When debating whether a fetus’ “right to life” trumps a woman’s “right to choose” – or whether the news media have paid enough attention to the trial of a Philadelphia doctor who allegedly killed seven babies born alive during late-term abortions, as well as a pregnant woman – Americans are bitterly divided on abortion. Before abandoning facts for rhetoric, let’s tackle some misunderstandings about this procedure.
Abortion was generally legal in the United States until the mid-19th century. At that time, physicians eager to professionalize obstetrics pressed state legislatures to outlaw midwifery and abortion while granting doctors sole authority over pregnancy and childbearing. State anti-abortion statutes were primarily justified on the grounds that women needed to be saved from uneducated folk practitioners, infections, future infertility and other physical risks.
In the courtroom, prosecutors rarely discussed the unborn, instead accusing abortion providers of preventing women from fulfilling their destiny: motherhood. When early feminists such as Susan B. Anthony opposed abortion, they argued that the disconnect between sexual intercourse and maternity endangered women’s chastity – at the time considered their main basis for moral standing and personal dignity.
Then, in the second half of the 20th century, technology such as sonogram imaging and genetic testing allowed us to see a fetus not simply as a potential life but as a patient requiring diagnosis and treatment, and sometimes entitled to more medical intervention than a pregnant woman.
New imaging techniques furthered the idea that the interests of a woman and her fetus may be inimical: the woman’s “right to choose” versus the fetus’ “right to life.” Over the past generation, some state legislatures have passed laws imbuing fetuses with civic personhood while sidelining the rights and needs of pregnant women.
Despite the charges surrounding the abortion practice of Kermit Gosnell in Philadelphia, there is little evidence that abortion caused high rates of morbidity or mortality before Roe v. Wade legalized the procedure in 1973. According to the Guttmacher Institute, for instance, abortion was listed as the official cause of death for almost 2,700 women in 1930 – a relatively small number in a time before antibiotics, when estimates are that at least 1 million abortions were performed per year. By 1940, the number of deaths had fallen under 1,700, and by 1965, below 200.
Even when abortion was illegal, it was often practiced with the knowledge and protection of district attorneys and police chiefs who considered these practitioners assets to public health. For example, Ruth Barnett, the proprietor of one of the busiest abortion clinics on the West Coast before Roe, wrote in a self-published memoir that her clinic in downtown Portland, Ore., was well-known: “The duly elected officers of the law, members of the medical profession and state medical board knew we were in business,” she wrote, and sent clients to her office.
Abortion-rights advocates have argued that Roe shields women from “back-alley butchers.” But that is a consumer-protection argument, not an argument about what rights women have over their bodies. Before legalization, laws against abortion endangered women, keeping them from making fundamental decisions about their lives.
According to the Guttmacher Institute, at least 1 million illegal abortions were performed in the United States each year before Roe. Today, the number of abortions performed annually is still about 1 million. The Centers for Disease Control and Prevention reports that almost half of U.S. pregnancies are unintended. About 4 in 10 of these are ended by abortions, according to the Guttmacher Institute, and these are performed in clean, safe, medically appropriate settings.
Roe didn’t mark the beginning of an abortion era – it legalized an already widespread practice.
In 2008, Johns Hopkins University researchers conducted a comprehensive review of the scientific literature concerning the impact of abortion on women’s mental health, finding that “the highest-quality research available does not support the hypothesis that abortion leads to long-term mental health problems.” The American Psychological Association’s Task Force on Mental Health and Abortion concluded that, among women with unplanned pregnancies, the risk of mental health problems is no greater for those who obtain first-trimester abortions than for those who carry the pregnancies to term. Neither the American Psychological Association nor the American Psychiatric Association recognizes “post-abortion syndrome,” a term popularized after an abortion critic used it in 1981 when testifying before Congress.
In the 1990s, some abortion opponents claimed an association between abortion and breast cancer. In 2003, the National Cancer Institute convened a group of leading experts on the subject; it concluded that having an abortion or a miscarriage does not increase a woman’s chances of developing breast cancer. In addition, contemporary studies have found that abortions performed in the first trimester – when nearly 90 percent occur – pose virtually no long-term risk of infertility, ectopic pregnancy, birth defect, miscarriage, or preterm or low-weight delivery.
The full legalization of contraception and the qualified legalization of abortion in the middle of the 20th century mean that women have a chance to make personal choices about their fertility. But some women have much better access to reproductive choices than others.
Decisions about whether to get pregnant, stay pregnant or raise a child are shaped by laws and policies that can compromise personal choice. For example, the Hyde Amendment – a rider attached to appropriations bills each year since 1976 – forbids the use of federal Medicaid funds for abortion, making the decision not to be a mother financially impossible for some women.
As states pass laws making abortion practice untenable for doctors, a growing number of women live somewhere without an abortion provider. Fewer than half of states mandate sex education, and 26 give preference to “abstinence only” sex education, limiting what teenagers can learn about pregnancy prevention.
Women who lack the resources to limit reproduction – and, after giving birth, have no access to paid family leave or to quality day care – have been stigmatized by politicians. Rather than providing dignity and safety for all women, “choice” is often an economic privilege.