities, while also exploring societal, cultural, or circumstantial factors that might influence abortion decision. Incorporating both perspectives would allow to create a supportive environment where individuals feel seen and acknowledged in their complexities.

As introduced earlier, past research on the relationship between thinking style and abortion attitudes was inconclusive. To clarify the relationship, the present study adopted the validated need for cognition scale. Need for cognition has demonstrated its involvement in consequential events, such as political elections and the adoption of preventive measures during the Covid-19 pandemic (Sohlberg, 2019 ; Xu and Cheng, 2021 ). In the present study, we discovered that need for cognition was positively related to the support toward elective abortion. Such a finding was consistent with the notion that need for cognition was negatively related to stereotypes (Crawford and Skowronski, 1998 ; Curşeu and de Jong, 2017 ). Additionally, as need for cognition drives individuals to seek and update knowledge, our result was also in line with the finding that gaining knowledge about abortion led to more positive view on abortion (Hunt, 2019 ; Mollen et al., 2018 ). Our study implied that future research could empirically evaluate if indeed abortion knowledge mediates the relationship between need for cognition and abortion attitudes.

It is worth noting that the present study also clarified the role of need for cognition in attitudes toward abortion by examining a potential artifact. Specifically, the observed positive relationship between need for cognition and support for abortion might be an artifact, given that liberal ideology is positively correlated with both abortion attitudes and need for cognition (Young et al., 2019 ). However, as shown in our regression, the relationship between need for cognition and elective abortion remained significant in the presence of other variables, including political ideology. Thus, the finding suggested that at least part of the relationship between need for cognition and attitude toward abortion was unique and not driven by political ideology.

Our findings related to need for cognition had an implication on abortion-related education. As discussed earlier, having adequate knowledge about abortion could facilitate the support for making informed decisions. As need for cognition was found to be related to openness and motivation to seek and update information (Russo et al., 2022 ), our finding suggested that cultivating willingness to engage into critical thinking might be beneficial for education on abortion and reproductive rights. While we are fully aware that correlation does not equate to causation, our study still offers a starting point for future research and practice on abortion-related education.

Traumatic abortion vs. elective abortion

While some researchers argued that the dichotomization of “pro-choice” and “pro-life” was oversimplified, to date, only two studies have empirically examined attitude variation between different abortion scenarios (Hoffmann and Johnson, 2005 ; Osborne et al., 2022 ). Both studies demonstrated that public views on abortion can be grouped into two categories: traumatic and elective. Our research not only replicated these findings but also introduced two significant advancements. First, we incorporated a scenario addressing underage pregnancy, given its high prevalence and significance. Secondly, instead of a binary response, we employed a 7-point Likert scale, allowing us to more accurately capture potential conflicting attitudes among participants.

Furthermore, our findings revealed that the roles of external locus of control and need for cognition varied in relation to attitudes toward the two types of abortion. Interestingly, we observed that neither of these variables significantly related to attitudes toward traumatic abortion, as indicated by both zero-order correlation and regression analyses. Conceptually, the scenarios of traumatic abortion (e.g., pregnancy caused by rape; mother life endangered) tend to be more extreme and emergent than the scenarios of elective abortion. Hence, there might be less room for psychological factors, such as thinking or attribution, to function in traumatic abortion than in elective abortion. Our interpretation was also consistent with the statistical pattern between the two abortions. That is, compared to elective abortion, the standard deviation of traumatic abortion was smaller. Additionally, there were more participants rated seven on the Likert scale in the scenarios of traumatic abortion (29.6%) than in the scenarios of elective abortion (18%). Despite the difference between the two types of abortion, it is essential to acknowledge that elective abortion does not imply a stress-free experience. Both traumatic and elective abortions involve significant levels of stress and emotional challenges. While traumatic abortion scenarios can be considered more extreme, it is crucial to recognize that individuals undergoing elective abortion may also experience considerable emotional distress.

Taken together, with concrete evidence, our study demonstrated that the public’s attitude toward abortion depended on abortion reasons. Our study also implied that future research should focus on attitudes toward specific abortion scenarios rather than a holistic concept of abortion. Furthermore, the differentiation between the traumatic and elective abortions suggested the limitation and potential ineffectiveness of one-size-fits-all legislative solutions. Given the varying and often conflicting attitudes that people harbor, it would be reasonable for legislative frameworks to be flexible, adaptive, and cognizant of the different circumstances surrounding abortion. This will not only be more reflective of public opinions but also more supportive of individuals who undergo different types of abortion experiences, each of which carries its own set of emotional and psychological challenges.

Expanding findings with a quantitative approach

Some past studies employed a qualitive approach when dealing with attitudes toward abortion (e.g., Dozier et al., 2020 ; Sundstrom et al., 2018 ; Valdez et al., 2022 ; Woodruff et al., 2018 ). These investigations have provided insights and served as inspirations for our own research. However, the relationship between abortion attitudes and pertinent factors may remain somewhat opaque. This is particularly true when considering the intricate interconnectedness among these factors. The present study demonstrated that findings from qualitative studies could be extended and enriched with a quantitative approach. For instance, we utilized quantitative scales to measure empathy toward the unborn —a variable that was previously identified through interviews in the study by Dozier et al. ( 2020 ). Moreover, we further exhibited the role of empathy toward the unborn when statistically controlled other variables, including empathy toward the pregnant. Similarly, the role of internal locus of control was revealed in interviews in Sundstrom et al. ( 2018 ). With validated scales, we exhibited the correlation with internal locus of control in both types of abortion. Furthermore, by detecting and interpreting a suppressing effect, we showed the interplay between internal locus of control, religious belief, and attitude toward abortion. Thus, our study implied that using quantitative scales and analyses was a viable approach to examine attitude toward abortion and could deepen the understanding of relevant factors.

Limitations and future directions

Despite the contributions, limitations should be acknowledged as well. First and foremost, we believe our study was still in the explorative stage. The specific psychological factors tested in the present study were not exhaustive and not theoretically driven. We hope the present study could provide initial empirical evidence to show the sophisticated role of psychology in attitudes toward abortion. Future studies could use a more theoretical driven approach to examine the specific psychological involvement in abortion attitudes. For example, given the correlation between need for cognition and attitudes toward abortion, future research could further elucidate the role of thinking style in attitudes toward abortion by incorporating the Dual-Process Theory (Evans, 2008 ). The Dual-Process Theory posits that humans have two distinct systems of information processing: System 1, which is intuitive, automatic, and fast; and System 2, which is deliberate, analytical, and slower. By examining the interplay between these two systems, researchers might gain insights into how intuitive emotional responses versus more deliberate cognitive analyses influence individuals’ attitudes toward abortion. For instance, are individuals who predominantly rely on System 1 more swayed by emotive narratives or imagery related to abortion?

Second, when analyzing and discussing the results, we proposed several possible underlying mechanisms that might elucidate the relationships observed. To illustrate, we employed the concept of attribution to shed light on the role of an external locus of control, positing that individuals with a strong external locus might attribute abortion decisions to external factors or circumstances rather than personal choices. Furthermore, we suggested that the observed positive relationship between the need for cognition and abortion attitudes might be mediated through abortion knowledge. This implies that individuals with a higher need for cognition could potentially seek out more information on abortion, leading to more informed attitudes. However, while these interpretations offer potential insights, we recognize their speculative nature. It’s crucial to emphasize that our proposed mechanisms require rigorous empirical testing for validation. For example, it would be of interest to test whether indeed, gaining various types of abortion knowledge improves views of abortion.

Third, as described above, we strived to show how our findings could be potentially used in abortion-related counseling. However, we acknowledge that our study is explorative but not counseling focused. Therefore, while we believe our findings offer meaningful implications, we caution against over-extrapolating their direct applicability to counseling contexts. Future research could delve into empirically investigating how psychological factors, such as varying empathy types and loci of control, could be utilized to alleviate negative feelings associated with abortion decisions. Additionally, understanding how various psychological factors interact with cultural and social norms could further help tailor counseling approaches.

Fourth, the present study did not include an attention check item. We believe the quality of our survey could have been improved had we included one or more attention check items. However, the reliabilities of our scales were relatively high (ranged from 0.84 to 0.93). Additionally, we also replicated some major findings from previous research (e.g., the associations between attitudes toward abortion and religious belief and political ideology). Thus, we believe that overall, inattention did not affect the quality of our data. Future online surveys could consider using attention check items for quality control.

In conclusion, the present study demonstrates the unique contribution of empathy, locus of control, and need for cognition to how people perceived abortion in different scenarios. The findings suggests that attitudes toward complex moral issues like abortion are shaped by individual psychological traits and cognitive needs, in addition to societal, religious, and cultural norms. Future research could use our study as a starting point to expand on these findings, exploring other psychological traits and cognitive processes that may similarly affect perceptions of abortion and other controversial subjects.

Data availability

Data included in this project may be found in the online repository, https://doi.org/10.7910/DVN/E5AB5R .

Batson CD, Polycarpou MP, Harmon-Jones E, Imhoff HI, Mitchener EC, Highberger L et al. (1997) Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group? J Person Soc Psychol 72(1):105–118

Article CAS Google Scholar

Bilewicz M, Mikołajczak G, Babińska M (2017) Speaking about the preborn. How specific terms used in the abortion debate reflect attitudes and (de)mentalization. Person Individ Differ 111:256–262

Article Google Scholar

Brown L, Swiezy S, McKinzie A, Komanapalli S, Bernard C (2022) Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school. Heliyon 8(7):e09894. https://doi.org/10.1016/j.heliyon.2022.e09894

Article PubMed PubMed Central Google Scholar

Cacioppo JT, Petty RE, Kao CF (1984) The efficient assessment of need for cognition. J Person Assess 48(3):306–307. https://doi.org/10.1207/s15327752jpa4803_13

Comrey AL, Lee HB (1992) A first course in factor analysis (2nd ed.). Lawrence Erlbaum Associates, Inc

Coursey LE, Kenworthy JB, Jones JR (2013) A meta-analysis of the relationship between intrinsic religiosity and locus of control. Arch Psychol Relig 35:347–368. https://doi.org/10.1163/15736121-12341268

Crawford MT, Skowronski JJ (1998) When motivated thought leads to heightened bias: high need for cognition can enhance the impact of stereotypes on memory. Person Soc Psycholo Bull 24(10):1075–1088. https://doi.org/10.1177/01461672982410005

Curşeu PL, de Jong JP (2017) Bridging social circles: need for cognition, prejudicial judgments, and personal social network characteristics. Front Psychol 8:1251. https://doi.org/10.3389/fpsyg.2017.01251

Ding D, Chen Y, Lai J, Chen X, Han M, Zhang X (2020) Belief bias effect in older adults: roles of working memory and need for cognition. Front Psychol 10:2940. https://doi.org/10.3389/fpsyg.2019.02940

Dozier JL, Hennink M, Mosley E, Narasimhan S, Pringle J, Clarke L, Blevins J, James-Portis L, Keithan R, Hall KS, Rice WS (2020) Abortion attitudes, religious and moral beliefs, and pastoral care among Protestant religious leaders in Georgia. PloS one 15(7):e0235971. https://doi.org/10.1371/journal.pone.0235971

Article CAS PubMed PubMed Central Google Scholar

Eliner Y, Gulersen M, Kasar A, Lenchner E, Grünebaum A, Chervenak FA, Bornstein E (2022) Maternal and neonatal complications in teen pregnancies: a comprehensive study of 661,062 patients. J Adolesc Health 70(6):922–927. https://doi.org/10.1016/j.jadohealth.2021.12.014

Article PubMed Google Scholar

Embree RA (1998) Attitudes toward elective abortion: preliminary evidence of validity for the personal beliefs scale. Psychol Rep 82(3 Pt 2):1267–1281. https://doi.org/10.2466/pr0.1998.82.3c.1267

Article CAS PubMed Google Scholar

Evans JSTBT (2008) Dual-processing accounts of reasoning, judgment and social cognition. Ann Rev Psychol 59:255–278. https://doi.org/10.1146/annurev.psych.59.103006.093629

Falkowski CK (2000) Locus of control, religious values, work values and social policy choices. Diss Abstracts Int. Sec B: Sci Eng 61:1694

Google Scholar

Felix., M., Sobel, L., & Salganicoff, A. (2023). Legal challenges to state abortion bans since the dobbs decision. Kaiser Family Foundation . Retrieved from https://www.kff.org/womens-health-policy/issue-brief/legal-challenges-to-state-abortion-bans-since-the-dobbs-decision/

Fischhoff B, Broomell SB (2020) Judgment and decision making. Ann Rev Psychol 71:331–355

Foster DG, Gould H, Taylor J, Weitz TA (2012) Attitudes and decision making among women seeking abortions at one U.S. clinic. Perspect Sexual Reprod Health 44(2):117–124. https://doi.org/10.1363/4411712

Hess JA, Rueb JD (2005) Attitudes toward abortion, religion, and party affiliation among college students. Curr Psychol 24(1):24–42. https://doi.org/10.1007/s12144-005-1002-0

Hill A (2004) The relationship between attitudes about abortion and cognitive complexity. UW-J Undergrad Res VII:1–6

ADS Google Scholar

Hodgkinson S, Beers L, Southammakosane C, Lewin A (2014) Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics 133(1):114–122. https://doi.org/10.1542/peds.2013-0927

Hoffmann JP, Johnson SM (2005) Attitudes toward abortion among religious traditions in the United States: change or continuity. Soc Relig 66(2):161–182. https://doi.org/10.2307/4153084

Holman M, Podrazik E, Silber Mohamed H (2020) Choosing choice: how gender and religiosity shape abortion attitudes among Latinos. J Race Ethnicity Politics 5(2):384–411. https://doi.org/10.1017/%20rep.2019.51

Homaifar N, Freedman L, French V (2017) “She’s on her own”: a thematic analysis of clinicians’ comments on abortion referral. Contraception 95(5):470–476. https://doi.org/10.1016/j.contraception.2017.01.007

Hunt ME (2019) Shifting Abortion Attitudes using an Empathy-based Media Intervention: a randomized controlled study. graduate theses and dissertations Retrieved from https://scholarworks.uark.edu/etd/3256

Jelen TG (2017) Public attitudes toward abortion and LGBTQ issues: a dynamic analysis of region and partisanship. SAGE Open 7(1):1–6. https://doi.org/10.1177/2158244017697362

Jelen TG, Wilcox C (1997) Attitudes toward abortion in Poland and the United States. Soc Sci Q 78(4):907–921

Jelen TG, Wilcox C (2003) Causes and consequences of public attitudes toward abortion: a review and research agenda. Political Res Q 56(4):489–500. https://doi.org/10.2307/3219809

Kearney MS, Levine PB (2012) Why is the teen birth rate in the United States so high and why does it matter. J Econ Perspect 26(2):141–166. https://doi.org/10.1257/jep.26.2.141

Kim-Prieto C, Diener E, Tamir M, Scollon C, Diener M (2005) Integrating the diverse definitions of happiness: a time-sequential framework of subjective well-being. J Happiness Studies 6(3):261–300. https://doi.org/10.1007/s10902-005-7226-8

Klimecki O, Mayer S, Jusyte A et al. (2016) Empathy promotes altruistic behavior in economic interactions. Sci Rep 6:31961. https://doi.org/10.1038/srep31961

Article ADS CAS PubMed PubMed Central Google Scholar

Klimecki OM (2019) The role of empathy and compassion in conflict resolution. Emotion Rev 11(4):310–325

Krause N, Hayward RD (2013) Prayer beliefs and change in life satisfaction over time. J Relig Health 52:674–694

Lantos, H., Pliskin, E., Wildsmith, E., & Manlove, J. (2022). State-level abortion restrictions will negatively impact teens and children. Child Trend s. Retrieved from https://www.childtrends.org/blog/state-level-abortion-restrictions-will-negatively-impact-teens-and-children

Levenson H (1981) Differentiating among internality, powerful others, and chance. In: Lefcourt HM (Ed.) Research with the Locus of Control Construct. Academic Press, New York, NY, p 15–63. 10.1016/b978-0-12-443201-7.50006-3

Iles-Caven Y, Gregory S, Ellis G, Golding J, Nowicki S (2020) The relationship between locus of control and religious behavior and beliefs in a large population of parents: an observational study. Front Psychol 11:1462. https://doi.org/10.3389/fpsyg.2020.01462

Marton G, Pizzoli SFM, Vergani L, Mazzocco K, Monzani D, Bailo L, Pancani L, Pravettoni G (2021) Patients’ health locus of control and preferences about the role that they want to play in the medical decision-making process. Psychol Health Med 26(2):260–266. https://doi.org/10.1080/13548506.2020.1748211

Mollen D, Hargons C, Klann EM, Mosley DV (2018) Abortion knowledge and attitudes among psychologists and graduate students. Counseling Psychol 46(6):738–760. https://doi.org/10.1177/0011000018795296

Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S (2020) The role of empathy in health and social care professionals. Healthcare 8(1):26. https://doi.org/10.3390/healthcare8010026

Osborne D, Huang Y, Overall NC, Sutton RM, Petterson A, Douglas KM, Davies PG, Sibley CG (2022) Abortion attitudes: an overview of demographic and ideological differences. Political Psychol 43:29–76. https://doi.org/10.1111/pops.12803

Pew Research Center. (2022, May 17). Public Opinion on Abortion. Retrieved from https://www.pewresearch.org/religion/fact-sheet/public-opinion-on-abortion/

Pfattheicher S, Nockur L, Böhm R, Sassenrath C, Petersen MB (2020) The emotional path to action: empathy promotes physical distancing and wearing of face masks during the COVID-19 pandemic. Psychol Sci 31(11):1363–1373. https://doi.org/10.1177/0956797620964422

Prusaczyk E, Hodson G (2018) Left-right differences in abortion policy support in America: clarifying the role of sex and sexism in a nationally representative 2016 sample. Person Individual Differ 127:22–25. https://doi.org/10.1016/j.paid.2018.01.030

Reknes I, Visockaite G, Liefooghe A, Lovakov A, Einarsen SV (2019) Locus of control moderates the relationship between exposure to bullying behaviors and psychological strain. Front Psychol 10:446169. https://doi.org/10.3389/fpsyg.2019.01323

Richardson M, Abraham C, Bond R (2012) Psychological correlates of university students’ academic performance: a systematic review and meta-analysis. Psychol Bull 138(2):353–387. https://doi.org/10.1037/a0026838

Russo D, Masegosa AR, Stol KJ (2022) From anecdote to evidence: the relationship between personality and need for cognition of developers. Empir Software Eng 27:71. https://doi.org/10.1007/s10664-021-10106-1

Rye BJ, Underhill A (2020) Pro-choice and pro-life are not enough: an investigation of abortion attitudes as a function of abortion prototypes. Sexuality Culture 24:1829–1851. https://doi.org/10.1007/s12119-020-09723-7

Saad, L. (2023, June 21). Abortion remains a potent issue for pro-choice voters. Gallup . Retrieved from https://news.gallup.com/poll/507527/abortion-remains-potent-issue-pro-choice-voters.aspx

Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S (2015) Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health 56(2):223–30

Scott J (1989) Conflicting beliefs about abortion: legal approval and moral doubts. Soc Psychol Q 52(4):319–326. https://doi.org/10.2307/2786995

Shafir E, LeBoeuf RA (2002) Rationality. Ann Rev Psychol 53(1):491–517. https://doi.org/10.1146/annurev.psych.53.100901.135213

Sohlberg J (2019) Elections are (not) exciting: need for cognition and electoral behaviour. Scand Political Stud 42(2):138–150. https://doi.org/10.1111/1467-9477.12138

Steffen J, Cheng J (2023) The influence of gain-loss framing and its interaction with political ideology on social distancing and mask wearing compliance during the COVID-19 pandemic. Curr Psychol 42(10):8028–8038. https://doi.org/10.1007/s12144-021-02148-x

Sundstrom B, Szabo C, Dempsey A (2018) “My Body. My Choice”: a qualitative study of the influence of trust and locus of control on postpartum contraceptive choice. J Health Commun 23(2):162–169. https://doi.org/10.1080/10810730.2017.1421728

Valdez D, Jozkowski KN, Haus K et al. (2022) Assessing rigid modes of thinking in self-declared abortion ideology: natural language processing insights from an online pilot qualitative study on abortion attitudes. Pilot Feasib Stud 8:127. https://doi.org/10.1186/s40814-022-01078-0

Verplanken B, Hazenberg PT, Palenéwen GR (1992) Need for cognition and external information search effort. J Res Person 26(2):128–136. https://doi.org/10.1016/0092-6566(92)90049-A

Whitaker AK, Quinn MT, Martins SL, Tomlinson AN, Woodhams EJ, Gilliam M (2015) Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention. Contraception 92(4):323–329. https://doi.org/10.1016/j.contraception.2015.06.015

Woodruff K, Biggs MA, Gould H, Foster DG (2018) Attitudes toward abortion after receiving vs. being denied an abortion in the USA. Sexuality Res Soc Policy 15(4):452–463. https://doi.org/10.1007/s13178-018-0325-1

Xie W, Campbell S, Zhang W (2020) Working memory capacity predicts individual differences in social distancing compliance during the COVID-19 pandemic in the U.S. PNAS 117(30):17667–17674

Article ADS PubMed PubMed Central Google Scholar

Xu P, Cheng J (2021) Individual differences in social distancing and mask-wearing in the pandemic of COVID-19: the role of need for cognition, self-control and risk attitude. Person Individual Differ 175:110706. https://doi.org/10.1016/j.paid.2021.110706

Young DG, Bagozzi BE, Goldring A, Poulsen S, Drouin E (2019) Psychology, political ideology, and humor appreciation: why is satire so liberal. Psychol Popular Media Culture 8(2):134–147. https://doi.org/10.1037/ppm0000157

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Cheng, J., Xu, P. & Thostenson, C. Psychological traits and public attitudes towards abortion: the role of empathy, locus of control, and need for cognition. Humanit Soc Sci Commun 11 , 23 (2024). https://doi.org/10.1057/s41599-023-02487-z

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Published: 15 July 2024

The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022

Elham Shirdel ORCID: orcid.org/0000-0002-3381-0937 1 ,
Khadijeh Asadisarvestani ORCID: orcid.org/0000-0002-7106-8286 1 , 2 &
Fatemeh Hami Kargar ORCID: orcid.org/0000-0003-1953-9914 3

BMC Public Health volume 24 , Article number: 1885 ( 2024 ) Cite this article

Metrics details

Given Iran’s recent shift towards pronatalist population policies, concerns have arisen regarding the potential increase in abortion rates. This review study examines the trends of (medical), intentional (illegal), and spontaneous abortions in Iran over the past two decades, as well as the factors that have contributed to these trends.

This paper reviewed research articles published between 2005 and 2022 on abortion in Iran. The study employed the PRISMA checklist for systematic reviews. Articles were searched from international (Google Scholar, PubMed, Science Direct, and Web of Science) and national databases (Magiran, Medlib, SID). Once the eligibility criteria were applied, 42 records were included from the initial 349 records.

Abortion is influenced by a variety of socioeconomic and cultural factors and the availability of family planning services. Factors that contribute to unintended pregnancy include attitudes toward abortion, knowledge about reproductive health, access to reproductive health services, and fertility desires, among others. In addition to health and medical factors, consanguineous marriage plays an important role in spontaneous and therapeutic abortion. A higher number of illegal abortions were reported by women from more privileged socioeconomic classes. In comparison, a higher number of medical and spontaneous abortions were reported by women from less privileged socioeconomic classes.

Iranian policymakers are concerned about the declining fertility rate and have turned to pronatalist policies. From a demographic standpoint, this seems to be a reasonable approach. However, the new population policies, particularly, the Family Protection and Young Population Law, along with creating limitations in access to reproductive health services and prenatal screening tests as well as stricter abortion law could potentially lead to an increase in various types of abortions and their associated consequences.

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Introduction

From 2015 to 2019, there was an annual incidence of roughly 121 million unintended pregnancies worldwide, with approximately 61% of them resulting in induced abortion. Although the global rate of unintended pregnancy has declined, the proportion of such pregnancies ending in abortion has increased. Indeed, 45% of these terminations are deemed unsafe, meaning they are carried out in an environment inconsistent with medical standards [ 1 ]. Even though preventable, unsafe abortions are among the most important global challenges in terms of public health and human rights. Moreover, they remain a significant cause of mortality and morbidity among women in the developing world [ 1 , 2 , 3 , 4 ].

Abortions are of different types, including therapeutic (medical), intentional (illegal), and spontaneous abortions. In Iran, unsafe abortion is a highly challenging issue within the context of reproductive health [ 5 ]. There are no official statistics on abortions in Iran due to the sensitive nature of this phenomenon and strict abortion laws. It is estimated that 300,000 to 600,000 illegal abortions are performed in Iran every year [ 6 ]. Until the enactment of the Family Protection and Young Population Law in 2021, therapeutic abortion was legally authorized with the consent of the mother after a definite diagnosis of fetal anomaly or a life-threatening maternal disease. This could be met if the diagnosis was made by three medical specialists and subsequently confirmed by the legal medicine organization, all before the 19th week of gestation [ 7 , 8 , 9 ]. This new law is part of the recent shift toward pronatalist policies in Iran, which started in 2005 [ 9 ]. The primary objective of new population policies is to enhance the fertility rate and overall population size. New restrictions have been imposed on access to family planning services, along with stricter rules regarding prenatal screening and abortion [ 9 , 10 ]. Specifically, this act prohibits the free distribution or financing of contraceptives, the implantation of contraceptive devices, and the promotion of their use. Permanent sterilization of men and women is also prohibited, with female sterilization allowed only in specific cases when the health or life of mothers and pregnant women is in danger. This law also severely restricts access to abortion services [ 9 ].

The new population policies, limitations in access to reproductive health and family planning services, and stricter abortion laws have prompted considerable worries. Nonetheless, there is no clear outlook about their impacts on the status of abortion in Iran. Accordingly, the main aim of this study was to examine researches conducted on abortion in Iran from 2005 to 2022. This study illustrates the trend of intentional abortion (illegally performed), spontaneous abortion, and therapeutic abortion, as well as the key factors influencing these types of abortions during this time frame.

This systematic review (registration code: CRD42023474372) followed the PRISMA checklist [ 11 ].

Search strategy and selection of articles

Because the primary goal of this study was to clarify the abortion trend in the context of Iran’s new population policies, this review only included studies conducted in Iran between 2005 and 2022. The period chosen for this study was based on the timing of changes in the population policies. While the policies officially shifted towards a pronatalist approach in 2012, discussions about the need for changes in population policies had already begun in 2005. Additional criteria for inclusion were studies written in either English or Persian (Farsi) and published or made available in full text for quality assessment. Studies that were carried out outside of Iran, predated 2005, solely focused on abortions from a medical standpoint, failed to provide the complete text, or were written in languages other than English or Persian (Farsi) were excluded.

The documents were retrieved from national (Magiran, Medlib, SID) and international (Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library) databases. The articles were specifically searched using the MeSH vocabulary and the full titles (Prevalence and determinants of abortion in Iran) followed by keywords (therapeutic abortion, spontaneous abortion, illegal abortion, selective abortion, abortion applicants, abortion seekers, induced abortion, legal abortion, aborted embryo, aborted fetus). Initially, 349 records were identified. However, only 42 documents were deemed suitable for the final analysis after they were reviewed per the specified criteria.

Study selection

This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) guidelines (see Fig. 1 ). The first and second reviewers (KHA and ESH) independently assessed the quality of the included documents, as the quality of a systematic review is based on the quality of the records. Each reviewer screened the titles and abstracts retrieved from the search. If the papers met the inclusion criteria, they were subjected to the reviewing process. If both reviewers disapproved of the title and abstract, the paper was excluded from the study. If there were a discrepancy between the first and second reviewers regarding the selection of a certain document, the third reviewer (FHK) made instead of would be brought in to make the final decision on whether to include the paper in the review.

Selection process of the included studies

Data extraction

A third reviewer (FHK) extracted data from submitted articles, following PRISMA guidelines. In addition, the first reviewer (KHA) and the second reviewer (ESH) checked the extracted data for potential errors to ensure the information’s quality.

The data extracted from each article included the following: author/authors, year of publication, study population/participants, study context (which province, city, or rural area in Iran), sample size, study design, and research outcomes. Finally, the data were presented in a summary table.

Risk of bias

In order to reduce bias, the quality of the articles was evaluated by two independent reviewers using a checklist of inclusion and exclusion criteria and also based on the Newcastle-Ottawa scale. The Newcastle-Ottawa scale is a tool used to evaluate the quality of non-randomized studies in a systematic review. Using this tool, each study was examined in terms of the selection process of the study groups and the research method, and stars were given for scoring. Studies with less than four stars were excluded from the study. The process of giving stars to the studies was done by two reviewers (ESH and KHA). The studies were examined by the third reviewer (FHK), where there was a disagreement between the two reviewers, and finally the final summary was made.

Strategy for data synthesis

A PRISMA flowchart was developed to aid in process transparency based on how the search results were presented and how many studies were included in the review. In order to summarize the findings of the included articles, a narrative synthesis of the key findings of the studies was presented in answer to the review questions. The factors related to non-medical abortions were collected and reported from the relevant studies. Furthermore, a summary table summarizing the key elements of the research, such as study settings, participants, and abortion-related variables, is supplied.

Nine of the 42 studies included in this study [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] examined people’s attitudes toward abortion. Fifteen studies [ 7 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] investigated the factors associated with spontaneous abortion and therapeutic abortion, while eighteen studies [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ] focused on illegal abortion (see Table 1 ). In the conducted studies, women aged 25 to 35 exhibited the highest rate of intentional abortions [ 37 , 43 , 46 , 47 , 48 , 49 ]. Moreover, the mean age of mothers undergoing therapeutic abortions fell within the range of 28 to 32 years [ 21 , 22 , 28 ].

The role of socio-cultural factors

Iranian society holds differing views on abortion, ranging from complete rejection to acceptance [ 12 ]. However, most Iranians hold a neutral or negative stance, believing that the appropriateness of a decision should be contingent on the specific circumstances [ 15 , 16 , 20 ]. Moreover, studies have shown that women tend to hold more positive attitudes toward abortion compared to men and younger individuals [ 14 , 15 , 17 ]. Compared to married people, unmarried and divorced people hold a more favorable view of abortion [ 14 , 15 ]. A study found that Fars people have a more favorable attitude toward abortion compared to other ethnic groups [ 14 ]. The partner’s attitude is a contributing factor in the occurrence of illegal abortions among women. The findings indicate that some women underwent abortion due to pressure from their partners [ 38 , 47 , 49 ].

The findings also showed that religious affiliation has correlation with attitudes toward abortion and guilt following an abortion [ 35 , 38 ]. Religiosity and religious adherence decline the positive attitude toward abortion [ 13 , 14 , 15 , 17 , 18 ] and rate of intentional abortion [ 35 , 36 , 37 , 39 , 40 , 42 , 44 , 45 , 47 , 48 , 52 , 53 ]. Some women conceal abortion from people around them due to religious and cultural reasons, as well as the social stigma associated with engaging in an unlawful activity [ 53 , 54 ].

The shift in social norms regarding childbearing and the ideal number of children fosters a favorable attitude toward abortion [ 14 , 15 ]. It increases motivations for intentional abortion, particularly in the event of unintended pregnancy [ 38 , 51 ]. The incidence of illegal abortion has a significant relationship with pregnancy after achieving the desired number of children [ 37 , 40 , 41 , 42 , 46 , 50 , 51 , 53 ]. There is a higher incidence of spontaneous and therapeutic abortions among women from less privileged socioeconomic classes. However, illegal abortions are more prevalent among women belonging to higher socioeconomic classes [ 13 , 15 , 16 , 24 , 27 , 28 , 33 , 35 , 37 , 40 , 41 , 42 , 46 , 48 , 53 ]. Economic and livelihood problems are among the factors that diminish women’s desire to keep the baby and, consequently, increase the abortion rate [ 37 , 38 , 44 , 49 , 51 ]. Family conflicts, particularly those involving couples, have been identified as factors that contribute to women’s inclination to retain their baby in the event of an unintended pregnancy [ 41 , 49 , 51 ]. Another factor to consider is nontraditional pregnancy, which refers to an unintended pregnancy during dating or engagement, leading to illegal abortion [ 41 ].

The role of health-related factors and unintended pregnancies

Pregnancy health encompasses the well-being of both the mother and baby throughout pregnancy. Factors such as uterine defects, maternal diseases, and the fetal’s genetic abnormalities increase the risk of spontaneous abortion [ 33 , 55 ]. When it comes to therapeutic abortion, the primary reasons are disorders such as thalassemia and nervous system defects in the baby and cardiovascular problems in the mother (55, 24, 27, 23, 22, 29, 105, 111, 7, 30, 25). Some studies have noted that the type of marriage influences the rate of spontaneous and therapeutic abortions. The significance of consanguineous marriage in the incidence of spontaneous abortion cannot be understated, as it leads to a higher likelihood of chromosomal mutations and genetic defects [ 27 , 32 , 34 ]. The findings of a study by Aghakhani et al. (2017) in Urmia revealed that over 20% of legal abortions performed due to baby disorders were associated with consanguineous marriages [ 27 ].

Unintended pregnancy is the main reason for intentional (illegal) abortion [ 36 , 39 , 44 ]. Women who experience an unintended pregnancy within two years of their previous childbirth are more likely to seek abortion compared to women who have pregnancies at appropriate time intervals [ 50 , 51 ]. Inadequate reproductive health knowledge and insufficient access to reproductive health services are among the major determinants of unintended pregnancies [ 35 , 40 , 42 , 46 , 48 , 50 , 53 ].

The main goal of this study was to investigate the trend of abortion and the primary factors contributing to it in Iran after the turn in population policies from antinatalist to pronatalist. Accordingly, this systematic review analyzed 42 studies published on therapeutic (medical), intentional (illegal), and spontaneous abortions between 2005 and 2022.

The findings indicate that abortion is affected by a complex set of interrelated factors. The most important factor in illegal abortion is unintended pregnancy [ 1 , 56 ], which is one of the major health concerns in Iran [ 1 , 57 , 58 , 59 ]. Critics of Iran’s new population policies believe that the limited access to contraceptives and reproductive health knowledge will increase the number of unintended pregnancies and illegal abortions. Put simply, when most couples prefer to have one or two children, imposing restrictions on family planning services and prenatal screenings not only fails to boost the fertility rate but also leads to a rise in abortion rates and its associated consequences [ 9 , 60 ]. Despite the strict abortion rules that have been in place since 1979, unofficial estimates show that many women undergo illegal abortions, often without any attention to legal consequences [ 9 , 39 , 61 ]. A study reported that from 2015 to 2017, 21,477 cases in Iran were referred to the legal medicine centers to obtain abortion permission, but 27.29% of these cases were rejected. Most of these rejections (25.8%) were cases with major anomalies but their gestational age had exceeded 19 weeks [ 62 ]. This study shows that even before the enactment of the new population law in 2021, there were shortcomings in health reproductive and family planning programs.

Indeed, limiting access to prenatal screening and implementing strict abortion laws may seem to decrease the number of medical abortions. However, in reality, it can lead to an increase in illegal and spontaneous abortions [ 9 , 57 , 63 ]. An overview of the abortion situation around the world reveals that the rate of unsafe abortions is higher in countries with stricter abortion laws [ 64 ]. As an example, Brazil has the highest estimated frequency of abortions in the world, while it has the most punitive laws for illegal abortions [ 65 ]. There are concerns that Iran may be repeating mistakes similar to the strict pronatalist policy implemented in Romania in 1966. This policy banned abortion (with some exceptions) and greatly limited access to contraception in order to increase the fertility rate. The outcome was a significant increase in unintended pregnancies, unsafe abortions, and maternal morbidity [ 9 , 57 , 63 ].

The findings of this study showed that illegal abortions were reported to a greater extent by women from more privileged socioeconomic classes and less religious groups. In contrast, spontaneous abortions and therapeutic abortions were reported to a greater extent among women from less privileged socioeconomic classes [ 9 , 62 ]. It is believed that the new limitation in access to family planning services can negatively affect couples who are living in rural areas rather than urban areas because before the new law, many of them relied on the free provision of contraception by health centers [ 9 ].

While further investigation is needed to fully understand the disparities between socioeconomic classes, the impact of these disparities on abortion rates underscores the significance of considering socioeconomic and cultural factors when developing population policies. So, it is important for policymakers to consider that Iran is a vast country with different economic, social, and cultural groups. While there are certain similarities among these groups [ 9 , 66 ], they have differences in their fertility desires and attitudes towards population policies and abortion [ 67 ]. As a result, implementing a uniform population policy that ignores these differences may lead the country down the wrong path [ 9 ]. Policymakers should consider that fertility is a multidimensional issue and Iran’s dramatic fertility decline over the recent decades can be seen as a response to the wider global transition towards smaller family size [ 68 ]. So, it is impossible to draw a simple cause-effect link between policies and fertility change [ 9 , 69 ]. The findings of this study showed that economic difficulties and family conflict are among the contributing factors to illegal abortions, thus, the government can support such families instead of the stricter abortion law.

Last but not least, when it comes to abortion, the main focus is on women. Men play a significant role in women’s decision-making process regarding abortion, and their involvement can impact the way women seek care [ 70 ]. Based on the findings, some women have had abortions under the pressure of their partners. Thus, designing effective reproductive health policies requires considering the role of men and improving their participation in this regard.

In sum, focusing on social and economic factors affecting fertility intentions would be better than violating the reproductive rights and freedoms defined in the 1994 International Conference on Population and Development (ICPD) Programme of Action [ 9 , 71 ] public health planners can improve their strategies to reduce the number of therapeutic (medical) and spontaneous abortions and support families to have healthy children and obtain their desired number of children. Increasing access to family planning and abortion services as well as improving reproductive health knowledge can decline unintended pregnancies, abortions, and their costs both for families and society.

Strengths and limitations

This study reviewed all studies conducted on different types of abortion during the past two decades in Iran. It provided a clearer picture of abortion and its major contributors following Iran’s shift toward pronatalist population policies. One of the primary limitations of this study is the absence of precise data on the rate of abortion and its fluctuations during the period under investigation. Furthermore, because causality cannot be established using the systematic review method and observational studies, we only discussed the factors that contribute to abortion.

Further research

Most studies on abortion in Iran have been conducted in larger, more developed cities. In addition, no studies were found regarding abortion among sexually active single women, immigrants, and women with disabilities. It is crucial to conduct thorough studies to assess and monitor the effects of recent population policies on all types of abortions across different groups of society.

This study tried to illustrate the trends of therapeutic (medical), intentional (illegal), and spontaneous abortions in Iran after turns to pronatalist population policies as well as clarifying their main contributing. The findings of this study showed that abortion is a complicated issue which is affected by a complex set of socio-economic factors, fertility desires, accessibility of family planning services and population policies. In spite of some similarities, each type of abortion has its special contributing factors. Accordingly, Iranian policymakers should be aware of the possible impacts of new population policies on different types of abortions. Tightening abortion laws, restricted access to family planning services and prenatal screening tests may inadvertently lead to an increase in all types of abortions.

Population policies encompass more than just engineering the population size. They also involve prioritizing and enhancing population health, as well as upholding reproductive health rights. These aspects are crucial and interconnected components of population policies.

Data availability

All data generated or analysed during this study are included in this published article.

Bearak J, Popinchalk A, Ganatra B, Moller AB, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020;8(9):e1152–61.

Article PubMed Google Scholar

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a bayesian hierarchical model. Lancet. 2017;390(10110):2372–81.

Article PubMed PubMed Central Google Scholar

Singh S, Maddow-Zimet I. Facility‐based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries. BJOG. 2016;123(9):1489–98.

Article CAS PubMed Google Scholar

Latt SM, Milner A, Kavanagh A. Abortion laws reform may reduce maternal mortality: an ecological study in 162 countries. BMC Womens Health. 2019;19(1):1.

Mohammadi E, Nourizadeh R, Simbar M, Rohana N. Iranian women’s experiences of dealing with the complexities of an unplanned pregnancy: a qualitative study. Midwifery. 2018;62:81–5.

United Nations. https://www.ohchr.org/en/press-releases/2022/01/iran-repeal-crippling-new-anti-abortion-law-un-experts . 2021.

Mosavi NB, Hejazi SA, Sadeghipour F, Fotovat A, Hoseini M. Examination of Fetal Indications in 548 Cases of Abortion Therapy Permissions Issued by Forensic Medicine Center of Razavi Khorasan, Iran, in 2015. Iranian Journal of Obstetrics Gynecology and Infertility. 2018;21(5):6–13. https://www.magiran.com/paper/1867249

Ardeshir Larijani MB, Zahedi F. Changing parameters for abortion in Iran. Indian J Med Ethics. 2006;3:130–1. https://api.semanticscholar.org/CorpusID:73983778

Asadisarvestani K, Sobotka T. A pronatalist turn in population policies in Iran and its likely adverse impacts on reproductive rights, health and inequality: a critical narrative review. Sex Reprod Health Matters. 2023;31(1).

Burki T. Iran’s population policy: consequences for youth. Lancet Child Adolesc Health. 2022;6(9):601.

Article Google Scholar

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1

Chinichian M, Poorreza A. Anthropological study of the beliefs and behaviors of women about abortion in Azerbaijan neighborhood in an area in downtown Tehran. sjsph. 2004;2(1):65–72. http://sjsph.tums.ac.ir/article-1-279-fa.html

Rahimi M, Yadollahpour MH, Jorsaraie GA, Khafri S. Evaluation of the Effect of Religious Beliefs on the Attitude toward Abortion among the Students and Healthcare Personnel of Babol University of Medical Sciences. Babol-Jbums. 2016;18(5):70–6. http://jbums.org/article-1-5759-fa.html

Kheialo NF, Ramzi N, Sadeghi R. Social and cultural determinants of students’ attitudes toward abortion. Women’s Strategic Studies. 2021;22(87):109–30. https://www.magiran.com/paper/2245100

Forootan Y, Sadeghi K. Social Attitudes towards the Challenges of Contemporary Family with Emphasis on Abortion in Iran. Journal of Iranian Social Studies. 2017;11(3):55–76. https://www.magiran.com/paper/1903591

Ranjbar M, Iranfar S, Najafi F, Foroughi F, Janjani P. Attitude of women referring to in health care centers of the Social Development Research Center toward induced abortion in Kermanshah, (2010). Journal of Clinical Research in Paramedical Sciences. 2014;2(4):e82272. https://brieflands.com/articles/jcrps-82272

Movahed M, Azemat S, Moaven Z. A Study onCulturalFactors Associated with Attitudes towards Abortion (CaseStudy: 18–29 Year-old Youth in Shiraz City). Journal of Sociological Cultural Studies. 2014;5(1):87–111. https://www.magiran.com/paper/1399709

Sarayi H, Roshanshomal P. Examining Social Factors Affecting Pregnant Women’s Attitude towards Induced Abortion. Women in Development and Politics. 2012;10(2):5. https://www.magiran.com/paper/1048400

Jarahi L, Meysamie A, Shojaee R. Iranian women’s knowledge needs to improve for prevention of induced abortion; an educational need assessment. Ann Biol Res. 2013;4:109–13.

Google Scholar

Masoumi SZ, Khani S, Kazemi F, Mir-Beik Sabzevari A, Faradmal J. Attitude of Reproductive Age Women towards Factors Affecting Induced Abortion in Hamedan, Iran. Journal of Midwifery and Reproductive Health. 2016;4(3):696–703. https://jmrh.mums.ac.ir/article_7119.html

Sadr SS, Abedi MH, Ghadyani MH, Abedi M. Examining the abortion licenses issued by the country’s forensic medicine organization during one year from 22/12/2003 to 20/12/2004. Scientific Journal of Forensic Medicine. 2006;11(4):198. https://www.magiran.com/paper/330874

Sayedoshohadaie DF, Zandvakili DF, Yousefinejad DV, Yousefi DZ, Gharibi F. Investigation of the causes of therapeutic abortion requests in Legal Medicine Organization in Sanandaj, from 2004 to 2008. Scientific Journal of Kurdistan University of Medical Sciences. 2011;16(3):76–83. https://www.magiran.com/paper/916477

Naeeji H, Mirtorabi SD, Shojamoradi MH. Azitakhatami. The Requests for Therapeutic Abortion in Legal Medicine Organization of Tehran: Indications for Acceptance and Rejection. Forensic Medicine. 2012;17(1):41. https://www.magiran.com/paper/1002291

Fatemi Z, Akbari S. Characteristics and indications of legal abortion among the pregnant women in Lorestan Province of Iran during 2017–2019. Adv Public Health. 2020;2020:1–6.

Rostam Nejad M, Asadzadeh F, Mostafazadeh F, Karmi R, Kazemzadeh R. Examining abortion cases referred to Ardabil Forensic Medicine Center. Journal of Health and Care. 2010;11(4):38–42. https://www.magiran.com/paper/1027249

Soleymanpour A, Mogharehzadeh M, Pourbakhtiya M, Mehmandoost N, Karimi J. Evaluation of fetal congenital abnormalities leading to the licensing of therapeutic abortion in Legal Medicine of Isfahan from 2012 to 2014. Iranian Journal of Obstetrics Gynecology and Infertility. 2017;20(4):23–33. https://www.magiran.com/paper/1712293

Aghakhani N, Cleary M, Zarei A, Lopez V. Women’s attitudes to safe-induced abortion in Iran: findings from a pilot survey. J Adv Nurs. 2018;74(1):61–4.

Sharifi A, Janatolmakan M, Khatony A. The prevalence and the reasons for issuing permission for therapeutic abortion in the department of Forensic Medicine, Kermanshah, Iran, from 2005 to 2010. BMC Res Notes. 2019;12(1):574. https://doi.org/10.1186/s13104-019-4622-4

Astaraki P, Mahmoudi GA, Anbari K, Souri BM, Dosti L. Evaluation of approved and non-approved requests for therapeutic abortion in cases referred to legal medicine organization of Lorestan province in 2013. Yafteh. 2015;17(2):5–13. https://www.magiran.com/paper/1443558

Amini K, Yari Nasab F. A comparative study of the amount and reasons for issuing legal abortion licenses in women referring to the forensic medicine of Boyar Ahmad city in 1991–1996. Qanun Yar. 2021;4(16):57–72.

Alizadeh Mohajer M, Veisani Y, Bakhtiyari A. Maternal and fetal risk factors of licensing therapeutic abortion by ilam legal medicine organization: a cross-sectional study. Urmiamj. 2020;31(10):717–24. http://umj.umsu.ac.ir/article-1-5181-fa.html

Hassanzadeh Nazarabadi M, Abu Tarabi RB, Raufian R. The comparison of frequent idiopathic recurrent abortions frequency in Consanguineous and Non-consanguineous marriages. Iran J Obstet Gynecol Infertility. 2006;9(2):23–31.

Sarani A, Aribi M, Nouri N, Mirparsa F. Investigating factors related to abortion and stillbirth in pregnant women referring to Ali Ibn Abi Talib hospital in Zahedan city. Beyhaq. 2019;24(4):13–24. https://beyhagh.medsab.ac.ir/article_1324.html

Shams Ghahfarokhi M. Relationship between consanguineous marriage and spontaneous abortion and stillbirth. payeshj. 2018;17(4):455–62. http://payeshjournal.ir/article-1-39-fa.html

Hosseini-Chavoshi M, Abbasi-Shavazi M, Glazebrook D, Mcdonald P. Social and psychological consequences of abortion in Iran. Int J Gynaecol Obstet. 2012;118(Suppl 2):S172–7.

PubMed Google Scholar

Motaghi Z, Keramat A, Shariati M, Yunesian M. Triangular Assessment of the Etiology of Induced Abortion in Iran: A Qualitative Study. Iran Red Crescent Med J. 2013;15. https://api.semanticscholar.org/CorpusID:10117424

Ranji A. Induced abortion in Iran: prevalence, reasons, and consequences. J Midwifery Womens Health. 2012;57 5:482–8. https://api.semanticscholar.org/CorpusID:46631420

Ebtekar F, Riji HMohd, Saeedi ZA. Kurdish women’s stories of abortion in Sanandaj, Iran. J Public Health Epidemiol. 2013;5:222–7. https://api.semanticscholar.org/CorpusID:72952663

Erfani A. Abortion in Iran: What Do We Know? In. 2008. https://api.semanticscholar.org/CorpusID:54103417

Erfani A, Levels. Trends and Correlates of Abortion in Tehran, Iran: 2009–2014. Int Perspect Sex Reprod Health. 2016;42 2:93–101. https://api.semanticscholar.org/CorpusID:3765849

Nasrabadi HB. Factors associated with induced abortion Among women: the lived experience of women from abortion in Tehran. Women’s studies (Sociological & Psychological). 2017;15(2):105–36. https://www.magiran.com/paper/1793696

Erfani A. Determinants of induced abortion in Tehran, Iran: the role of contraceptive failure. Eur J Contracept Reprod Health Care. 2021;26(3):233–9. https://www.unboundmedicine.com/medline/citation/33615944/Determinants_of_induced_abortion_in_Tehran_Iran:_the_role_of_contraceptive_failure_

Erfani A. Induced Abortion in Tehran, Iran: estimated rates and correlates. Int Perspect Sex Reprod Health. 2011;37:134–42.

Chinichian M, Holakoic Nainie K, Rafale Shirpak K. Voluntary abortion in Iran: a qualitative study. Payesh. 2007;6(3):219. https://www.magiran.com/paper/462323

Shahbazi S, Fathizadeh N, Taleghani F. Decision-Making Processes in Illegal Abortions. J Reprod Infertil. 2008;8(4):352. https://www.magiran.com/paper/512197

Nikpour B, Majlesi F, Eshraghi N. Assessment of Induced Abortions and its Effective Factors in Comparison with Spontaneous Abortions among Women Refer to Hospitals in South of Tehran. Journal of Health Breeze. 2013;1(3):14–20. https://www.magiran.com/paper/1226102

Nejati Hatamian S. The experience of voluntary abortion in married women of Tehran. Iranian Journal of Social Studies. 2014;8(1):167–87. https://www.magiran.com/paper/1528115

Rezaei M, Partovi L. Abortion among Kurdish Women from Mahabad in 2016. Iran Journal of Nursing. 2018;30(109):32–43. https://www.magiran.com/paper/1792676

Abdoljabbari M, Karamkhani M, Saharkhiz N, Pourhosseingholi M, Khoubestani MS. Study of the Effective Factors in Women’s Decision to Make Abortion and Their Belief and Religious Views in this Regard. Journal of Pizhuhish dar din va salamat. 2016;2(4):44–54. https://www.magiran.com/paper/1603782

Veisi DF, Zanganeh DM. The Causes of Illegal Abortions and Their Methods in Outpatient Clinics of Kermanshah University of Medical Sciences. Forensic Medicine. 2013;18(1):47. https://www.magiran.com/paper/1175295

Mohammadi E, Nourizadeh R, Simbar M. Understanding reasons why women facing unintended pregnancy seek abortion: a qualitative study. Payesh. 2014;13(4):413. https://www.magiran.com/paper/1300991

Gholami Z. Investigating the relationship between religious beliefs and induced abortion in unwanted pregnancies. Journal of Urmia Nursing And Midwifery. 2021;19(5):378–86. https://www.magiran.com/paper/2338214

Cheraghi P, Poorolajal J, Moeini B, Cheraghi Z. Predictors of Unintended Pregnancy among Married Women in Hamadan, Western Iran: A Case-Control Study. Iran J Public Health. 2013;42:854–9. https://api.semanticscholar.org/CorpusID:17592553

Zamanian M, Baneshi MR, Haghdoost A, Zolala F. Estimating the visibility rate of abortion: a case study of Kerman, Iran. BMJ Open. 2016;6(10). https://bmjopen.bmj.com/content/6/10/e012761

Alipanahpour S, Tayebi N, Taheri M, Akbarzadeh M. Causes of Different Types of Abortion in Women Referring To Educational and Medical Centers in Shiraz, Iran. Journal of Midwifery and Reproductive Health. 2021;9(4):3034–42. https://jmrh.mums.ac.ir/article_18888.html

Otobo D, Aouta A, Otsyina E, Tatere Y. The unmet need for abortion law reforms and modern contraceptive uptake in Nigeria, Kenya, Ghana, and Ethiopia: a systematic review. Int J Clin Obstet Gynecol. 2022;6(1).

Asadi Sarvestani K, Ahmadi A, Enayat H, Movahed M. Level and factors related to unintended pregnancy with a brief review of New Population policies in Iran. Iran J Public Health. 2017;46(7):973–81.

PubMed PubMed Central Google Scholar

Gwesere DD, Namutebi M, Osinganda C. Prevalence and socio-demographic determinants of unintended pregnancy among women attending Antenatal Clinic in Thyolo District, Malawi. J Biosci Med (Irvine). 2022;10(05):7–24.

Ayalew HG, Liyew AM, Tessema ZT, Worku MG, Tesema GA, Alamneh TS et al. Prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa, a multilevel analysis. BMC Womens Health. 2022;22(1):464. https://doi.org/10.1186/s12905-022-02048-7

Abbasi-Shavazi MJ, McDonald PF, Chavoshi MH. Changes in Family, Fertility Behavior and Attitudes in Iran. In. 2003. https://api.semanticscholar.org/CorpusID:62883624

Rashidpouraie R, Sharifi MN, Rashidpouraei M. Abortion laws and regulations in Iran and European countries during the COVID-19 pandemic. J Arak Univ Med Sci. 2020;23(5):686–97. https://doi.org/10.32598/JAMS.23.COV.6394.1

Mahdavi SA, Jafari A, Azimi K, Dehghanizadeh N, Barzegar A. Therapeutic abortion in Iran: an epidemiologic study of legal abortion in 2 years. BMC Res Notes. 2020;13:1–6.

Horga M, Gerdts C, Potts M. The remarkable story of Romanian women’s struggle to manage their fertility. J Family Plann Reproductive Health Care. 2013;39(1):2–4. https://doi.org/10.1136/jfprhc-2012-100498

Ganatra B, Gerdts C, Rossier C, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a bayesian hierarchical model. Lancet. 2017;390(10110):2372–81. https://doi.org/10.1016/S0140-6736(17)31794-4

Malta M, Wells S, LeGrand S, Seixas M, Baptista A, da Silva CM, Kalume C, Whetten K. Abortion in Brazil: the case for women’s rights, lives, and choices. Lancet Public Health. 2019;4(11):e552.

Abbasi-Shavazi MJ. Fertility revolution in Iran. Popul Soc, 2001; 373(4). https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.218 .3630&rep=rep1&type=pdf

Foroutan Y. Sociological analysis of fertility desires and religious affiliations in Iran. J Culture-Communication Stud. 2020;21(52):9–33.

Bongaarts J, Hodgson D. Fertility transition in the developing world. Cham: Springer; 2022. https://doi.org/10.1007/978-3-031-11840-1

Book Google Scholar

Ouedraogo A, Tosun MS, Yang J. Fertility and population policy. Public Sect Econ. 2018;42(1):21–43. https://doi.org/10.3326/pse.42.1.2

Freeman E, Coast E, Murray SF. Men’s roles in women’s abortion trajectories in urban Zambia. Int Perspect Sex Reproductive Health. 2017;43(2):89–98.

UNFPA. International Conference on Population and Development (ICPD). 1994. https://www.unfpa.org/events/international-conference-population-and-development-icpd

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Elham Shirdel & Khadijeh Asadisarvestani

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KHA proposed the initial design of the study but all authors contributed to improving the study design. KHA wrote the background of the article. ESH and KHA collected the studies. ESH extracted the data. All authors participated in the quality assessment process of the studies. FHK and ESH wrote the report of the findings. KHA wrote the discussion and conclusion sections. All authors edited and completed the final version of the manuscript.

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Shirdel, E., Asadisarvestani, K. & Kargar, F.H. The abortion trend after the pronatalist turn of population policies in Iran: a systematic review from 2005 to 2022. BMC Public Health 24 , 1885 (2024). https://doi.org/10.1186/s12889-024-19249-4

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Support for legal abortion has risen since Supreme Court eliminated protections, AP-NORC poll finds

FILE - Abortion rights activists and Women’s March leaders protest as part of a national day of strike actions outside the Supreme Court, June 24, 2024, in Washington. A new poll finds that a solid majority of Americans oppose a federal abortion ban and that a rising number support access to abortions for any reason. (AP Photo/Alex Brandon, File)

FILE - Rev. Patrick Mahoney, center, chief strategy officer for Stanton Healthcare, an Idaho-based pregnancy center that does not provide abortions, is flanked by Katie Mahoney, left, and supporter Kevin Krueger, right, as he speaks to the press outside the Supreme Court June 27, 2024, in Washington. A new poll finds that a solid majority of Americans oppose a federal abortion ban and that a rising number support access to abortions for any reason. (AP Photo/Mark Schiefelbein, File)

FILE - Anti-abortion protesters gather for a news conference after Arizona abortion-rights supporters deliver over 800,000 petition signatures to the capitol to get abortion rights on the November general election ballot July 3, 2024, in Phoenix. A new poll finds that a solid majority of Americans oppose a federal abortion ban and that a rising number support access to abortions for any reason. (AP Photo/Ross D. Franklin, File)

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WASHINGTON (AP) — A solid majority of Americans oppose a federal abortion ban as a rising number support access to abortions for any reason, a new poll finds, highlighting a politically perilous situation for candidates who oppose abortion rights as the November election draws closer.

Around 6 in 10 Americans think their state should generally allow a person to obtain a legal abortion if they don’t want to be pregnant for any reason, according to a new poll from The Associated Press-NORC Center for Public Affairs Research . That’s an increase from June 2021 , a year before the Supreme Court overturned the constitutional right to the procedure, when about half of Americans thought legal abortion should be possible under these circumstances.

Americans are largely opposed to the strict bans that have taken effect in Republican-controlled states since the high court’s ruling two years ago. Full bans , with limited exceptions, have gone into effect in 14 GOP-led states, while three other states prohibit abortion after about six weeks of pregnancy, before women often realize they’re pregnant.

They are also overwhelmingly against national abortion bans and restrictions. And views toward abortion — which have long been relatively stable — may be getting more permissive.

Vincent Wheeler, a 47-year-old Republican from Los Angeles, said abortion should be available for any reason until viability , the point at which health care providers say it’s possible for a fetus to survive outside the uterus.

“There’s so many reasons as to why someone may want or need an abortion that it has to be up to that person of what they have to do in that specific circumstance,” Wheeler said, acknowledging that some fellow Republicans might disagree.

Likely Republican presidential nominee Donald Trump has declined to endorse a nationwide abortion ban, saying the issue should be left up to the states. But even that stance is likely to be unsatisfying to most Americans, who continue to oppose many bans on abortion within their own state, and think Congress should pass a law guaranteeing access to abortions nationwide, according to the poll.

Seven in 10 Americans think abortion should be legal in all or most cases, a slight increase from last year, while about 3 in 10 think abortion should be illegal in all or most cases.

Robert Hood, a 69-year-old from Universal City, Texas, who identifies as an “independent liberal,” has believed that abortions should be allowed for any reason since he was an 18-year-old high school senior, because “life is full of gray situations.” He recalls reading stories as a teenager about women who died trying to get an abortion before the 1973 Roe v. Wade decision provided a constitutional right to the procedure.

“Pregnancy is complicated,” he said. “Women should make the choice with the advice of their doctor and family, but at the end of the day it’s her choice and her body and her life.”

He said he would support national protections for abortion rights.

Views on abortion have long been nuanced and sometimes contradictory. The new AP-NORC survey shows that even though the country is largely antagonistic to restrictions on abortion, a substantial number of people hold opinions and values that are not internally consistent.

About half of those who say a woman should be able to get an abortion for any reason also say their state should not allow abortion after 24 weeks of pregnancy and about one-quarter say their state should not allow abortion after 15 weeks of pregnancy.

But the vast majority of Americans — more than 8 in 10 — continue to say abortion should be legal in extreme circumstances, such as when a patient’s life would be endangered by continuing the pregnancy. About 8 in 10 say the same about a pregnancy caused by rape or incest or when a fetal anomaly would prevent the child from surviving outside the womb.

National bans on abortion are broadly unpopular: Around 8 in 10 Americans say Congress should not pass a federal law banning abortion. About three-quarters say there should not be a federal law banning abortion at six weeks, and 6 in 10 oppose a federal law banning abortion at 15 weeks.

Most Republicans — about two-thirds, according to the survey — say a nationwide abortion ban should not happen.

On the campaign trail, Trump has courted anti-abortion voters by highlighting his appointment of three Supreme Court justices who helped overturn Roe. But his strategy on abortion policy has been to defer to the states , an attempt to find a more cautious stance on an issue that has become a major vulnerability for Republicans since the 2022 Dobbs decision.

Despite Trump’s statements, Penny Johnson, 73, from Sherman Oaks, California, said she is still afraid Republicans might pursue a national abortion ban if they win the White House and Congress in November.

The poll of 1,088 adults was conducted June 20-24, 2024, using a sample drawn from NORC’s probability-based AmeriSpeak Panel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 4.0 percentage points.

Fernando reported from Chicago. Associated Press polling writer Linley Sanders contributed to this report.

The Associated Press receives support from several private foundations to enhance its explanatory coverage of elections and democracy. See more about AP’s democracy initiative here . The AP is solely responsible for all content.

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First study to measure toxic metals in tampons shows arsenic and lead, among other contaminants

By Elise Proulx
3 min. read ▪ Published July 3
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Tampons from several brands that potentially millions of people use each month can contain toxic metals like lead, arsenic, and cadmium, a new study led by a UC Berkeley researcher has found.

Tampons are of particular concern as a potential source of exposure to chemicals, including metals, because the skin of the vagina has a higher potential for chemical absorption than skin elsewhere on the body. In addition, the products are used by a large percentage of the population on a monthly basis—50–80% of those who menstruate use tampons—for several hours at a time.

“Despite this large potential for public health concern, very little research has been done to measure chemicals in tampons,” said lead author Jenni A. Shearston , a postdoctoral scholar at the UC Berkeley School of Public Health and UC Berkeley’s Department of Environmental Science, Policy, & Management. “To our knowledge, this is the first paper to measure metals in tampons. Concerningly, we found concentrations of all metals we tested for, including toxic metals like arsenic and lead.”

Metals have been found to increase the risk of dementia, infertility, diabetes, and cancer. They can damage the liver, kidneys, and brain, as well as the cardiovascular, nervous, and endocrine systems. In addition, metals can harm maternal health and fetal development.

“Although toxic metals are ubiquitous and we are exposed to low levels at any given time, our study clearly shows that metals are also present in menstrual products, and that women might be at higher risk for exposure using these products,” said study co-author Kathrin Schilling , assistant professor at Columbia University Mailman School of Public Health.

Researchers evaluated levels of 16 metals (arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc) in 30 tampons from 14 different brands. The metal concentrations varied by where the tampons were purchased (US vs. EU/UK), organic vs. non-organic, and store- vs. name-brand. However, they found that metals were present in all types of tampons; no category had consistently lower concentrations of all or most metals. Lead concentrations were higher in non-organic tampons but arsenic was higher in organic tampons.

Metals could make their way into tampons a number of ways: The cotton material could have absorbed the metals from water, air, soil, through a nearby contaminant (for example, if a cotton field was near a lead smelter), or some might be added intentionally during manufacturing as part of a pigment, whitener, antibacterial agent, or some other process in the factory producing the products.

“I really hope that manufacturers are required to test their products for metals, especially for toxic metals,” said Shearston. “It would be exciting to see the public call for this, or to ask for better labeling on tampons and other menstrual products.”

For the moment, it’s unclear if the metals detected by this study are contributing to any negative health effects. Future research will test how much of these metals can leach out of the tampons and be absorbed by the body; as well as measuring the presence of other chemicals in tampons.

Additional authors include: Kristen Upson of the College of Human Medicine, Michigan State University; Milo Gordon, Vivian Do, Olgica Balac, and Marianthi-Anna Kioumourtzoglou of Columbia University Mailman School of Public Health; and Khue Nguyen and Beizhan Yan of Lamont-Doherty Earth Observatory of Columbia University.

Funding was provided by the National Institute of Environmental Health Sciences; the National Heart, Lung, and Blood Institute; and the National Institute of Nursing Research.

In the Media:

A study found toxic metals in popular tampon brands. Here’s what experts advise – NPR
Lead, Arsenic, Other Toxic Metals Found in Dozens of Tampon Products – Los Angeles Magazine
Lead and other toxic metals found in tampons, study finds – The Atlanta Journal-Constitution
Toxic Metal in Tampons Risks Brain’s Cognitive Function, Scientists Warn – Newsweek
New study finds lead and arsenic in tampons. But don’t panic, experts say – TODAY
Tampons contain toxic metals such as lead and arsenic, UC Berkeley study finds – San Francisco Chronicle
Toxic Tampon Warning As Arsenic and Lead Found in Common Menstrual Products – Newsweek
Some tampons found to contain LEAD and other toxic metals that could be absorbed into the body, alarming study suggests – Daily Mail

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