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"A woman with a voice is, by definition, a strong woman."
Melinda Gates
What Were The Societal And Medical Norms Of Abortion In Early America?
Abortions have been practiced in the US since its conception and have been well documented, as early as the late 1700s and early 1800s. Newspapers and medical literature at the time recorded the use of herbs and medications as abortion-inducing methods, given surgical knowledge was limited especially in the case of women. The US government hadn’t legislated or outlawed abortion until the mid-1800s. From colonial times up until the first laws, abortion was normalized and common. The laws first referred to a term known as “quickening” which means fetal movement, typically occurring at 4 months. Before the Civil War, white men were not generally involved in the gynecological or obstetric (OB/GYN) practices we know today. Half of the women who provided reproductive care were Black women, some of whom were enslaved; midwives also included Indigenous and White women. Enslaved Black women were valued as property and as such were not granted permission to have abortions under any circumstance. Enslaved women would use emmenagogues herbs which stimulated menstruation, to self-induce their abortions in secret.
What Is The History Of Abortion In The US?
1847 - The American Medical Association (AMA) is founded
The male-dominated field of medicine sought to control abortion restrictions, scrutinize reproductive healthcare providers, and was the catalyst that started state-legislated abortion bans.
1873 - Comstock Act "chastity laws"
This act criminalized obscene, vulgar, or lusty material in the postal service and any information related to birth control, sex, and methods of terminating a pregnancy.
1880 - Criminalization and Stigma
All states had an abortion restriction in place by this time and some states had an exception for the life of the mother. As abortion became criminalized, the stigma surrounding it grew.
1910 - Nationwide Abortion Bans
Abortions were completely outlawed in the US and only the wealthy (White women) were able to bypass laws to receive abortion care.
1930 - United States v Dennett
Dennett was charged via the Comstock Act by the United States Postal Service for distributing her sex education pamphlets by mail. The court ruled that materials on contraceptives and reproductive health were legal and shall be accessible.
1955 - First Conference on Abortion Legalization
Planned Parenthood held the first conference on abortion issues and the mission of the conference was to propose legislation changes to current laws. The conference also supported improving public health and access to reproductive care.
1962 - Thalidomide "Contergan"
Thalidomide was a popular and affordable non-prescription drug that thousands of women used to ease pregnancy symptoms. It was discovered in 1961 that the drug caused birth defects. In 1962, a pregnant TV host who took Thalidomide was unable to obtain an abortion in Phoenix Arizona. The medical discovery and story combined propelled support for abortion law reform.
1964 - Association for the Study of Abortion (ASA) is founded
Abortion reform activists registered their first organization and were joined by Planned Parenthood doctors. The ASA advocated for medically necessary abortions while the overall law reform movement sought to legalize abortion for all people.
1966 - The San Francisco Nine
Nine doctors in California were being sued for performing abortions on women who had contracted Rubella, a disease known to cause birth defects. This case resulted in California amending its abortion laws to allow hospital committees to approve abortions.
1969 - The National Association for the Repeal of Abortion Laws (NARAL) is founded
The first national group with the sole intent to repeal abortion laws and eliminate all laws and practices that would force a woman to bear a child against her will.
1970/1971 - State Abortion Bans Repealed
Alaska, Hawaii, and New York all repealed their state abortion bans in 1970 and Washington did the same in 1971.
1970 - New York Planned Parenthood
Planned Parenthood located in Syracuse, New York was the first in the nation to provide abortion services following the state's abortion ban repeal. In the first two years after abortion was legal in New York, two-thirds of abortion procedures were performed on out-of-state patients.
1973 - Roe v Wade
The Supreme Court ruled that abortion is protected under the right to privacy and that an individual's right to privacy encompasses choosing to continue or end a pregnancy. This landmark case set the precedent that states had the right to restrict abortion via parameters set by the Supreme Court but otherwise could not obstruct access to care.
1977 - Hyde Amendment
The Hyde Amendment banned any use of federal funds for abortions except in the cases of incest, rape, or life of the mother. Medicaid is the program of note that was not allowed to insure abortions or related procedures. Medicaid has historically been intended for and received by people of color, LGBTQ+, and low income individuals.
1983 - City of Akron v Akron Center for Reproductive Health
The court ruled that states are prohibited from forcing physicians to provide patients with information that may dissuade them from an abortion. This includes imposing 24-hour waiting periods after signing consent forms.
1984 - Global Gag Rule (GGR)
President Ronald Reagan established the GGR to prohibit foreign organizations that receive US health aid from referring, offering, or promoting abortions. Foreign organizations include Save The Children, Doctors Without Borders, and The International Rescue Committee.
1992 - Planned Parenthood of Southeastern Pennsylvania v Casey
This case reaffirmed that the Constitution protects abortion rights. State governments began passing medically unnecessary restrictions on abortion in retaliation and these new restrictions were found constitutional.
2007 - Gonzales v Carhart & Gonzalez v Planned Parenthood Federation of America
These two cases resulted in a ruling that allowed Congress to ban certain second-trimester abortion procedures. This congressional legislation did not have any exception for the woman's health, effectively overruling a component of Roe v Wade.
2011 - Wisconsin Defunds Planned Parenthood
Wisconsin Governor Scott Walker signed a budget that defunds Planned Parenthood. This budget affected patients' quality and access to care for annual exams, cancer screening, HIV/STI testing, birth control, and more.
2011 - TRAP Laws on the Rise
TRAP laws are restrictive and medically unnecessary, requiring abortion providers to meet particular regulations to practice their regular care. Some of these regulations include hallways to be of a certain width and requiring abortion providers to relocate closer to a hospital or further away from schools. These regulations led to clinic closures nationwide.
2014 - Reproductive Health Services v Marshall
This case resulted in the court striking down a law out of Alabama that required minors to be put on trial and cross-examined by prosecutors to obtain abortion care without their parent's consent.
2016 - Whole Women's Health v Hellerstedt
The US Supreme Court ruled in this case that the Texas law HB 2 is a TRAP law and unconstitutional. The enforcement of HB 2 would lead to most clinics in the state closing down and that alone imposes an undue burden on Texans' access to abortion care.
2016 - President Trump Promises to Overturn Roe v Wade
A part of President Trump's campaign in 2016 was the potential for him to appoint as many as 3 Supreme Court justices and would be making justice selections with the intention of overturning Roe.
2017 - President Trump Reinstates & Expands the Global Gag Rule
President Trump expanded the GGR by forcing any foreign organization receiving US aid to prove they are not receiving assistance from another nation or group that is providing information on abortion.
2018 - Louisiana TRAP Law
A federal appeals court allows a Louisiana TRAP law to remain in effect. This law forced abortion providers to acquire hospital admittance privileges so any patient at the clinic could easily be transferred to a hospital to receive further care. Full enforcement of this law closes all abortion clinics in the state except for the New Orleans health center.
2019 - Supreme Court Strikes Down Louisiana TRAP Law
In a 5-4 decision, the court temporarily halted the TRAP law from being enforced while they reviewed the case. Justice Kavanaugh (appointed by Trump) voted to keep the law in place.
2019 - Trump Administration Introduces Title X Gag Rule
Title X is a federal program that provides family planning and related healthcare services to low-income families, LGTBQ+, people of color, and rural communities. This gag rule banned doctors working within the Title X program from informing their patients of safe and legal abortion access.
2019 - Alabama Abortion Ban
Alabama has passed the most restrictive law of any state since 1973 without any exceptions for rape or incest. Anti-abortion legislatures were seeking legal challenges to this law with the inevitability of it reaching the Supreme Court and with it a chance to overturn Roe v Wade.
2020 - June Medical Services v Russo
The Supreme Court struck down a medically unnecessary law that was almost identical to the one they ruled on in Whole Woman's Health. This law would have made abortion nearly impossible to access anywhere in the state of Louisiana.
2021 - Texas Abortion Ban
Texas passed a 6-week abortion ban called 'SB 8' and was allowed to stay in place by the Supreme Court. This ban restricts abortion to a gestational period that many mothers don't even know they're pregnant yet.
2022 - Roe v Wade is Overturned
In a 6-3 decision, Roe was overturned and with it the constitutional and federal protections for abortion. This left ultimate power up to state legislatures without any guidelines for extreme circumstances, quality of care, access to care or, accuracy of information.
What Are The Current Policies On Abortion And Access By State?
How Did The Supreme Court Decide Roe v Wade In 1973?
The Supreme Court found that abortion is protected under the right to privacy, the right to privacy comes from the Due Process Clause of the 14th amendment. Although the Due Process Clause does not specifically state that US citizens have a right to privacy, the court has ruled in that way dating back to 1891. In a statement from the court a year before Roe; "In a Constitution for a free people, there can be no doubt that the meaning of 'liberty' must be broad indeed." In Roe v Wade, the court found that pregnancy and the control a woman has over her pregnancy are protected by the right to privacy.
The court cited the state's argument of life beginning at conception to be void of constructive evidence and therefore the definition of "person" came into question. Through this line of argument, the court found that the Constitution defines a person's rights are granted once born or naturalized into the United States and not when conceived. The court concluded that; "the unborn have never been recognized in the law as persons in the whole sense." The Supreme Court did not rule that abortion was an absolute right in their decision on Roe, they explicitly said that states have the right to regulate abortions so long as the access to such care is not obstructed. The court laid out some specific circumstances in which abortion may be regulated based on gestational age.
During the first trimester, the state may not regulate abortion beyond requiring that abortion procedures be performed by licensed doctors in medically safe conditions.
During the second trimester, the state may regulate abortion if said regulations are directly related to the effects on the pregnant person's health.
During the third trimester, the state's interest in protecting potential human life outweighs the right to privacy. Therefore states can prohibit abortions during this trimester except for in cases of the life or health of the pregnant person.
What Rights And Political 'Firsts' Have Women Achieved Throughout US History?
How Does Sex-Education Relate To Women's Health And Abortion?
Sex-Ed is a subject of teaching meant to educate people in various age groups on sex, sexuality, and related topics. In addition to intimate or sexual interactions, sex-ed supports relationships and communication skills between partners, neighbors, communities, and also with an individual's relationship with themself. Sex-Ed can help young people develop a better understanding of their gender identity, sexuality, and their bodies. Sex-Ed is more commonly known for instructing young people on safe sex habits and the general anatomy of the human body during puberty. A comprehensive sex-ed would also include information and resources regarding contraceptive access, reproductive health access, and appropriate places to go for potential cases of a sexual crime (rape, incest, harassment, assault, abuse, solicitation).
Sex-Ed ultimately has a direct effect on abortion rates and how abortion is interpreted by young people in the ways this broad topic is presented. If there is an effort to promote abstinence, the absence of intercourse and sexual relations, this does not lower teen pregnancy, HIV/STD rates, abortion rates, or reduce teen sexual activities. A well-rounded sex education geared towards providing all of the necessary information for individuals to practice safe sex, use and know where to access contraceptives, know who and where to go in cases of STIs or unexpected pregnancies, and know how the human body functions are all imperative.
In 2021, data was collected and released to show each state's rate of abortion in the 15-44 age demographic and this information was gathered through the CDC and Morbidity & Mortality Weekly Report. The abortion rate is the number of reported legal abortions per 1,000 women. The top 10 states with the highest abortion rates are down below;
Illinois - 20.8 Does not mandate sex-ed, represents abortion negatively in curriculum, limits contraceptives in sex-ed, abstinence stressed.
Florida - 20.3 Mandates sex-ed, no standards on abortion education, contraceptives not required in sex-ed, abstinence stressed.
Georgia - 18.8 Mandates sex-ed, no standards on abortion education, contraceptives not required in sex-ed, abstinence stressed.
New York - 16.3 Does not mandate sex-ed, no standards on abortion education, contraceptives not required in sex-ed, abstinence stressed.
Michigan - 15.9 Mandates sex-ed, prohibits abortion topics, contraceptives not required in sex-ed, abstinence stressed.
North Carolina - 15.7 Mandates sex-ed, no standards on abortion education, expansive coverage on contraceptives, abstinence stressed.
Connecticut - 14.8 Does not mandate sex-ed, prohibits abortion topics, contraceptives not required in sex-ed, does not cover abstinence.
Nevada - 14.2 Mandates sex-ed, no standards on abortion education, contraceptives not required in sex-ed, does not cover abstinence.
Kansas - 13.8 Mandates sex-ed, no standards on abortion education, contraceptives not required in sex-ed, does not cover abstinence.
Pennsylvania - 13.7 Does not mandate sex-ed, no standards on abortion education, contraceptives not required in sex-ed, does not cover abstinence.
This data comparison concludes that the top 10 states with the highest abortion rate either don't have standards for abortion education, they instruct it to be negatively enforced or it's entirely prohibited in sex-ed. 8 of these states have no standard for contraceptive education, 1 of them is expansive on this topic and another has limits on the education of contraceptives. 6 of them mandate sex-ed where 4 do not and same in the case of abstinence, 6-4. There are other sex-ed-related topics in the maps below such as healthy relationships, LGBTQ topics, social skills, and HIV/STD education.
What Are The Variations Of Abortion Procedures And Related Healthcare?
Abortion is a medical procedure to end a pregnancy growing in the womb (uterus). Surgical procedures to terminate a pregnancy are always performed in a clinic or hospital. Medical abortions are typically performed at home with prescription medication such as Mifepristone and Misoprostol. The use of a surgical or medical abortion will vary by patient but the determining factor is typically how far along the pregnancy is. Almost all abortion procedures are out-patient, meaning there is no overnight stay at the hospital or clinic. When seeking an abortion an appointment will be scheduled with a clinic, doctor's office, or hospital. Since in-clinic abortions are defined as a surgical procedure, the patient will likely need to fast the night before the appointment. When arriving at the clinic, standard paperwork and medical history will be recorded. A pre-abortion checkup will be conducted; physical examination, pregnancy test, blood test, screening for STIs, and potentially other tests depending on the circumstances. Many times an ultrasound will be performed to discover and assess uterine, placental, or fetal abnormalities. After these results are compiled, the healthcare provider will counsel the patient on their options and recommendations.
First Trimester Abortion: Vacuum Aspiration (suction abortion)
For this procedure, the patient is not likely to need their cervix dilated or prepped. However, if the pregnancy is about 10-12 weeks cervical dilation will be performed so the medical tools can access the uterus. To achieve this, small moisture-absorbent sticks of seaweed called Laminaria are inserted to expand the uterus. An anesthetic is inserted directly into the cervix and following is a small tube attached to a manual or automatic suction machine that then clears out the contents. This procedure generally takes minutes and the recovery is about half an hour following the procedure. If a patient chooses to be sedated rather than local anesthetic and acetaminophen, their recovery may be longer.
Second Trimester Abortion: Dilation and Evacuation (D&E)
Vacuum aspiration abortions can be performed up to 14 weeks but the most commonly practiced second-trimester abortion is D&E. The prep work for a second trimester abortion is very similar to a first, however, the farther along in a pregnancy a patient is the more pre-op and post-op work there is. An ultrasound is always performed when an abortion is requested in the second trimester so the provider can date the pregnancy. Preparation and dilation of the cervix are necessary in this trimester to prevent injury. Laminaria sticks will likely be used overnight. A dose of Misoprostol may be administered either orally or vaginally to soften the vagina before the procedure. The main difference between D&E procedures and vacuum aspiration is the combination of suction and tools to remove contents from the uterus. Some providers use a medication that is put directly into the abdomen to stop the fetal heartbeat before the procedure. Following the procedure, the patient will receive another medication to contract the uterus to reduce bleeding. The procedure takes 10-20 minutes and rest is anywhere from 30 minutes to an hour.
Third Trimester Abortion: Late-Term Abortion Dilation and Extraction (D&X)
Abortions in this trimester are almost always performed by a specialized and experienced provider in D&X procedures. This is a procedure that is almost always reserved for fetal or maternal complications. All previous steps are the same, paperwork, prep work, cervical dilation, anesthetic, ultrasound, etc. There are some other options in this trimester such as labor induction, hysterectomy, and hysterotomy. Labor induction is the use of medications or other methods to start labor before it naturally occurs. Inducing labor is used when pregnancies are 41+ weeks, problems with the fetus or placenta, uterine infections, maternal health problems, and more. A hysterectomy is a surgical procedure to remove the uterus and cervix, fallopian tubes and ovaries may also be removed. A hysterotomy is a surgical incision into the uterus that is used for C-sections, abortions, resuscitation, and fetal surgeries.
Facts & Stats
In-clinic abortions are 99% effective.1
Medication abortions are 87-99% effective.2
Plan B is 89% effective within 72hrs of intercourse.3
1 in 4 women in the US will have an abortion by age 45.4
Adolescents make up 10% of all people obtaining abortions, 2% of them are 17 or younger.5
55% of people who obtain abortions had previously had at least one birth.6
45% of abortions are performed at 6 weeks or earlier, 49% at 7-13 weeks, and 7% at 14 weeks or later.7
More than 53% of people paid out of pocket for their abortion in 2021-2022.8
16% of people having abortions are LGBTQ+.9
As of March 2024, there were no clinics providing abortion care in the 14 states that had total abortion bans. These states had 63 clinics in 2020.10
More than 166,000 abortion patients traveled to other states to obtain care in 2023. Half as many (81,000) did so in 2020.11
Among people obtaining abortions, 33% are age 20-24 and 28% are age 25-29.12
41% of people obtaining abortions had an income below the federal poverty line (the annual income range is 1 person household of $15,000 -> 4 person household of $31,000).13
45% of people getting clinical abortions have Medicaid, 27% have private insurance, 6% are insured through the ACA, and 2% are not insured.14
87% of abortion patients in 2021 were not married.15
"I am not free while any woman is unfree, even when her shackles are very different from my own."
Audre Lorde
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