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Civil Rights, Culture, Economic Inequality, Gender, Government, Health Care, Health Disparities, Healthcare, Justice, Justice System, Politics, Public Health, Public Policy, Reproductive Rights, Social Justice, Society, Women's Health, Women's Rights

The Medical And Social Benefits Of Safe And Legal Abortion

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“The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women… Women suffer and die because they are not valued.”

World Health Organization

Despite the claims of those who oppose safe and legal abortion, many demonstrable health benefits — physical, emotional, and social — have accrued to Americans since 1973, when the U.S. Supreme Court legalized abortion in its decision, Roe v. Wade.

The most important benefit was the end of an era that supported the proliferation of “back alley butchers” who were motivated by money alone and performed unsafe, medically incompetent abortions that left many women dead or injured. Also, compassionate mainstream physicians, who provided clandestine, medically safe abortions, did not exploit their patients, and were motivated by principle rather than by financial concerns, no longer had to fear imprisonment and the loss of their medical licenses for performing abortions after Roe was decided (Joffe, 1995). Today, as women’s right to choose is being challenged by Republican lawmakers across the country, it is important to remember how far Roe has brought us as a society and to note some of the many benefits that resulted from the legalization of abortion.

Roe v. Wade did not “invent” abortion

  • Estimates of the annual number of illegal abortions in the 1950s and 1960s range from 200,000 to 1.2 million (Cates et al., 2003; Rock & Jones, 2003; Tietze & Henshaw, 1986).
  • In 1969, one year before New York State legalized abortion, complications from illegal abortions accounted for 23 percent of all pregnancy-related admissions to municipal hospitals in New York City (Institute of Medicine, 1975).
  • After California liberalized its abortion law in 1967, the number of admissions for infection resulting from illegal abortion at Los Angeles County/University of Southern California Medical Center fell by almost 75 percent (Seward et al., 1973).

Since Roe v. Wade, women have obtained abortions earlier in pregnancy when health risks to them are at the lowest.

  • In 1973, only 36 percent of abortions were performed at or before eight weeks of pregnancy (CDC, 2008).
  • Today, 91.9 percent of all legal abortions are performed within the first 13 weeks of pregnancy, and 65.9 percent
take place within the first eight weeks of pregnancy. Only 1.2 percent occur after 20 weeks (CDC, 2013).

Deaths from abortion declined dramatically during the past three decades.

  • In 1965, when abortion was still illegal nationwide except in cases of life endangerment, at least 193 women died from illegal abortions, and illegal abortion accounted for nearly 17 percent of all deaths due to pregnancy and childbirth in that year (Gold, 1990; NCHS, 1967).
  • In 1973, the risk of dying from an abortion was 3.4 deaths per 100,000 legal abortions. This rate fell to 
1.3 by 1977 (Gold, 1990). Today, the risk of death associated with abortion increases with the length of pregnancy, from one death for every one million vacuum aspiration abortions at eight or fewer weeks to 8.9 deaths after 20 weeks’ gestation (Boonstra et al., 2006). The risk of death from medication abortion through 63 days’ gestation is about one per 100,000 procedures (Grimes, 2005). Comparatively, the risk of death from miscarriage is about one per 100,000 (Saraiya et al., 1999). And the risk of death associated with childbirth is about 14 times as high as that associated with abortion (Raymond & Grimes, 2012). After 20 weeks’ gestation there is no statistically significant difference in maternal mortality rates between ending a pregnancy by abortion and carrying it to term (Kochanek et al., 2004; Paul et al., 2009).

Medically safe, legal abortion has had a profound impact on American women and their families.

  • Couples at risk of having children affected with severe and often fatal genetic disorders have been willing to conceive because of the availability of amniocentesis and safe, legal abortion (Milunsky, 1989).
  • Following the legalization of abortion, the largest decline in birth rates were seen among women for whom the health and social consequences of unintended childbearing are the greatest — women over 35, teenagers, and unmarried women (Levine et al., 1999). Today, 27 percent of the abortions in the U.S. are provided to women over 35 and to teenagers (CDC, 2013).
  • Today, less than 0.3 percent of women undergoing legal abortion procedures at all gestational ages sustain a serious complication requiring hospitalization (Boonstra et al., 2006; Henshaw, 1999). Among women undergoing legal first-trimester abortion procedures, the percentage sustaining serious complications drops to 0.05% (Weitz et al., 2013).
  • Nearly half of all pregnancies in the U.S. each year are unintended, and four in 10 of these are ended by medically safe, legal abortions. In 2011, an estimated 1.1 million abortions took place, a 13 percent decline from 2008. The abortion rate in 2011 was the lowest rate since 1973 (Jones and Jerman, 2014). From 1973 through 2011, nearly 53 million legal abortions occurred (Guttmacher Institute, 2014).
  • In 1973, the majority of abortions were performed in hospitals. Today, most abortions are performed in health centers. This change in locale has also allowed more women to have access to comprehensive reproductive health services, including, but not limited to, contraceptive counseling, family planning services, and gynecological care (Cates et al., 2003).

The health and well-being of women and children suffer the most in states that have the most stringent laws that restrict access to safe and legal abortion.

  • Compared to states that support women’s health, those states that oppose safe and legal abortion spend far less money per child on a range of services such as foster care, education, welfare, and the adoption of children who have physical and mental disabilities (Schroedel, 2000).
  • The states that have the strongest laws against safe and legal abortion are also the states in which women suffer from lower levels of education and higher levels of poverty, as well as from a lower ratio of female-to-male earnings. They also have a lower percentage of women in the legislature and fewer mandates requiring insurance providers to cover minimum hospital stays after childbirth (Schroedel, 2000).

In sum, no amount of controversy over abortion can negate the evidence that American women, men, children, and families have reaped great benefits to their physical, mental, and social health from the U.S. Supreme Court’s historic decision in Roe v. Wade. Any erosion of a woman’s right and access to medically safe, legal abortion jeopardizes the health of women, their families, and the nation as a whole.

Note: References can be found at the bottom of the page.

Related Articles

Cited References

Boonstra, Heather D., et al. (2006). Abortion In Women’s Lives. New York: Guttmacher Institute.
Cates Jr., Williard, et al. (2003). “The Public Health Impact of Legal Abortion: 30 Years Later.” Perspectives on Sexual and Reproductive Health, 35(1), 25-8.

CDC — Centers for Disease Control and Prevention. (2008, November 28). “Abortion Surveillance — United States, 2005.” Morbidity and Mortality Weekly Report, 57 (SS-13). [Online]. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm.

CDC (2013, November 29). “Abortion Surveillance — United States, 2010.” Morbidity and Mortality Weekly Report, 62 (SS-8). [Online]. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6208a1.htm?s_cid=ss6208a1_w.

Gold, Rachel Benson. (1990). Abortion and Women’s Health: A Turning Point for America? New York: The Alan Guttmacher Institute. Grimes, D.A. (2005). “Risks of Mifepristone Abortion in Context.” Contraception, 71, 161.

Guttmacher Institute. (2014, February). Facts Sheet: Induced Abortion in the United States. [Online]. http://www.guttmacher.org/pubs/ fb_induced_abortion.html

Henshaw, Stanley K. (1999). “Unintended Pregnancy and Abortion: A Public Health Perspective.” Pp. 11-22 in Maureen Paul, et al., eds., A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.

Institute of Medicine. (1975). Legalized Abortion and the Public Health. Washington, DC: National Academy of Sciences.

Joffe, Carole. (1995). Doctors of Conscience: The Struggle to Provide Abortion Before and After Roe v. Wade. Boston: Beacon Press.

Jones, Rachel K., and Jenna Jerman. (2014). “Abortion Incidence and Service Availability in the United States, 2011.” Perspectives on Sexual and Reproductive Health, 46(1). [Online]. http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf.

Kochanek, Kenneth D., et al. (2004, October 12). “Deaths: Final Data for 2002.” National Vital Statistics Reports, 53(5). Hyattsville, MD: National Center for Health Statistics.

Levine, Phillip, et al. (1999). “Roe v Wade and American Fertility.” American Journal of Public Health, 89(2), 199–203.

Milunsky, Aubrey. (1989). Choices, Not Chances: An Essential Guide to Your Heredity and Health. Boston: Little, Brown and Company.

NCHS — National Center for Health Statistics. (1967). Vital Statistics of the United States, 1965: Vol. 11 — Mortality, Part A. Washington, DC: U.S. Government Printing Office (GPO).

Paul, Maureen, et al. (2009). Management of Unintended and Abnormal Pregnancy. Chichester, West Sussex: Wiley-Blackwell.

Raymond, Elizabeth G., and David A. Grimes. (2012). “The Comparative Safety of Legal Induced Abortion and Childbirth in the United States.” Obstetrics and Gynecology, 119(2 Part 1), 215-9.

Rock, John A. & Howard W. Jones III. (2003). TeLinde’s Operative Gynecology — Ninth Edition. Philadelphia, PA: Lippincott Williams & Wilkins.

Saraiya, M., et al. (1999). “Spontaneous Abortion-Related Deaths Among Women in the United States, 1981-1991.” Obstetrics and Gynecology, 94(2), 172-6.

Schroedel, Jean Reith. (2000). Is the Fetus a Person? A Comparison of Policies across the Fifty States. Ithaca, NY: Cornell University Press.

Seward, Paul N., et al. (1973). “The Effect of Legal Abortion on the Rate of Septic Abortion at a Large County Hospital.” American Journal of Obstetrics and Gynecology, 115(335), 335–8.

Tietze, Christopher & Stanley K. Henshaw. (1986). Induced Abortion: A World Review, 1986. New York: The Alan Guttmacher Institute.

Weitz, Tracy A., et al. (2013). “Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver.” American Journal of Public Health, 103(3), 454-61.

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