Abortion Rights in the United States

The abortion ethics debate has kept termination of pregnancy in the courts and media since the landmark decision in Roe v Wade. The original ruling was fairly straightforward, legally confirming a woman's right to a private medical decision when selecting a medical procedure (abortion).

As the debate has raged and the medical issues have become more complex, rulings in the courts and in the legislatures have extended beyond this simplistic question to restrictions on gestational age, viability determinations, spousal and parental consents, enforced waiting periods, enforced language in consents, enforcement of provider qualifications, the right to use fetal tissue for research or medical treatments, the rights of providers and patients to be shielded from overt protest, and, finally, on access to birth control.

In a typical year, hundreds of laws and rulings are proposed, and some even specifically criminalize performing abortions. Current laws are difficult to follow, but a summary is available in the State Policies in Brief section on The Alan Guttmacher Institute Web site.

Prior to the 1960s, an estimated nine of 10 out-of-wedlock pregnancies were electively aborted. These procedures were performed in a variety of medical and nonmedical settings, and almost 20% of all pregnancy-related complications were due to illegal abortions.

• Roe v Wade
  
  
  • An important early decision by the US Supreme Court constitutionally establishing a woman's right to privacy was Griswold v Connecticut in 1965.
    
    
  • In the early 1970s, political support was overwhelmingly in support of legalized abortion, and activists for abortion rights specifically sought a plaintiff so that a legal challenge to abortions could be argued in court. The plaintiff, Norma McCorvey, was the "Jane Roe" for whom the decision is named. The Centers for Disease Control and Prevention define an induced abortion as "a procedure intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age."

• Late-term abortions

• Although only 2% of people express opposition to abortion in any circumstance, wider political support exists for abortion bans on late-term abortions or abortions performed in the third trimester of pregnancy. Since advances in surgical techniques have allowed for surgical terminations to be performed later in pregnancy, another divisive factor has crept into the debate. Abortion opponents have lobbied against specific procedures performed late in pregnancy, and they have the stance that other techniques are preferable.
  
  
• By 1998, 28 states had passed bans on this procedure, referred to as a partial-birth abortion, which is the medical procedure called intact dilatation and extraction.
  
  

• o In November, 2003, President George Bush signed a partial birth abortion ban. This Act was not in effect because of a court order, and in 2007 the Supreme Court passed the Partial Birth Abortion Ban.

• Parental consent

• Most young women have parents or family involvement in their decision to have an abortion. Adolescents who are older, especially those living independently, often do not. In spite of ample scientific evidence that many teens seek parental involvement and widespread legal concern that young women who do not seek parental involvement may be at risk physically or emotionally, a barrage of legislation mandates that all minors seek parental consents or that the parents be notified in advance of a minor child having an abortion.
  
  
• The laws that have enabled this to occur legally are backed by the US Supreme Court. As of 2007, 35 states require some sort of parental involvement in a minor's decision to have an abortion. Twentytwo states require parental consent only, 11 states require parental notification only, and two states require both parental consent and parental notification. Currently, only Connecticut, Hawaii, Maine, New York, Oregon, Vermont, and Washington do not require parental involvement. For a summary of laws, see Parental Involvement in Minors' Abortions. As a result, abortion providers in states that do not require parental consent for minors have begun to see adolescents who may travel hundreds of miles to seek an abortion.
  
  
• Patient rights bills have been developed by a variety of groups, including the Consumers' Bill of Rights and Responsibilities that has been developed by a presidential task force. These bills specifically state that patients have a right to access knowledge and that providers have a right to discuss care they think is medically appropriate regardless of the source of that care.

• Mandatory waiting periods

• Mandatory waiting periods mandate by law that the woman seeking to end a pregnancy must first, in person, receive specific information about the pregnancy and pregnancy alternatives.

• In spite of the fact that these laws typically only mandate a short 24-hour waiting period, they have the effect of increasing the percentage of second-trimester abortions in states with these laws.

• Special concerns

• Advances in neonatal medicine leading to improved survival by babies born very early in gestation have fueled the abortion debate in the past 2 decades, overshadowing the continued cultural debate on when life begins.

• Recently, the progress in using fetal tissue, fetal stem cells, or even discarded embryos for research and medical treatments continues. These potential therapies may be indicated for the treatment of diabetes, Parkinson's disease, kidney disease, and cartilage diseases, among others.

• Current national regulations prohibit most fetal tissue research, but the National Institutes of Health revealed late in 2000 that it will allow stem cell research. In June 2002, President Bush enacted a law restricting stem cell research to only preexisting cell lines and embryos "left over" from in vitro fertilization procedures.

• Many world cultures place a premium on male children, and reports of selective abortion of female fetuses have continued to surface.

• Provider issues

• Most abortion providers are obstetricians and gynecologists. However, providers from a variety of backgrounds (such as family practitioners and nurses) can be taught to perform abortions safely. Physicians are generally receptive to the concept of legal abortions being available in the United States. Research shows those most receptive tend to be non-Catholic and trained in a residency program where abortion observation was a requirement.

• Keeping abortions safe, legal, and rare are the goals of abortion providers.  

• As providers have decreased in number, women are traveling farther to obtain abortions, seeking abortions later in pregnancy, and are unable to obtain services if they are poor and live in most rural areas.
  
  
• Posttraumatic stress has been reported in abortion workers exposed to violent abortion protests at their clinics.
  
  
• Insurance Coverage
  
  
  • While few state public funding sources cover abortions except in cases of jeopardy to maternal life, many private health care plans do cover abortion counseling and procedures.