abortion research paper conclusion

Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > The British Journal of Psychiatry
• > Volume 199 Issue 3
• > Abortion and mental health: quantitative synthesis...

Article contents

Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009.

Published online by Cambridge University Press:  02 January 2018

• Supplementary materials
• eLetters (17)

Given the methodological limitations of recently published qualitative reviews of abortion and mental health, a quantitative synthesis was deemed necessary to represent more accurately the published literature and to provide clarity to clinicians.

To measure the association between abortion and indicators of adverse mental health, with subgroup effects calculated based on comparison groups (no abortion, unintended pregnancy delivered, pregnancy delivered) and particular outcomes. A secondary objective was to calculate population-attributable risk (PAR) statistics for each outcome.

After the application of methodologically based selection criteria and extraction rules to minimise bias, the sample comprised 22 studies, 36 measures of effect and 877 181 participants (163 831 experienced an abortion). Random effects pooled odds ratios were computed using adjusted odds ratios from the original studies and PAR statistics were derived from the pooled odds ratios.

Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour.

This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

Despite federal legalisation of abortion in the USA in 1973, women’s right to choose abortion has been hotly debated, factoring heavily into the broader political landscape. Paralleling political division at the societal level, there has been considerable debate among academics regarding the extent to which abortion poses serious mental health risks to women. Over the past several decades, hundreds of studies have been published indicating statistically significant associations between induced abortion and adverse psychological outcomes of various forms. Reference Bradshaw and Slade 1 – Reference Thorp, Hartman and Shadigan 4 However, the authors of the three most recent qualitative literature reviews arrived at the conclusion that abortion does not pose serious risks above those associated with unintended pregnancy carried to term. 5 – Reference Robinson, Stotland, Russo, Lang and Occhiogrosso 7 This conclusion is problematic for several reasons, the most salient of which are described briefly below.

First, only a handful of studies have actually included unintended pregnancy carried to term as a control group. Pregnancy intendedness is not well defined in the literature and basic conceptualisation and measurement issues challenge the validity of the intendedness variable as used in the available studies. Specifically, pregnancies that are terminated are sometimes initially intended by one or both partners and pregnancies that are initially unintended may become wanted as the pregnancy progresses, rendering assessment of intendedness subject to considerable change over time. In addition, pregnancy intendedness is typically measured dichotomously (intended/unintended) when true responses may actually fall on a continuum from fully intended and planned for years to entirely unintended, with a great deal of variation likely between these two extremes. At least half of all pregnancies in the USA are classified as unintended and among adolescents and women over 40 years old the percentage is over 75%, Reference Kost and Forrest 8 , Reference Squires 9 meaning the majority of women in the control groups in studies comparing abortion with term pregnancy actually delivered unintended pregnancies even if the variable was not directly assessed.

Second, many recently published studies with extensive controls for third variables were not reflected in the three recent reviews, with no explanation given as to why large segments of the peer-reviewed literature were missing. For instance, in the 2008 review by Charles et al , Reference Charles, Polis, Sridhara and Blum 6 several of the studies that were overlooked actually met the inclusion criteria. Reference Coleman 10 – Reference Slade, Heke, Fletcher and Stewart 19 Similarly, studies examining substance misuse were not included in two of the three reviews, Reference Charles, Polis, Sridhara and Blum 6 , Reference Robinson, Stotland, Russo, Lang and Occhiogrosso 7 with no rationale for excluding them. Numerous studies have demonstrated statistically significant associations between abortion and subsequent substance misuse, a widely recognised and prevalent mental health problem. Reference Coleman 2 , Reference Coleman 10 , Reference Coleman, Coyle, Shuping and Rue 20 – Reference Pedersen 24

Third, in all three literature reviews the choice of studies lacked sufficient methodologically based selection criteria. 5 – Reference Robinson, Stotland, Russo, Lang and Occhiogrosso 7 As a result the sample of studies included was either too broad, resulting in incorporation of results from numerous weaker studies, or too narrow, resulting in unjustified elimination of sound studies. Ironically, the largest review, by the American Psychological Association Task Force, exemplifies both problems as the selection criteria for one type of study (those with a comparison group) were simply publication of empirical data on induced abortion with at least one mental health measure in peer-reviewed journals in English on US and non-US samples; 5 however, non-US samples were avoided entirely for a second type of study (no comparison group) examined in this review without an appropriate rationale, resulting in elimination of dozens of methodologically sophisticated international studies. In the review conducted by Robinson et al the authors mention having identified 216 peer-reviewed papers on the topic of abortion and mental health and then note selection of a sample of studies that ‘exemplify common errors in research methodology’ as well as ‘major articles that attempt to correct the flaws’. Reference Robinson, Stotland, Russo, Lang and Occhiogrosso 7 No details were offered regarding how studies were chosen to fit into these two categories.

The fourth troubling issue is the fact that quantification of effects was not attempted by any of the three research teams. Given the expansive literature on abortion and mental health, there is no reasonable justification for not quantifying effects. In the only truly systematic review available, published in 2003 by Thorp et al , stringent selection criteria were employed and their analysis of the largest and strongest studies available resulted in the conclusion that abortion is associated with an increased risk of depression that may lead to self-harm. Reference Thorp, Hartman and Shadigan 4 Owing to the broad objective of this review, which addressed physical complications as well, a wide range of mental health effects were not examined.

In this highly politicised area of research it is imperative for researchers to apply scientifically based evaluation standards in a systematic, unbiased manner when synthesising and critiquing research findings. If not, authors open themselves up to accusations of shifting standards based on conclusions aligned with a particular political viewpoint. Moreover, the results may be dangerously misleading and result in misinformation guiding the practice of abortion. Through a process of systematically combining the quantitative results from numerous studies addressing the same basic question (e.g. ‘is there an association between abortion and mental health?’) far more reliable results are produced than from particular studies that are limited in size and scope. Moreover, as a methodology wherein studies are weighted based on objective scientific criteria, meta-analysis offers a logical, more objective alternative to qualitative reviews when the area of study is embedded in political controversy. Therefore, in an effort to provide a long overdue, dispassionate analysis of the literature on abortion and mental health, the primary objective of this review was to conduct meta-analyses of associations between induced abortion and adverse mental health outcomes (depression, anxiety, substance use and suicidal behaviour) with sensitivity to the use of distinct control groups employed in the various studies (no abortion, unintended pregnancy delivered, pregnancy delivered). The focus was on studies published between 1995 and 2009 because of the considerable improvement in research designs on the topic of post-abortion mental health in recent years. Contemporary research on abortion and mental health has addressed a number of shortcomings of the earlier work by employing comparison groups with controls for third variables. However, there has also been increased emphasis on incorporating nationally representative samples, prospective designs, controls for prior psychiatric history and comprehensive assessments of mental health outcome measures which in some cases included actual medical records. A secondary objective of this review was to calculate population-attributable risk (PAR) percentages using pooled odds ratios derived from the meta-analysis subdivided by outcome measures. These statistics reflect the incidence of a disorder in the exposed sample (e.g. women who have undergone abortion) that is directly due to the exposure (the abortion procedure). Both the pooled odds ratios and the PAR percentages yielded herein provide readily interpretable indices of the mental health consequences of abortion and should offer new clarity to the academic debate and to clinicians seeking information to guide effective practice.

Inclusion criteria

Studies identified using the Medline and PsycINFO databases were included in this review if they met the following criteria: a sample size of 100 or more participants; use of a comparison group (no abortion, pregnancy delivered or unintended pregnancy delivered); one or more mental health outcome variables (depression, anxiety, alcohol use, marijuana use or suicidal behaviour); controls for third variables; use of odds ratios to express effects observed to facilitate calculation of readily interpretable pooled odds ratios and PAR statistics; publication in English in peer-reviewed journals between 1995 and 2009.

Rules for extraction and synthesis of effects

In addition to the above criteria, rules for extracting and synthesising data derived from the studies selected were developed based on the recommendations outlined by Lipsey, Reference Lipsey, Cooper, Hedges and Valentine 25 to avoid overrepresentation of particular samples and statistical dependences among effects, and generally to ensure the most conservative and unbiased assemblage of results from the individual studies exhibiting considerable variability in reporting.

(a) Relevant studies contributed a maximum of one effect per outcome. When authors reported more than one effect per variable based on separate analyses conducted for distinct demographic groups, or when different diagnoses were reported on within a general class such as anxiety or depression, a composite odds ratio was derived to avoid overweighting in favour of particular studies.

(b) When studies had more than one comparison group, selection rules were employed to provide more weight to comparisons wherein the control group was most closely matched to the abortion group. Specifically, if ‘unintended pregnancy delivered’ was used the results relative to this group were selected, and when only ‘pregnancy delivered’ and ‘no abortion’ comparison groups were used, the effects pertaining to the ‘pregnancy delivered’ group were selected.

(c) In situations wherein separate results were reported based on one v . two or more abortions, the results specific to one abortion were selected to enable sampling of a more homogeneous population. There are studies suggesting differential effects based on the number of abortions. Reference Coleman, Reardon and Cougle 26 , Reference Steinberg and Russo 27

(d) When particular authors used the same sample and variables in more than one publication, only the most recent publication was selected. When the same data-set was used by different groups, both sets of results were included when distinct samples were defined.

Statistical analysis

Meta-analyses were conducted using Comprehensive Meta-Analysis version 2.0 for Windows (Biostat, www.meta-analysis.com ). Random effects meta-analyses were computed based on the sociodemographic heterogeneity of the study samples. Reference Borenstein, Hedges, Higgins and Rothstein 43 The random effects model takes into account two sources of variance (within-study error and variation in the true effects across studies) with the study weights designed to minimise both sources of variance. Reference Borenstein, Hedges, Higgins and Rothstein 43 A pooled odds ratio was computed using the full 36 effects extracted. In addition, two sets of subgroup pooled odds ratios were calculated based on the type of comparison group used and on specific forms of mental health problems. Adjusted odds ratios with controls for third variables were used in all the random effects meta-analyses. Finally, PAR percentages were computed using the pooled odds ratios (OR) derived from the random effects model subdivided by outcome measures. The PAR percentages were calculated using the formula 100×( Px (OR–1))/(1 + Px (OR–1)), where Px is the estimate of population exposure; Px is calculated as c /( c + d ), where c is the number of women in the abortion group who did not experience the mental illness in question and d is the number of women in the ‘no abortion’ group who were identified as not having the mental illness examined.

After applying the inclusion criteria and rules detailed above, the sample consisted of 22 peer-reviewed studies (15 from the USA and 7 from other countries); Reference Coleman, Reardon, Strahan and Cougle 3 , Reference Coleman, Coyle, Shuping and Rue 20 – Reference Fergusson, Horwood and Boden 22 , Reference Pedersen 24 , Reference Coleman, Reardon and Cougle 26 – Reference Taft and Watson 42 these comprised 36 measures of effect (9 alcohol use/misuse, 5 marijuana, 7 anxiety, 11 depression, 4 suicidal behaviour) and a total of 877 181 participants, of whom 163 831 had experienced an abortion (see online Table DS1).

The first random effects meta-analysis, which included 36 adjusted odds ratios from the 22 studies identified, resulted in a pooled odds ratio of 1.81 (95% CI 1.57–2.09, P <0.0001). The results of this analysis indicated that women who have had an abortion experienced an 81% higher risk of mental health problems of various forms when compared with women who had not had an abortion ( Fig. 1 ). Results of a second random effects meta-analysis, wherein separate effects were produced based on the type of outcome measure, are provided in Fig. 2 . All effects were statistically significant, with the largest pooled odds ratio derived for marijuana use (OR = 3.30, 95% CI 1.64–7.44, P = 0.001), followed by suicide behaviours (OR = 2.55, 95% CI 1.31–4.96, P = 0.006), alcohol use/misuse (OR = 2.10, 95% CI 1.77–2.49, P <0.0001), depression (OR = 1.37, 95% CI 1.22–1.53, P <0.0001) and anxiety (OR = 1.34, 95% CI 1.12–1.59, P <0.0001). These results indicate that the level of increased risk

Fig. 1 Abortion and subsequent mental health outcomes. alco , alcohol misuse; anx , anxiety; dep , depression; marij , marijuana use; NCS, National Comorbidity Survey; NCFG, National Survey of Family Growth; suic , suicide.

associated with abortion varies from 34% to 230% depending on the nature of the outcome.

In the third random effects meta-analysis ( Fig. 3 ) three separate pooled odds ratios were produced based on the type of comparison group employed in the respective studies. When women who had terminated a pregnancy were compared with women who had not done so relative to all mental health problems, the result was statistically significant (OR = 1.59, 95% CI 1.36–1.85, P <0.0001). When women who terminated a pregnancy were compared with women who carried to term, using the full set of mental health variables, the result was considerably stronger (OR = 2.38, 95% CI 1.62–3.50, P <0.0001). Finally, when ‘unintended pregnancy carried to term’ operated as the comparison group, the result was likewise statistically significant and closer to the result relative to the ‘no abortion’ comparison group (OR = 1.55, 95% CI 1.30–1.83, P <0.0001). These data indicate that regardless of the type of comparison group used, abortion is associated with an enhanced risk of experiencing mental health problems, with the magnitude of this risk ranging from 55% to 138%.

The last set of analyses involved calculation of PAR percentages based on pooled odds ratio estimates. The overall PAR percentage was nearly 10%, with the range for particular mental health problems extending from 8.3% for anxiety to 26.5% for marijuana use ( Table 1 ). In addition, a pooled odds ratio for the two large-scale studies in which actual suicide was

Fig. 2 Abortion and subsequent mental health outcomes, organised by dependent measures. NCS , National Comborbidity Survey; NCFG , National Survey of Family Growth; suic , suicide.

measured yielded a significant result (OR = 4.11, 95% CI 1.82–9.31) and a PAR percentage of 34.9% was derived using this pooled odds ratio.

Based on data extracted from 22 studies, the results of this meta-analytic review of the abortion and mental health literature indicate quite consistently that abortion is associated with moderate to highly increased risks of psychological problems subsequent to the procedure. The magnitude of effects derived varied based on the comparison group (no abortion, pregnancy delivered, unintended pregnancy delivered) and the type of problem examined (alcohol use/misuse, marijuana use, anxiety, depression, suicidal behaviours). Overall, the results revealed that women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be directly attributable to abortion. The strongest effects were observed when women who had had an abortion were compared with women who had carried to term and when the outcomes measured related

Table 1 Population-attributable risk (PAR) percentages based on outcome measure

to substance use and suicidal behaviour. Great care was taken to assess accurately the risks from the most methodologically sophisticated studies, and the quantitatively based conclusions reflect data gathered on over three-quarters of a million women. Of particular significance is the fact that all effects entered into the analyses were adjusted odds ratios with controls for numerous third variables.

The finding that abortion is associated with significantly higher risks of mental health problems compared with carrying

Fig. 3 Abortion and subsequent mental health outcomes, organised by comparison group. alco , alcohol misuse; anx , anxiety; dep , depression; marij , marijuana use; NCS , National Comorbidity Survey; NCFG , National Survey of Family Growth; suic , suicide.

a pregnancy to term is consistent with literature demonstrating protective effects of pregnancy delivered relative to particular mental health outcomes. For example, with regard to suicide, Gissler et al reported the annual suicide rate for women of reproductive age to be 11.3 per 100 000, whereas the rate was only 5.9 per 100 000 in association with birth. Reference Gissler, Hemminki and Lonnqvist 34 Several other studies conducted in different countries have revealed even lower rates of suicide following birth when compared with women in the general population. Reference Appleby 44 – Reference Schiff and Grossman 47 More research is needed to examine systematically the specific nature of this protective effect against suicide, to determine the extent to which the protective effect holds for unintended pregnancies delivered, and to examine possible protective effects of childbirth relative to other mental health variables.

When the abortion group was compared with the no pregnancy group and with the unintended pregnancy delivered group, the magnitude of the effects was very close. This finding challenges the generally accepted belief that unintended pregnancy delivered represents the only or most appropriate control group for studies designed to explore the impact of abortion on mental health. Use of a no pregnancy delivered group may be a cleaner control group, since many women experience postpartum depression and/or anxiety following childbirth. From a practical standpoint, a no pregnancy comparison group should be considerably easier to secure than a group of women who deliver an unintended pregnancy.

Future research

Future studies should explore possible process mechanisms linking abortion to substance misuse and suicidal behaviour, since the strongest effects were detected for these variables. For example, substance misuse and suicidal behaviour may result from efforts to block or avoid any psychological pain associated with the procedure and may be construed as faster, easier remedies for personal suffering than seeking professional help. Women could find it particularly difficult to reach out to others if they experience shame or guilt associated with the abortion. Consistent with the contemporary ethos of evidence-based medicine wherein effective use is made of the best available data from systematic research, firm standards should be articulated for accessing and synthesising information from the published literature for the purpose of training healthcare personnel. The results of this systematic, quantitative review cast serious doubt on the conclusions derived from the recently published traditional reviews described earlier, 5 – Reference Robinson, Stotland, Russo, Lang and Occhiogrosso 7 and suggest that there are in fact some real risks associated with abortion that should be shared with women as they are counselled prior to an abortion decision.

Healthcare professionals are responsible for educating patients in a manner that reflects the current scientific literature; however, the average practitioner does not generally have the time and expertise to study and attempt to resolve conflicting interpretations of the published research in order to extract the most reliable information. The responsibility therefore rests initially within the research community to set aside personal ideological commitments, objectively examine all high-quality published data, and conduct analyses of the literature that are based on state-of-the-art data analysis procedures, yielding readily interpretable synopses as has been attempted here. Once this goal is satisfactorily realised, professional organisations will face the challenge of developing efficient protocols for informing practitioners and for streamlining the dissemination of information to the public.

The US Preventive Services Task Force (USPSTF) within the Agency for Healthcare Research and Quality, which is a division of the US Department of Health and Human Services ( www.ahrq.gov/clinic/3rduspstf/ratings.htm ), has identified basic guidelines for how scientific evidence should be used to inform practice. These are summarised below and are based on an analysis of risks and benefits as established in the scientific literature.

• Level A: Good scientific evidence indicates the benefits of the service substantially outweigh the risks with clinicians advised to discuss the service with eligible patients.

• Level B: Fair scientific evidence indicates the benefits of the service outweigh the risks with clinicians encouraged to discuss the service with eligible patients.

• Level C: At least fair scientific evidence indicating benefits are provided by the service, but the balance between benefits and risks precludes general recommendations. Clinicians are advised to only offer the service if there are special considerations.

• Level D: At least fair scientific evidence indicates the risks of the service outweigh benefits with clinicians advised not to routinely offer the service.

• Level I: Scientific evidence is deficient, poorly done, or conflicting precluding assessment of the risk benefit ratio. Clinicians are advised to convey the uncertainty of evidence surrounding the service to patients.

Putative benefits of abortion

Procedure benefits of abortion have not been empirically established and the results of the substantial review by Thorp et al described earlier in conjunction with the results of the present quantitative synthesis indicate considerable evidence documenting mental health risks. Reference Thorp, Hartman and Shadigan 4 Without more research pertaining to possible benefits, the above guidelines are difficult to apply. In one study by Major et al , Reference Major, Cozzarelli, Cooper, Zubek, Richards and Wilhite 14 the average response of the study respondents reflecting their positive post-abortion emotional reactions (defined as ‘happy’, ‘pleased’ or ‘satisfied’) was 2.24 on a scale of 1 to 5, with 1 corresponding to ‘not at all’ and a 5 representing ‘a great deal’. The passage of time apparently did not result in more positive emotions, because 2 years after abortion the average rating dropped by a statistically significantly amount to 2.06. A few additional studies have addressed associations between abortion and educational attainment, income and other outcomes of this nature, which may be construed as indirect indicators of mental health; Reference Bailey, Bruno, Bezerra, Queiroz, Oliveira and Chen-Mok 48 , Reference Fergusson, Boden and Horwood 49 however, mental health benefits have received scant direct attention in the literature.

Concerns regarding the deficient positive effects literature were echoed in an editorial published in the Psychiatric Bulletin , Reference Fergusson 50 in which Fergusson questioned the legitimacy of justifying over 90% of UK abortions based on the presumption that abortion offers the benefit of reducing mental health risks associated with continuing the pregnancy. Fergusson specifically stated:

Although decisions on whether to proceed with induced abortion are made on the basis of clinical assessments of the extent to which abortion poses a risk to maternal mental health, these clinical assessments are not currently supported by population-level evidence showing the provision of abortion reduces mental health risks for women having unwanted pregnancy. Reference Fergusson 50

Until sound evidence documenting mental health benefits of abortion is available, clinicians should convey the current state of uncertainty related to benefits of abortion in addition to sharing the most accurate information pertaining to statistically validated risks.

Strengths and limitations of this review

Motivated by the shortcomings of previous non-quantitative efforts to synthesise and analyse a complex literature prone to biased interpretations, I have attempted in this study to evaluate systematically a wealth of data on the topic of abortion and mental health. The use of inclusion criteria that resulted in incorporation of the largest and strongest studies published in recent years is an obvious strength. However, the review is clearly not exhaustive as only a 15-year publication window was examined and studies that did not incorporate a comparison group were not analysed. There is a strong need for a quantitative review of literature examining the hundreds of studies that have been conducted on samples of women who obtained abortions without inclusion of a comparison group. As noted previously, the review of literature conducted by the American Psychological Association Task Force confined their examination of this study form to US samples. 5 Another limitation of my study relates to the lack of uniformity in control variables, demographic characteristics of the samples, length of time between the procedure and the follow-up assessments, and considerable variation in how the outcomes were measured.

It is encouraging to note that methodologically sophisticated studies on the topic of abortion and mental health are being published at a significantly higher rate than ever before. Researchers throughout the world are seeking to understand the experience of induced abortion more fully and are increasingly willing to take on a subject that has been shrouded in political controversy and has not received the scholarly attention it deserves. The latest example is a study based on National Comorbidity Survey – Replication data by Canadian researchers Mota et al . Reference Mota, Burnett and Sareen 51 This 2010 study was published after the analyses reported herein were conducted; however, its results are startlingly similar. Statistically significant associations were observed between abortion history and a wide range of mental health problems after controlling for the experience of interpersonal violence and demographic variables. When compared with women without an abortion history, women with a prior abortion experienced a 61% increased risk of mood disorders. Abortion was further linked with a 61% increased risk of social phobia, and increased the risk of suicide ideation by 59%. In the realm of substance misuse, the abortion-related increased risks for alcohol misuse, alcohol dependence, drug misuse, drug dependence and any substance use disorder were 261%, 142%, 313%, 287% and 280% respectively. Population-attributable risk percentages were likewise similar, ranging from 5.8% to 24.7%. Reference Mota, Burnett and Sareen 51

Concluding remarks

This review was undertaken in an effort to produce an unbiased, quantitative analysis of the best available evidence addressing abortion as one risk factor among many others that may increase the likelihood of mental health problems. The composite results reported herein indicate that abortion is a statistically validated risk factor for the development of various psychological disorders. However, when the independent variable cannot be ethically manipulated, as is the case with abortion history, definitive causal conclusions are precluded from both individual studies and from a quantitative synthesis such as this one. Although an answer to the causal question is not readily discerned based on the data available, as more prospective studies with numerous controls are being published, indirect evidence for a causal connection is beginning to emerge.

Coleman supplementary material

Supplementary Table S1

This article has been cited by the following publications. This list is generated based on data provided by Crossref .

• Google Scholar

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Volume 199, Issue 3
• Priscilla K. Coleman (a1)
• DOI: https://doi.org/10.1192/bjp.bp.110.077230

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Important conclusions from abortion studies

• PMID: 12287992

In general, it can be concluded that the initiative on the determinants and consequences of induced abortion has shown some important patterns. For example, induced abortion is not restricted to adolescents but occurs also within marriage to limit family size. Induced abortion is prevalent both where family planning services are available and contraceptive prevalence is high as well as where family planning is not common, but for different reasons. In the former, motivation to limit family size is high and women would use any option if contraception fails or an unwanted pregnancy occurs. In the latter case, induced abortion forms part of a mix of incipient fertility regulation alternatives, most of which are traditional and of little effectiveness but including some use or improper use of modern methods. Few abortion seekers, and among them even fewer adolescents, were using a modern contraceptive at the time the pregnancy started. High use of traditional methods in some countries leads to abortion as women/couples fail to follow proper instructions with regards to the safe period. Unsafe clandestine abortions are more likely to be sought by poorer women and by adolescents. The findings of this research are increasingly being used to question the legal status of abortion in countries where the law is restrictive, or to strengthen family planning efforts in order to reduce abortion incidence.

PubMed Disclaimer

Similar articles

• [Induced abortion: a vulnerable public health problem]. Requena M. Requena M. Enfoques Aten Prim. 1991 Mar;6(1):11-8. Enfoques Aten Prim. 1991. PMID: 12343306 Spanish.
• "Common sense" abortion assumption supported. [No authors listed] [No authors listed] Popline. 1997 Jan-Feb;19:3, 4. Popline. 1997. PMID: 12293001
• Preventing unsafe abortion and limiting its consequences: what can be done? Misago C. Misago C. Kangaroo. 1994 Dec;3(2):172-7. Kangaroo. 1994. PMID: 12319582
• [Family planning--the role of general practitioner in abortion prophylaxis]. Skrzypulec V, Drosdzol A, Nowosielski K, Rozmus-Warcholińska W, Walaszek A, Piela B, Zdun D. Skrzypulec V, et al. Wiad Lek. 2004;57 Suppl 1:290-4. Wiad Lek. 2004. PMID: 15884260 Review. Polish.
• Unwanted pregnancy--medical and ethical dimensions. Ravindran J. Ravindran J. Med J Malaysia. 2003 Mar;58 Suppl A:23-35. Med J Malaysia. 2003. PMID: 14556348 Review.
• Search in MeSH

LinkOut - more resources

• MedlinePlus Health Information
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• Open access
• Published: 17 July 2008

Experiences of abortion: A narrative review of qualitative studies

• Mabel LS Lie 1 ,
• Stephen C Robson 2 &
• Carl R May 3  

BMC Health Services Research volume  8 , Article number:  150 ( 2008 ) Cite this article

65k Accesses

61 Citations

11 Altmetric

Metrics details

Although abortion or termination of pregnancy (TOP) has become an increasingly normalized component of women's health care over the past forty years, insufficient attention has been paid to women's experiences of surgical or medical methods of TOP.

To undertake a narrative review of qualitative studies of women's experiences of TOP and their perspectives on surgical or medical methods.

Keyword searches of Medline, CINAHL, ISI, and IBSS databases. Manual searches of other relevant journals and reference lists of primary articles.

Qualitative studies (n = 18) on women's experiences of abortion were identified. Analysis of the results of studies reviewed revealed three main themes: experiential factors that promote or inhibit the choice to seek TOP; experiences of TOP; and experiential aspects of the environment in which TOP takes place.

Women's choices about TOP are mainly pragmatic ones that are related to negotiating finite personal and family and emotional resources. Women who are well informed and supported in their choices experience good psychosocial outcomes from TOP. Home TOP using mifepristone appears attractive to women who are concerned about professionals' negative attitudes and lack of privacy in formal healthcare settings but also leads to concerns about management and safety.

Peer Review reports

Although abortion or termination of pregnancy (TOP) by clinical means is politically contentious in some countries (notably the US), in most developed countries it has become a normalized [ 1 ] component of women's health care [ 2 ] over the past forty years. For most of this period, TOP was a surgical procedure but since the mid-1990s, pharmaceutical developments (i.e. RU-486 also known as mifepristone, and methotrexate [ 3 ]), have made medical TOP possible. Clinical trials have established that medical TOP provides a clinical and cost effective alternative to vacuum aspiration for the early termination of pregnancy [ 4 – 8 ]. While a Cochrane systematic review highlighted inadequate evidence [ 9 ], a more recent systematic review concluded that the incidence of side effects in medical abortion was low [ 10 ]. Even so, mifepristone has only been approved in the US since September 2000, whereas the UK and Sweden have had more than a decade of experience of its use and it is approved for use in 14 European countries [ 11 ].

The emphasis on establishing clinical and cost effectiveness of medical versus surgical TOP means that less attention has been paid to women's experiences of the two methods. This paper goes some way towards filling that gap by providing a narrative review of qualitative studies of women's experiences of TOP and their perspectives on surgical or medical methods. Given the importance of this topic to policy and clinical practice around reproductive health, this is a surprisingly small body of literature, but it is highly heterogeneous and contextually specific.

An initial scoping exercise established that the qualitative research literature was too heterogeneous to permit a systematic review of qualitative studies along the lines proposed by Dixon-Woods [ 12 ], or a theoretical qualitative meta-synthesis using the methods proposed by Sandelowski [ 13 ]. For this reason, a narrative review [ 14 ] was undertaken.

The review focused on the period 1998–2007 because it was during this period that medical TOP has become established in practice. The primary focus of the review is therefore on women's experiences of TOP, and this meant that other studies (for example qualitative studies of attitudes and moral considerations) were excluded. Studies included in the review were identified by keyword searches of Medline, Psychinfo, CINAHL, ISI, and IBSS databases. Keywords searched included 'abortion', 'terminat*, pregnan*', 'unplanned pregnancy', in combination with 'qualitative study', semi-structured, ethnograph* experiences', of which 'abortion experiences' yielded the most relevant material. Manual searches of other relevant journals ( Reproductive Health Matters ; Health Care for Women International ; Contraception ) and reference lists of primary articles found from initial searches were also conducted. These searches revealed four comparative qualitative studies of surgical versus medical TOP [ 15 – 18 ] of which three were conducted in the US and one in Latin America. A further 14 qualitative studies of women's experiences of TOP using either method were identified [ 19 – 32 ]. This is an extraordinarily small body of peer-reviewed research papers given the importance and contentiousness of the topic.

While many authors have observed that qualitative studies have important strengths in health policy and practice research [ 33 , 34 ] the studies included in this paper also have limitations that should be acknowledged. The most important of these are their small size and limited scope. Because this is not a systematic review and few articles were found, evaluations of methodological quality were not used to exclude papers from the study. However, it was accepted that non-probability sampling was employed and for ethical reasons, participants were self-selected. Even so, many studies provided insufficient socio-demographic information about their research participants and only nine acknowledged study limitations and recruitment biases [ 17 , 19 , 23 – 28 , 31 ]. In common with other narrative reviews of qualitative studies, this means that we do not seek to assess the ways that participant selection may have influenced results.

Discussion of ethnicity was virtually absent. Only one study [ 23 ], included participants who did not speak the dominant language in the country in which it was conducted, so that the views of migrant minority ethnic women were often not taken into account. While one study [ 28 ] recruited a significant proportion (two thirds) from minority ethnic communities, no attempt was made to explain their results on the basis of ethnicity.

Most studies recruited at clinical sites with the help of health professionals, others by advertising in public spaces (e.g. university, women's magazine) and snowballing [ 21 , 31 , 32 ] and the majority of studies interviewed single women from their late teens to their twenties. Only two studies interviewed participants prior to TOP [ 20 , 30 ]; two were longitudinal [ 24 , 35 ]; and two investigated the longer term effects of abortion [ 31 , 32 ]. Apart from two ethnographies [ 22 , 24 ] all studies collected data through semi-structured or in-depth interviews.

The review identified two groups of qualitative studies on TOP.

Studies that focused on experiences of medical TOP, (n = 4, summarised in table 1 ) mainly in comparison with experiences of surgical TOP. Three of these studies were conducted in the US. These included a study embedded in the 1994–95 pre-legalisation clinical trials of mifepristone [ 15 ], and two studies of the home administration of mifepristone within the Abortion Rights Mobilisation Trials [ 16 , 17 ]. A further study on Latin American women's perspectives on medical TOP was not connected with assessing mifepristone [ 18 ].

Studies that explored general experiences of TOP (n = 14, summarised in table 2 ). These focused on the process of arranging TOP [ 19 , 28 ], and the experience of undergoing it [ 21 , 22 , 26 , 30 ]. Two studies highlighted the influence of cultural and contextual features [ 23 , 24 ], with one looking more specifically at a sample of women involved in a clinical trial [ 25 ]. Other studies investigated the role of the male partner in TOP [ 35 , 36 ]; experiences of repeated TOP [ 20 ]; and recollections of abortion experiences years after undergoing the procedure [ 31 , 32 ]. Two studies specifically explored teenage TOP [ 24 , 29 ] and two the relationship between TOP and contraceptive service provision [ 29 , 37 ].

Analysis of the results of studies included in this paper revealed three main themes: experiential factors that promote or inhibit the choice to seek TOP; experiences of TOP; and experiential aspects of the environment in which TOP takes place.

The watchword of campaigners for abortion services has been that it is the woman's right to freely choose between abortion and pregnancy [ 38 ]. Studies reviewed for this paper suggest that although moral values are important [ 15 , 21 , 26 , 27 ], the choice to seek TOP is a pragmatic one that reflects the impact of pregnancy and childbearing on personal and household circumstances [ 17 , 18 , 21 , 26 , 27 , 29 ]. A number of studies described the role male partners played in women's decision of whether to undergo the procedure [ 16 , 20 – 22 , 24 , 30 ]. Lone mothers are often economically disadvantaged, but in Sweden, where universal childcare provision makes lone parenthood economically viable, one study showed that participants (n = 5) preferred not to bring up children on their own [ 26 ]. Partnered or married women were also concerned about planning their families well [ 27 ], taking into consideration their partners' attitudes and the needs of their children [ 18 ] and their quality of life [ 17 ]. However, a U.S. study reported that women were more likely to confide in their female friends about their pregnancy than family members or partners [ 25 ]. Women's childhood experiences such as growing up in a broken home could also affect women's decisions [ 26 ]. Studies conducted with women under the age of 21 revealed that other factors such as immaturity, parental attitudes, and education and employment prospects were more important than moral considerations [ 24 , 29 , 30 ]

Whatever women's circumstances, studies in this review suggest that the decision to seek TOP usually precedes any encounter with heath care professionals [ 17 , 28 , 29 ]. However, such decisions are moderated by the value systems and social norms of the society or community in question [ 15 , 19 , 22 – 24 , 29 ]. Feelings of ambivalence in the decision-making process were highlighted in a Swedish study [ 26 ], where women felt positive towards the right to abortion, but negative about their own decision to abort. It is argued that TOP allows women to return to 'normality' psychologically, physiologically and socially, and women appreciated being treated in a non-stigmatised way [ 19 ]. However, a study conducted in the UK found that the majority of teenage mothers who were interviewed did not associate motherhood with lack or loss of opportunity [ 29 ].

The range of services available also affects the choices of women. However, papers identified for review provided little about how the choice of TOP provider is framed, or even what choices are available. One study of young women in the UK [ 29 ] found that they preferred family planning services rather than general practitioners for their first point of contact and referral, for reasons of greater anonymity and specialised treatment. Anonymity and confidentiality are key issues in all settings where TOP is stigmatised [ 21 – 24 ]. For this reason, Israeli women tended to avoid publicly subsidised formal procedures opting instead for private abortion providers [ 23 ].

In the UK, expectations of better personal treatment and confidentiality were also reasons why some women chose private or voluntary sector clinics over National Health Service (NHS) clinics, although cost is an issue [ 19 ]. Those who had used independent providers reported more positive experiences than those who had used the NHS [ 29 ]. Further evidence of this comes from another British study [ 28 ], where participants (n = 21) reported difficulties in getting an urgent appointment with their family doctor, problems with the NHS telephone booking system and being asked by doctors to further consider their decision, thus delaying the process.

Finally, the choice of method is dependent not only on service availability but on medico-legal considerations such as the gestational age. Once again, data on this topic are very limited. Pragmatic reasons such as effectiveness and the side effects were found to over-ride women's moral and political considerations in one US study [ 17 ]. Previous experiences of surgical abortion may have led women to seek medical rather than surgical TOP in two other US studies [ 16 , 17 ]. The experiences of other family members or friends who had undergone abortion can also be influential [ 17 , 30 ].

2. Experiences

Studies that concentrated on women's experiences of the TOP procedure prefaced their findings with an account of the specific medical regimens in place at the time of the study. The US studies focused on women's perceptions of medical abortion as a new procedure, and often compared this with surgical TOP. In this context, women identified medical abortion as a way to avoid surgery, and anaesthesia and that permitted them privacy, autonomy and a greater sense of control [ 15 , 17 – 19 ]. Simonds et al [ 15 ], in particular, explored the idea of abortion being 'natural' describing this as 'not-really-abortion, but rather as a late period that finally comes' (p1316). As such, medical TOP was associated with reduced feelings of guilt for some participants in her study. This 'naturalness' (a subjective association with a miscarriage or menstruation without the insertion of instruments) seems to outweigh the pain and prolonged nature of the procedure, including the sight of fetus. Other women focused on the pain as a necessary part of the process [ 16 ].

Complex emotional experiences appear to be integral to TOP. These include regret and guilt [ 17 , 22 ], distress and anxiety [ 17 , 22 , 27 ] and grief, loss, emptiness and suffering [ 21 ]. These experiences are related to gestational age, for example, in one study a medical termination before any symptoms of pregnancy were perceived was described as involving a 'loss' whereas a surgical termination was described as a 'death' [ 16 ]. Anxiety about sterility and death is also experienced by some women [ 16 , 18 , 26 ]. Women were also found to associate an abortion with taking responsibility [ 27 ] for the consequences of what they considered was an irresponsible act [ 19 ], especially in medical TOP where women were conscious during the procedure [ 15 ]. Another study [ 16 ] described the experience of a medical abortion as a chance to grieve, and the pain experienced was described by the authors as 'cathartic', one woman describing this as 'a personal investigation into your own pain' (p171).

Such perceptions are mediated by the moral context within which the women are located. In Indonesia, for example, women's perception of the fetus is influenced by the Islamic view that ensoulment takes place at 120 days of pregnancy [ 22 ]. In the US, Pro-Life argument against TOP is rich with images of a destructive, act, often explicitly called murder , leading some women to think that they 'killed a baby', but also realising 'it wasn't really a child' [ 17 ]. In a study by Fielding and Schaff [ 25 ], reservations about abortion in the second trimester onwards were unanimous except in relation to abnormalities. The language used to describe the fetus reflects the closeness or distance that women feel towards the life growing in their bodies and impacts on women's post-abortion emotional reactions [ 25 , 30 , 32 ]. In one trial, women were encouraged to look at the expelled fetus at home, but the authors say that 'dramatic' responses were rare [ 15 ]. Some women in this study described relief in not seeing a distinguishable human being when the fetus was expelled.

Feminist researchers provide insights into the interaction of TOP with notions of reproductive independence. A study [ 27 ] on the long term emotional effects of abortion found that more than half of the women who had reported both positive and painful feelings continued to report these feelings after 12 months. However, respondents reported they coped well, experiencing strengthened self-esteem, personal growth and maturity over the year. A study [ 30 ] of young Swedish women (n = 10) found that they encountered an understanding of themselves, their bodies, their fertility, and the meaning of adult motherhood. A study [ 24 ] of African-American adolescents (n = 12), aged between 15–18, highlighted their poor knowledge of reproductive processes and health and suggested that elective TOP was a 'positive, growth-enhancing experience' (p432), with participants being empowered by their experience of decision-making. However, Simonds et al [ 15 ] showed that in a clinical trial, medical abortion may have been perceived no less invasive as surgical abortion because of repeated insertions of pessaries, pelvic examinations, and ultrasound examinations, to ensure the success of the procedure.

Other studies highlight the isolation of women undergoing TOP and their concerns to conceal it from others [ 21 , 26 ]. In studies of the home use of misoprostol [ 17 , 18 ], there are accounts of women who undergo the abortion alone, or in secret with others such as family members around but unaware of the situation. In contrast, women in another clinical trial [ 16 ] described the active participation of partners or friends who helped to minimise their discomfort by rubbing their backs, bringing them tea, or monitoring their blood loss. Women with knowledge of how TOP works, and who have support from both their clinic and their partner seem more likely to experience a better outcome [ 18 ]. Women's cultural affiliations and beliefs also have a bearing on their emotional experiences [ 18 , 22 , 27 ]. For example, Israeli women tended to interpret abortion as a personal failure whereas Russian immigrants looked upon it as bad luck or a mistake [ 23 ]. In relation to the emotional impact of the abortion experience, a woman's preparedness and post-abortion support [ 32 ] as well as the emotional work required from nurses in family planning and abortion clinics [ 26 ] were important considerations.

3. Environment

The role of service providers is examined in most of the studies and British studies have focused especially on health services access and quality [ 19 , 28 , 29 ]. The process of seeking abortion in the UK is sometimes confusing because of inadequate information and extended because of delays in referrals. In three US studies [ 15 – 17 ] participants compared positive experiences of treatment by professionals providing medical TOP in clinical trials with professionals' negative attitudes and impersonal clinic settings in ordinary services. A Canadian study [ 21 ] identified a mismatch between women's normative expectations that health care providers should provide them with options and access to whatever medical services they might need, and what they perceived to be an unsympathetic reception from medical staff. The effect of such attitudes is assumed to discourage women from seeking abortion, but there is no systematic evidence to support this assumption. In an Israeli study, Russian immigrants objected to state interference into their choice to abort, but were impressed with the quality of publicly provided abortion services and sympathetic staff [ 23 ].

Women's experiences of patient care during an abortion are also affected by the method of termination. In US trials on medical TOP, women relied on health professionals to assure them about the safety of the new procedure and to determine if the termination had been successful [ 17 ]. Women needed more counselling from clinical staff about the procedure of medical termination [ 17 ]. This may reflect the need to assess if they were appropriate candidates for the procedure [ 15 ]. Women also had to be assured of ready access to medical information and help from clinical staff. In reports [ 15 ] of experiences with surgical TOP, treatment by medical staff figured more prominently than the actual physical experience of abortion.

In some contexts, the attitudes of health providers to abortion were relative to the marital status of the women [ 22 ]. In Indonesia for example, medical staff endorse abortions as a form of birth control for married women, but held disapproving attitudes towards pre-marital sex which impact on young women's feelings of guilt and shame. A study on teenage mothers in the UK [ 29 ] also reported doctors' disapproval. In the UK, clinical attitudes appear to be more negative towards the termination of pregnancies after the first trimester and some NHS clinics do not offer services for late abortions.

Studies that included primary care primary care professionals suggested that these were perceived as less sympathetic and supportive than professionals working in abortion services. The latter were perceived to be more caring and less judgemental [ 19 , 28 ]. This distinction was also found in one of the U.S. studies, although clinical trial staff were also perceived as more conscientious than women's usual health care providers.

Counselling is referred to in different ways in the studies but most particularly as counselling prior to the TOP to discuss the different methods, their benefits, what to expect, compliance and follow-up [ 17 ] and in relation to decision-making [ 28 ]. Other studies take a nursing perspective referring to the emotional work of nurses [ 26 ] and the importance of providing opportunities for women to express their suffering [ 27 ]. The importance of counselling is highlighted particularly where women had not told family or friends about their pregnancy [ 28 ]. However, unnecessary or superficial counselling has also been questioned [ 28 , 29 ]. In some parts of the non-Western world where women are more vulnerable, women's decision-making regarding abortion was influenced by the recommendations of the abortion provider and cost implications [ 18 , 22 , 23 ]. In most studies, information provision and knowledge were critical factors. An American study recommended that each patient be given a choice in the amount of information she receives, and information packs could be provided accordingly [ 17 ]. In relation to contraception however, knowledge needs to be integrated into practice for effective family planning [ 20 ]. The physical setting e.g. waiting rooms, and cold, unfamiliar wards was also referred to in some studies [ 19 , 26 ]. While some women appreciated the presence of other women in alleviating the loneliness of the experience, others were concerned about privacy and the risk of meeting someone they knew in the waiting room [ 21 ].

Some studies also investigated women's experiences of medical TOP at home rather than at a clinical facility [ 16 – 18 , 22 ]. In the US, Fielding [ 17 ] and Elul [ 16 ] identified familiar surroundings, privacy and not having to encounter strangers, as adding to women's appreciation of home TOP. However, there are situations in which home abortions are problematic, for example where the abortion needs to be kept hidden from the rest of the household because of shame [ 18 , 22 ]. This is particularly complicated where women are victims of domestic or sexual violence. Women also fear the risks of having an abortion at home where health professionals are not readily available to them.

Qualitative studies published on TOP within the time frame of this review have been limited in scope and detail. In this article, we have identified two main groups of studies; those that specifically address the issue of medical abortion, and those that explore the experiences of TOP more generally. Studies reviewed in this paper were influenced by a range of contextual factors such as political, ethical, social and legislative environments as well as health, economic and welfare systems. Research from the US, UK and Sweden dominated the literature, but these three countries have very different patterns of service provision. This review leads to four main conclusions.

Women's choices about whether, where, and how, TOP should be undertaken are mainly pragmatic ones that are related to negotiating finite household and psychosocial resources.

Rapid access to services characterised by supportive non-judgemental staff who delegate medical control over the process to women appear to characterise positive responses to medical TOP.

Home TOP using mifepristone appears attractive to women who are concerned about professionals' negative attitudes and lack of privacy in formal healthcare settings but also leads to concerns about management and safety.

Women who are well informed and supported in their choices experience good psychosocial outcomes from TOP.

These are broad conclusions derived from a very limited corpus of qualitative research. A recent review [ 39 ] of psychological studies of TOP identified discrepancies between societal and individual experiences, due to "theoretical and methodological deficiencies plaguing this area of study, with the available data often missing the complexity and depth of individuals' inner experiences" [37:238]. This is also true of many of the qualitative studies reviewed in this paper, suggesting that major opportunities to inform current policy and practice debates – utilizing the strengths of qualitative methods – have been missed.

Conflict of interests

The authors declare that they have no competing interests.

May C: A rational model for assessing and evaluating complex interventions in health care. BMC Health Service Research. 2006, 6: 86-10.1186/1472-6963-6-86.

Article   Google Scholar  

Berer M: Medical abortion: issues of choice and acceptability. Reproductive Health Matters. 2005, 13 (26): 25-34. 10.1016/S0968-8080(05)26199-2.

Article   PubMed   Google Scholar  

Wiebe E, Dunn S, Guilbert E, Jacot F, Lugtig L: Comparison of abortions induced by methotrexate or mifepristone followed by misoprostol. Obstet Gynecol. 2002, 99 (5 part 1): 813-819. 10.1016/S0029-7844(02)01944-0.

CAS   PubMed   Google Scholar  

Ashok PW, Hamoda H, Flett GMM, Kidd A, Fitzmaurice A, Templeton A: Patient preference in a randomised study comparing medical and surgical abortion at 10-13 weeks gestation. Contraception. 2005, 71: 143-148. 10.1016/j.contraception.2004.08.013.

Ashok PW, Kidd A, Flett GMM, Fitzmaurice A, Graham W, Templeton A: A randomized comparison of medical abortion and surgical vacuum aspiration at 10-13 weeks gestation. Human Reproduction. 2002, 17: 92-98. 10.1093/humrep/17.1.92.

Creinin MD: Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion. Contraception. 2000, 62: 117-124. 10.1016/S0010-7824(00)00151-7.

Article   CAS   PubMed   Google Scholar  

Harvey SM, Beckman LJ, Satre SJ: Choice of and Satisfaction with Methods of Medical and Surgical Abortion among U.S. Clinic Patients. Family Planning Perspectives. 2001, 33 (5): 212-216. 10.2307/2673784.

Henshaw R, Naji SA, Russell IT, Templeton A: Comparison of medical abortion with vacuum aspiration: women's preferences and acceptability of treatment. British Medical Journal. 1993, 307 ((6906)): 714-717.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Say L, Kulier R, Gulmezoglu M, Campana A: Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database Syst Rev. 2002, CD003037-[update in Cochrane Database Syst Rev. 2005;(1):CD003037], 4

Zou Y, Li Y, Lei Z, Lu L, Jiang S, Li Q: Side effect of mifepristone in combination with misoprostol for medical abortion. [Chinese]. Chung-Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics & Gynecology]. 2004, 39 (1): 39-42.

Google Scholar  

Jones RK, Henshaw SK: Mifepristone for Early Medical Abortion: Experiences in France, Great Britain and Sweden. Perspectives on Sexual and Reproductive Health. 2002, 34 (3): 154-161. 10.2307/3097714.

Dixon-Woods M, Fitzpatrick R, Roberts K: Including qualitative research in systematic reviews: opportunities and problems. Journal of Evaluation in Clinical Practice. 2001, 7 (2): 125-133. 10.1046/j.1365-2753.2001.00257.x.

Sandelowski M, Docherty S, Emden C: Qualitative metasynthesis: Issues and techniques. Research in Nursing & Health. 1997, 20 (4): 365-371. 10.1002/(SICI)1098-240X(199708)20:4<365::AID-NUR9>3.0.CO;2-E.

Article   CAS   Google Scholar  

Collins JA, Fauser BCJM: Balancing the strengths of systematic and narrative reviews. Hum Reprod Update. 2005, 11 (2): 103-104. 10.1093/humupd/dmh058.

Simonds W, Ellertson C, Springer K, Winikoff B: Abortion, revised: participants in the U.S. clinical trials evaluate mifepristone. Social Science and Medicine. 1998, 46 (10): 1313-1323. 10.1016/S0277-9536(97)10063-6.

Elul B, Pearlman E, Sorhaindo A, Simonds W, Westhoff C: In-depth Interviews with Medical Abortion Clients: Thoughts on the Method and Home Administration of Misoprostol. J Am Med Womens Assoc. 2000, 55 (3 Suppl): 169-172.

Fielding SL, Edmunds E, Schaff EA: Having an Abortion Using Mifepristone and Home Misoprostol: A Qualitative Analysis of Women's Experiences. Perspectives on Sexual and Reproductive Health. 2002, 34 (1): 34-40. 10.2307/3030230.

Lafaurie MM, Grossman D, Troncoso E, Billings DL, Cháveze S: Women's Perspectives on Medical Abortion in Mexico, Colombia, Ecuador and Peru: A Qualitative Study . Reproductive Health Matters. 2005, 13 (26): 75-83. 10.1016/S0968-8080(05)26199-2.

Harden A, Ogden J: Young women's experiences of arranging and having abortions. Sociology of Health and Illness. 1999, 21 (4): 426-444. 10.1111/1467-9566.00165.

Törnbom M, Möller A: Repeat abortion: a qualitative study. Journal of Psychosomatic Obstetrics and Gynecology. 1999, 20 (1): 21-30. 10.3109/01674829909075573.

McIntyre M, Anderson B, McDonald C: The Intersection of Relational and Cultural Narratives: Women's Abortion Experiences. Canadian Journal of Nursing Research. 2001, 33 (3): 47-62.

Bennett LR: Single women's experiences of premarital pregnancy and induced abortion in Lombok, Eastern Indonesia. Reproductive Health Matters. 2001, 9 (17): 37-43. 10.1016/S0968-8080(01)90006-0.

Reminnick L, Segal R: Socio-cultural context and women's experiences of abortion: Israeli women and Russian immigrants compared. Culture, Health and Sexuality. 2001, 3 (1): 49-66. 10.1080/136910501750035671.

Andrews J, Boyle J: African American Adolescents' Experiences with Unplanned Pregnancy and Elective Abortion. Health Care for Women International. 2003, 24 (5): 414-433.

PubMed   Google Scholar  

Fielding SL, Schaff EA: Social Context and the Experience of a Sample of U.S. Women Taking RU-486 (Mifepristone) for Early Abortion. Qual Health Res. 2004, 14 (5): 612-627. 10.1177/1049732304263677.

Aléx L, Hammarström A: Women's experiences in connection with induced abortion - a feminist perspective. Scandinavian Journal of Caring Services. 2004, 18 (2): 160-168. 10.1111/j.1471-6712.2004.00257.x.

Kero A, Högberg U, Lalos A: Wellbeing and mental growth—long-term effects of legal abortion. Soc Sci Med. 2004, 58 (12): 2559-2569. 10.1016/j.socscimed.2003.09.004.

Kumar U, Baraitser P, Morton S, Massil H: Decision making and referral prior to abortion: a qualitative study of women's experiences. Journal of Family Planning and Reproductive Health Care. 2004, 30 (1): 51-54. 10.1783/147118904322702009.

Lee E, Clements S, Ingham R, Stone N: A matter of choice? Explaining national variations in teenage abortion and motherhood. 2004, York , Joseph Rowntree Foundation

Halldén BM, Christensson K, Olsson P: Meanings of Being Pregnant and Having Decided on Abortion: Young Swedish Women's Experiences. Health Care for Women International. 2005, 26 (9): 788-806. 10.1080/07399330500230961.

Trybulski JA: Women and abortion: the past reaches into the present. Journal of Advanced Nursing. 2006, 54 (6): 683-10.1111/j.1365-2648.2006.03871.x.

Goodwin P, Ogden J: Women's reflections upon their past abortions: An exploration of how and why emotional reactions change over time. Psychology and Health. 2007, 22 (2): 231-248. 10.1080/14768320600682384.

Leys M: Healthcare policy: Qualitative evidence and health technology assessment. Health Policy. 2003, 65: 217-226. 10.1016/S0168-8510(02)00209-9.

Mays N, Pope C: Qualitative research in health care. 1996, London , British Medical Journal Publishing Group

Kero A, Lalos A: Reactions and reflections in men, 4 and 12 months post-abortion. Journal of Psychosomatic Obstetrics & Gynecology. 2004, 25 (2): 135-143. 10.1080/01674820400000463.

Kero A, Lalos A, Högberg U, Jacobsson L: The male partner involved in legal abortion. Human Reproduction. 1999, 14 (10): 2669-2675. 10.1093/humrep/14.10.2669.

Kumar U, Baraitser P, Morton S, Massil H: Peri-abortion contraception: a qualitative study of users' experiences. Journal of Family Planning and Reproductive Health Care. 2004, 30 (1): 55-56. 10.1783/147118904322702018.

Oakley A: Telling the truth about Jerusalem. 1986, London , Basil Blackwell Ltd

Coleman P, Reardon DC, Strathan T, Cougle JR: The psychology of abortion: A review and suggestions for future research. Psychology and Health. 2005, 20 (2): 237-271. 10.1080/0887044042000272921.

Pre-publication history

The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6963/8/150/prepub

Download references

Acknowledgements

MLSL's contribution to this paper was supported by funding from the NIHR HTA R&D Programme. (Grant 03/11/02: ISRCTN07823656 A randomised preference trial of medical versus surgical termination of pregnancy less then 14 weeks' gestation). CRM's contribution to this paper was partly supported by an ESRC personal research fellowship (RES 000270084). Funding agreements with these agencies ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report. This paper does not represent the views of the NIHR or ESRC.

Author information

Authors and affiliations.

Institute of Health and Society, Newcastle University, William Leech Building, Newcastle upon Tyne, NE2 4HH, UK

Mabel LS Lie

School of Surgical and Reproductive Sciences, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK

Stephen C Robson

Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Mabel LS Lie .

Additional information

Authors' contributions.

CRM conducted an initial literature scoping exercise. MLSL conducted the literature searches, collected and collated articles, and drafted this paper. SCR and CRM commented in detail on drafts and contributed to the final version of the manuscript.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article.

Lie, M.L., Robson, S.C. & May, C.R. Experiences of abortion: A narrative review of qualitative studies. BMC Health Serv Res 8 , 150 (2008). https://doi.org/10.1186/1472-6963-8-150

Download citation

Received : 11 February 2008

Accepted : 17 July 2008

Published : 17 July 2008

DOI : https://doi.org/10.1186/1472-6963-8-150

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• National Health Service
• Mifepristone
• Narrative Review
• Teenage Mother
• Medical Abortion

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Home — Blog — Topic Ideas — 50 Abortion Essay Topics: Researching Abortion-Related Subjects

50 Abortion Essay Topics: Researching Abortion-Related Subjects

Abortion remains a contentious social and political issue, with deeply held beliefs and strong emotions shaping the debate. It is a topic that has been at the forefront of public discourse for decades, sparking heated arguments and evoking a range of perspectives from individuals, organizations, and governments worldwide.

The complexity of abortion stems from its intersection with fundamental human rights, ethical principles, and societal norms. It raises questions about the sanctity of life, individual autonomy, gender equality, and public health, making it a challenging yet critically important subject to explore and analyze.

This guide provides a comprehensive overview of the significance of choosing the right abortion essay topics and abortion title ideas , offering valuable insights and practical advice for students navigating this challenging yet rewarding endeavor. By understanding the multifaceted nature of abortion and its far-reaching implications, students can make informed decisions about their topic selection, setting themselves up for success in producing well-researched, insightful, and impactful essays.

Choosing the Right Abortion Essay Topic

For students who are tasked with writing an essay on abortion, choosing the right topic is essential. A well-chosen topic can be the difference between a well-researched, insightful, and impactful piece of writing and a superficial, uninspired, and forgettable one.

This guide delves into the significance of selecting the right abortion essay topic, providing valuable insights for students embarking on this challenging yet rewarding endeavor. By understanding the multifaceted nature of abortion and its far-reaching implications, students can identify topics that align with their interests, research capabilities, and the overall objectives of their essays.

Abortion remains a contentious social and political issue, with deeply held beliefs and strong emotions shaping the debate on abortion topics . It is a topic that has been at the forefront of public discourse for decades, sparking heated arguments and evoking a range of perspectives from individuals, organizations, and governments worldwide.

List of Abortion Argumentative Essay Topics

Abortion argumentative essay topics typically revolve around the ethical, legal, and societal aspects of this controversial issue. These topics often involve debates and discussions, requiring students to present well-reasoned arguments supported by evidence and persuasive language.

• The Bodily Autonomy vs. Fetal Rights Debate: A Balancing Act
• Exploring Abortion Rights: An Argumentative Analysis
• Gender Equality and Reproductive Freedom in the Abortion Debate
• Considering Abortion as a Human Right
• The Impact of Abortion Stigma on Women's Mental Health
• Abortion: A Controversial Issue
• Persuasive Speech Outline on Abortion
• Laughing Matters: Satire and the Abortion Debate
• Abortion Is Bad
• Discussion on Whether Abortion is a Crime
• Abortion Restrictions and Women's Economic Opportunity
• Government Intervention in Abortion Regulation
• Religion, Morality, and Abortion Attitudes
• Parental Notification and Consent Laws
• A Persuasive Paper on the Issue of Abortion

Ethical Considerations: Abortion raises profound ethical questions about the sanctity of life, personhood, and individual choice. Students can explore these ethical dilemmas by examining the moral implications of abortion, the rights of the unborn, and the role of personal conscience in decision-making.

Legal Aspects: The legal landscape surrounding abortion is constantly evolving, with varying regulations and restrictions across different jurisdictions. Students can delve into the legal aspects of abortion by analyzing the impact of laws and policies on access, safety, and the well-being of women.

Societal Impact: Abortion has a significant impact on society, influencing public health, gender equality, and social justice. Students can explore the societal implications of abortion by examining its impact on maternal health, reproductive rights, and the lives of marginalized communities.

Effective Abortion Topics for Research Paper

Research papers on abortion demand a more in-depth and comprehensive approach, requiring students to delve into historical, medical, and international perspectives on this multifaceted issue.

Medical Perspectives: The medical aspects of abortion encompass a wide range of topics, from advancements in abortion procedures to the health and safety of women undergoing the procedure. Students can explore medical perspectives by examining the evolution of abortion techniques, the impact of medical interventions on maternal health, and the role of healthcare providers in the abortion debate.

Historical Analysis: Abortion has a long and complex history, with changing attitudes, practices, and laws across different eras. Students can engage in historical analysis by examining the evolution of abortion practices in ancient civilizations, tracing the legal developments surrounding abortion, and exploring the shifting social attitudes towards abortion throughout history.

International Comparisons: Abortion laws and regulations vary widely across different countries, leading to diverse experiences and outcomes. Students can make international comparisons by examining abortion access and restrictions in different regions, analyzing the impact of varying legal frameworks on women's health and rights, and identifying best practices in abortion policies.

List of Abortion Research Paper Topics

• The Socioeconomic Factors and Racial Disparities Shaping Abortion Access
• Ethical and Social Implications of Emerging Abortion Technologies
• Abortion Stigma and Women's Mental Health
• Telemedicine and Abortion Access in Rural Areas
• International Human Rights and Abortion Access
• Reproductive Justice and Other Social Justice Issues
• Men's Role in Abortion Decision-Making
• Abortion Restrictions and Social Disparities
• Racial and Ethnic Disparities in Abortion Access
• Alternative Approaches to Abortion Regulation
• Political Ideology and Abortion Policy Debates
• Public Health Campaigns for Informed Abortion Decisions
• Abortion Services in Conflict-Affected Areas
• Healthcare Providers and Medical Ethics of Abortion
• International Cooperation on Abortion Policies

By exploring these topics and subtopics for abortion essays , students can gain a more comprehensive understanding of the multifaceted nature of the abortion debate and choose a specific focus that aligns with their interests and research objectives.

Choosing Abortion Research Paper Topics

When selecting research paper topics on abortion, it is essential to consider factors such as research feasibility, availability of credible sources, and the potential for original contributions.

Abortion is a complex and multifaceted issue that intersects with various aspects of society and individual lives. By broadening the scope of abortion-related topics, students can explore a wider range of perspectives and insights.

• Abortion Social Issue
• Exploring the Complexity of Abortion: Historical, Medical and Personal Perspectives
• Abortion: A Comprehensive Research
• An Examination of Abortion and its Health Implications on Women
• Abortion Introduction
• Comparative Analysis of Abortion Laws Worldwide
• Historical Evolution of Abortion Rights and Practices
• Impact of Abortion on Public Health and Maternal Mortality
• Abortion Funding and Access to Reproductive Healthcare
• Role of Misinformation and Myths in Abortion Debates
• International Perspectives on Abortion and Reproductive Freedom
• Abortion and the UN Sustainable Development Goals
• Abortion and Gender Equality in the Global Context
• Abortion and Human Rights: A Legal and Ethical Analysis
• Religious and Cultural Influences on Abortion Perceptions
• Abortion and Social Justice: Addressing Disparities and Marginalization
• Anti-abortion and Pro-choice Movements: Comparative Analysis and Impact
• Impact of Technological Advancements on Abortion Procedures and Access
• Ethical Considerations of New Abortion Technologies and Surrogacy
• Role of Advocacy and Activism in Shaping Abortion Policy and Practice
• Measuring the Effectiveness of Abortion Policy Interventions

Navigating the complex landscape of abortion-related topics can be a daunting task, but it also offers an opportunity for students to delve into a range of compelling issues and perspectives. By choosing the right topic, students can produce well-researched, insightful, and impactful essays that contribute to the ongoing dialogue on this important subject.

The 50 abortion essay ideas presented in this guide provide a starting point for exploring the intricacies of abortion and its far-reaching implications. Whether students are interested in argumentative essays that engage in ethical, legal, or societal debates or research papers that delve into medical, historical, or international perspectives, this collection offers a wealth of potential topics to ignite their curiosity and challenge their thinking.

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

The Safety and Quality of Abortion Care in the United States (2018)

Chapter: 1 introduction, 1 introduction.

When the Institute of Medicine (IOM) 1 issued its 1975 report on the public health impact of legalized abortion, the scientific evidence on the safety and health effects of legal abortion services was limited ( IOM, 1975 ). It had been only 2 years since the landmark Roe v. Wade decision had legalized abortion throughout the United States and nationwide data collection was just under way ( Cates et al., 2000 ; Kahn et al., 1971 ). Today, the available scientific evidence on abortion’s health effects is quite robust.

In 2016, six private foundations came together to ask the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine to conduct a comprehensive review of the state of the science on the safety and quality of legal abortion services in the United States. The sponsors—The David and Lucile Packard Foundation, The Grove Foundation, The JPB Foundation, The Susan Thompson Buffett Foundation, Tara Health Foundation, and William and Flora Hewlett Foundation—asked that the review focus on the eight research questions listed in Box 1-1 .

The Committee on Reproductive Health Services: Assessing the Safety and Quality of Abortion Care in the U.S. was appointed in December 2016 to conduct the study and prepare this report. The committee included 13 individuals 2 with research or clinical experience in anesthesiology,

___________________

1 In March 2016, the IOM, the division of the National Academies of Sciences, Engineering, and Medicine focused on health and medicine, was renamed the Health and Medicine Division.

2 A 14th committee member participated for just the first 4 months of the study.

obstetrics and gynecology, nursing and midwifery, primary care, epidemiology of reproductive health, mental health, health care disparities, health care delivery and management, health law, health professional education and training, public health, quality assurance and assessment,

statistics and research methods, and women’s health policy. Brief biographies of committee members are provided in Appendix A .

This chapter describes the context for the study and the scope of the inquiry. It also presents the committee’s conceptual framework for conducting its review.

ABORTION CARE TODAY

Since the IOM first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized controlled trials (RCTs), systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances ( Ashok et al., 2004 ; Autry et al., 2002 ; Bartlett et al., 2004 ; Borgatta, 2011 ; Borkowski et al., 2015 ; Bryant et al., 2011 ; Cates et al., 1982 ; Chen and Creinin, 2015 ; Cleland et al., 2013 ; Frick et al., 2010 ; Gary and Harrison, 2006 ; Grimes et al., 2004 ; Grossman et al., 2008 , 2011 ; Ireland et al., 2015 ; Kelly et al., 2010 ; Kulier et al., 2011 ; Lohr et al., 2008 ; Low et al., 2012 ; Mauelshagen et al., 2009 ; Ngoc et al., 2011 ; Ohannessian et al., 2016 ; Peterson et al., 1983 ; Raymond et al., 2013 ; Roblin, 2014 ; Sonalkar et al., 2017 ; Upadhyay et al., 2015 ; White et al., 2015 ; Wildschut et al., 2011 ; Woodcock, 2016 ; Zane et al., 2015 ). With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed ( Chen and Creinin, 2015 ; Jatlaoui et al., 2016 ; Lichtenberg and Paul, 2013 ). For example, the use of dilation and sharp curettage is now considered obsolete in most cases because safer alternatives, such as aspiration methods, have been developed ( Edelman et al, 1974 ; Lean et al, 1976 ; RCOG, 2015 ). The use of abortion medications in the United States began in 2000 with the approval by the U.S. Food and Drug Administration (FDA) of the drug mifepristone. In 2016, the FDA, citing extensive clinical research, updated the indications for mifepristone for medication abortion 3 up to 10 weeks’ (70 days’) gestation ( FDA, 2016 ; Woodcock, 2016 ).

Box 1-2 describes the abortion methods currently recommended by U.S. and international medical, nursing, and other health organizations that set professional standards for reproductive health care, including the American College of Obstetricians and Gynecologists (ACOG), the Society of Family Planning, the American College of Nurse-Midwifes, the National Abortion Federation (NAF), the Royal College of Obstetricians and Gynaecologists (RCOG) (in the United Kingdom), and the World

3 The terms “medication abortion” and “medical abortion” are used interchangeably in the literature.

Health Organization ( ACNM, 2011 , 2016 ; ACOG, 2013 , 2014 ; Costescu et al., 2016 ; Lichtenberg and Paul, 2013 ; NAF, 2017 ; RCOG, 2011 ; WHO, 2014 ).

A Continuum of Care

The committee views abortion care as a continuum of services, as illustrated in Figure 1-1 . For purposes of this study, it begins when a woman, who has decided to terminate a pregnancy, contacts or visits a provider seeking an abortion. The first, preabortion phase of care includes an initial clinical assessment of the woman’s overall health (e.g., physical examination, pregnancy determination, weeks of gestation, and laboratory and other testing as needed); communication of information on the risks and benefits of alternative abortion procedures and pain management options; discussion of the patient’s preferences based on desired anesthesia and weeks of gestation; discussion of postabortion contraceptive options if desired; counseling

and referral to services (if needed); and final decision making and informed consent. The next phases in the continuum are the abortion procedure itself and postabortion care, including appropriate follow-up care and provision of contraceptives (for women who opt for them).

A Note on Terminology

Important clinical terms that describe pregnancy and abortion lack consistent definition. The committee tried to be as precise as possible to avoid misinterpreting or miscommunicating the research evidence, clinical practice guidelines, and other relevant sources of information with potentially significant clinical implications. Note that this report follows Grimes and Stuart’s (2010) recommendation that weeks’ gestation be quantified using cardinal numbers (1, 2, 3...) rather than ordinal numbers (1st, 2nd, 3rd...). It is important to note, however, that these two numbering conventions are sometimes used interchangeably in the research literature despite having different meanings. For example, a woman who is 6 weeks pregnant has completed 6 weeks of pregnancy: she is in her 7th (not 6th) week of pregnancy.

This report also avoids using the term “trimester” where possible because completed weeks’ or days’ gestation is a more precise designation, and the clinical appropriateness of abortion methods does not align with specific trimesters.

Although the literature typically classifies the method of abortion as either “medical” or “surgical” abortion, the committee decided to specify methods more precisely by using the terminology defined in Box 1-2 . The term “surgical abortion” is often used by others as a catchall category that includes a variety of procedures, ranging from an aspiration to a dilation and evacuation (D&E) procedure involving sharp surgical and other instrumentation as well as deeper levels of sedation. This report avoids describing abortion procedures as “surgical” so as to characterize a method more accurately as either an aspiration or D&E. As noted in Box 1-2 , the term “induction abortion” is used to distinguish later abortions that use a

medication regimen from medication abortions performed before 10 weeks’ gestation.

See Appendix B for a glossary of the technical terms used in this report.

Regulation of Abortion Services

Abortion is among the most regulated medical procedures in the nation ( Jones et al., 2010 ; Nash et al., 2017 ). While a comprehensive legal analysis of abortion regulation is beyond the scope of this report, the committee agreed that it should consider how abortion’s unique regulatory environment relates to the safety and quality of abortion care.

In addition to the federal, state, and local rules and policies governing all medical services, numerous abortion-specific federal 4 and state laws and regulations affect the delivery of abortion services. Table 1-1 lists the abortion-specific regulations by state. The regulations range from prescribing information to be provided to women when they are counseled and setting mandatory waiting periods between counseling and the abortion procedure to those that define the clinical qualifications of abortion providers, the types of procedures they are permitted to perform, and detailed facility standards for abortion services. In addition, many states place limitations on the circumstances under which private health insurance and Medicaid can be used to pay for abortions, limiting coverage to pregnancies resulting from rape or incest or posing a medical threat to the pregnant woman’s life. Other policies prevent facilities that receive state funds from providing abortion services 5 or place restrictions on the availability of services based on the gestation of the fetus that are narrower than those established under federal law ( Guttmacher Institute, 2017h ).

Trends and Demographics

National- and state-level abortion statistics come from two primary sources: the Centers for Disease Control and Prevention’s (CDC’s) Abortion

4 Hyde Amendment (P.L. 94-439, 1976); Department of Defense Appropriations Act (P.L. 95-457, 1978); Peace Corps Provision and Foreign Assistance and Related Programs Appropriations Act (P.L. 95-481, 1978); Pregnancy Discrimination Act (P.L. 95-555, 1977); Department of the Treasury and Postal Service Appropriations Act (P.L. 98-151, 1983); FY1987 Continuing Resolution (P.L. 99-591, 1986); Dornan Amendment (P.L. 100-462, 1988); Partial-Birth Abortion Ban (P.L. 108-105, 2003); Weldon Amendment (P.L. 108-199, 2004); Patient Protection and Affordable Care Act (P.L. 111-148 as amended by P.L. 111-152, 2010).

5 Personal communication, O. Cappello, Guttmacher Institute, August 4, 2017: AZ § 15-1630, GA § 20-2-773; KS § 65-6733 and § 76-3308; KY § 311.800; LA RS § 40:1299 and RS § 4 0.1061; MO § 188.210 and § 188.215; MS § 41-41-91; ND § 14-02.3-04; OH § 5101.57; OK 63 § 1-741.1; PA 18 § 3215; TX § 285.202.

TABLE 1-1 Overview of State Abortion-Specific Regulations That May Impact Safety and Quality, as of September 1, 2017

a Excludes laws or regulations permanently or temporarily enjoined pending a court decision.

b States have abortion-specific requirements generally following the established principles of informed consent.

c The content of informed consent materials is specified in state law or developed by the state department of health.

d In-person counseling is not required for women who live more than 100 miles from an abortion provider.

e Counseling requirement is waived if the pregnancy is the result of rape or incest or the patient is younger than 15.

f Maximum distance requirement does not apply to medication abortions.

g Some states also exempt women whose physical health is at severe risk and/or in cases of fetal impairment.

h Some states have exceptions for pregnancies resulting from rape or incest, pregnancies that severely threaten women’s physical health or endanger their life, and/or in cases of fetal impairment.

SOURCES: Guttmacher Institute, 2017b , c , d , e , f , g , h , i , 2018b .

Surveillance System and the Guttmacher Institute’s Abortion Provider Census ( Jatlaoui et al., 2016 ; Jerman et al., 2016 ; Jones and Kavanaugh, 2011 ; Pazol et al., 2015 ). Both of these sources provide estimates of the number and rate of abortions, the use of different abortion methods, the characteristics of women who have abortions, and other related statistics. However, both sources have limitations.

The CDC system is a voluntary, state-reported system; 6 , 7 three states (California, Maryland, and New Hampshire) do not provide information ( CDC, 2017 ). The Guttmacher census, also voluntary, solicits information from all known abortion providers throughout the United States, including in the states that do not submit information to the CDC surveillance system. For 2014, the latest year reported by Guttmacher, 8 information was obtained directly from 58 percent of abortion providers, and data for nonrespondents were imputed ( Jones and Jerman, 2017a ). The CDC’s latest report, for abortions in 2013, includes approximately 70 percent of the abortions reported by the Guttmacher Institute for that year ( Jatlaoui et al., 2016 ).

Both data collection systems report descriptive statistics on women who have abortions and the types of abortion provided, although they define demographic variables and procedure types differently. Nevertheless, in the aggregate, the trends in abortion utilization reported by the CDC and Guttmacher closely mirror each other—indicating decreasing rates of abortion, an increasing proportion of medication abortions, and the vast majority of abortions (90 percent) occurring by 13 weeks’ gestation (see Figures 1-2 and 1-3 ) ( Jatlaoui et al., 2016 ; Jones and Jerman, 2017a ). 9 Both data sources are used in this chapter’s brief review of trends in abortions and throughout the report.

Trends in the Number and Rate of Abortions

The number and rate of abortions have changed considerably during the decades following national legalization in 1973. In the immediate years after

6 In most states, hospitals, facilities, and physicians are required by law to report abortion data to a central health agency. These agencies submit the aggregate utilization data to the CDC ( Guttmacher Institute, 2018a ).

7 New York City and the District of Columbia also report data to the CDC.

8 Guttmacher researchers estimate that the census undercounts the number of abortions performed in the United States by about 5 percent (i.e., 51,725 abortions provided by 2,069 obstetrician/gynecologist [OB/GYN] physicians). The estimate is based on a survey of a random sample of OB/GYN physicians. The survey did not include other physician specialties and other types of clinicians.

9 A full-term pregnancy is 40 weeks.

national legalization, both the number and rate 10 of legal abortions steadily increased ( Bracken et al., 1982 ; Guttmacher Institute, 2017a ; Pazol et al., 2015 ; Strauss et al., 2007 ) (see Figure 1-2 ). The abortion rate peaked in the

10 Reported abortion rates are for females aged 15 to 44.

1980s, and the trend then reversed, a decline that has continued for more than three decades ( Guttmacher Institute, 2017a ; Jones and Kavanaugh, 2011 ; Pazol et al., 2015 ; Strauss et al., 2007 ). Between 1980 and 2014, the abortion rate among U.S. women fell by more than half, from 29.3 to 14.6 per 1,000 women ( Finer and Henshaw, 2003 ; Guttmacher Institute, 2017a ; Jones and Jerman, 2017a ) (see Figure 1-2 ). In 2014, the most recent year for which data are available, the aggregate number of abortions reached a low of 926,190 after peaking at nearly 1.6 million in 1990 ( Finer and Henshaw, 2003 ; Jones and Jerman, 2017a ). The reason for the decline is not fully understood but has been attributed to several factors, including the increasing use of contraceptives, especially long-acting methods (e.g., intrauterine devices and implants); historic declines in the rate of unintended pregnancy; and increasing numbers of state regulations resulting in limited access to abortion services ( Finer and Zolna, 2016 ; Jerman et al., 2017 ; Jones and Jerman, 2017a ; Kost, 2015 ; Strauss et al., 2007 ).

Weeks’ Gestation

Length of gestation—measured as the amount of time since the first day of the last menstrual period—is the primary factor in deciding what abortion procedure is most appropriate ( ACOG, 2014 ). Since national legalization, most abortions in the United States have been performed in early pregnancy (≤13 weeks) ( Cates et al., 2000 ; CDC, 1983 ; Elam-Evans et al., 2003 ; Jatlaoui et al., 2016 ; Jones and Jerman, 2017a ; Koonin and Smith, 1993 ; Lawson et al., 1989 ; Pazol et al., 2015 ; Strauss et al., 2007 ). CDC surveillance reports indicate that since at least 1992 (when detailed data on early abortions were first collected), the vast majority of abortions in the United States were early-gestation procedures ( Jatlaoui et al., 2016 ; Strauss et al., 2007 ); this was the case for approximately 92 percent of all abortions in 2013 ( Jatlaoui et al., 2016 ). With such technological advances as highly sensitive pregnancy tests and medication abortion, procedures are being performed at increasingly earlier gestational stages. According to the CDC, the percentage of early abortions performed ≤6 weeks’ gestation increased by 16 percent from 2004 to 2013 ( Jatlaoui et al., 2016 ); in 2013, 38 percent of early abortions occurred ≤6 weeks ( Jatlaoui et al., 2016 ). The proportion of early-gestation abortions occurring ≤6 weeks is expected to increase even further as the use of medication abortions becomes more widespread ( Jones and Boonstra, 2016 ; Pazol et al., 2012 ).

Figure 1-3 shows the proportion of abortions in nonhospital settings by weeks’ gestation in 2014 ( Jones and Jerman, 2017a ).

Abortion Methods

Aspiration is the abortion method most commonly used in the United States, accounting for almost 68 percent of all abortions performed in 2013 ( Jatlaoui et al., 2016 ). 11 Its use, however, is likely to decline as the use of medication abortion increases. The percentage of abortions performed by the medication method rose an estimated 110 percent between 2004 and 2013, from 10.6 to 22.3 percent ( Jatlaoui et al., 2016 ). In 2014, approximately 45 percent of abortions performed up to 9 weeks’ gestation were medication abortions, up from 36 percent in 2011 ( Jones and Jerman, 2017a ).

Fewer than 9 percent of abortions are performed after 13 weeks’ gestation; most of these are D&E procedures ( Jatlaoui et al., 2016 ). Induction abortion is the most infrequently used of all abortion methods, accounting for approximately 2 percent of all abortions at 14 weeks’ gestation or later in 2013 ( Jatlaoui et al., 2016 ).

Characteristics of Women Who Have Abortions

The most detailed sociodemographic statistics on women who have had an abortion in the United States are provided by the Guttmacher Institute’s Abortion Patient Survey. Respondents to the 2014/2015 survey included more than 8,000 women who had had an abortion in 1 of 87 outpatient (nonhospital) facilities across the United States in 2014 ( Jerman et al., 2016 ; Jones and Jerman, 2017b ). 12 Table 1-2 provides selected findings from this survey. Although women who had an abortion in a hospital setting are excluded from these statistics, the data represent an estimated 95 percent of all abortions provided (see Figure 1-3 ).

The Guttmacher survey found that most women who had had an abortion were under age 30 (72 percent) and were unmarried (86 percent) ( Jones and Jerman, 2017b ). Women seeking an abortion were far more likely to be poor or low-income: the household income of 49 percent was below the federal poverty level (FPL), and that of 26 percent was 100 to 199 percent of the FPL ( Jerman et al., 2016 ). In comparison, the

11 CDC surveillance reports use the catchall category of “curettage” to refer to nonmedical abortion methods. The committee assumed that the CDC’s curettage estimates before 13 weeks’ gestation refer to aspiration procedures and that its curettage estimates after 13 weeks’ gestation referred to D&E procedures.

12 Participating facilities were randomly selected and excluded hospitals. All other types of facilities were included if they had provided at least 30 abortions in 2011 ( Jerman et al., 2016 ). Jerman and colleagues report that logistical challenges precluded including hospital patients in the survey. The researchers believe that the exclusion of hospitals did not bias the survey sample, noting that hospitals accounted for only 4 percent of all abortions in 2011.

TABLE 1-2 Characteristics of Women Who Had an Abortion in an Outpatient Setting in 2014, by Percent

NOTE: Percentages may not sum to 100 because of rounding.

SOURCES: (a) Jones and Jerman, 2017b (n = 8,098); (b) Jerman et al., 2016 (n = 8,380).

corresponding percentages among all women aged 15 to 49 are 16 and 18 percent. 13 Women who had had an abortion were also more likely to be women of color 14 (61.0 percent); overall, half of women who had had an abortion were either black (24.8 percent) or Hispanic (24.5 percent) ( Jones and Jerman, 2017b ). This distribution is similar to the racial and ethnic distribution of women with household income below 200 percent of the FPL, 49 percent of whom are either black (20 percent) or Hispanic (29 percent). 15 Poor women and women of color are also more likely than others to experience an unintended pregnancy ( Finer and Henshaw, 2006 ; Finer et al., 2006 ; Jones and Kavanaugh, 2011 ).

Many women who have an abortion have previously experienced pregnancy or childbirth. Among respondents to the Guttmacher survey, 59.3 percent had given birth at least once, and 44.8 percent had had a prior abortion ( Jerman et al., 2016 ; Jones and Jerman, 2017b ).

While precise estimates of health insurance coverage of abortion are not available, numerous regulations limit coverage. As noted in Table 1-1 , 33 states prohibit public payers from paying for abortions and other states have laws that either prohibit health insurance exchange plans (25 states) or private insurance plans (11 states) sold in the state from covering or paying for abortions, with few exceptions. 16 In the Guttmacher survey, only 14 percent of respondents had paid for the procedure using private insurance coverage, and despite the disproportionately high rate of poverty and low income among those who had had an abortion, only 22 percent reported that Medicaid was the method of payment for their abortion. In 2015, 39 percent of the 25 million women lived in households that earned less than 200 percent of the FPL in the United States were enrolled in Medicaid, and 36 percent had private insurance ( Ranji et al., 2017 ).

Number of Clinics Providing Abortion Care

As noted earlier, the vast majority of abortions are performed in nonhospital settings—either an abortion clinic (59 percent) or a clinic offering a variety of medical services (36 percent) ( Jones and Jerman, 2017a ) (see Figure 1-4 ). Although hospitals account for almost 40 percent of facilities offering abortion care, they provide less than 5 percent of abortions overall.

13 Calculation by the committee based on estimates from Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) .

14 Includes all nonwhite race and ethnicity categories in Table 1-2 . Data were collected via self-administered questionnaire ( Jones and Jerman, 2017b ).

15 Calculation by the committee based on estimates from Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) .

16 Some states have exceptions for pregnancies resulting from rape or incest, pregnancies that endanger the woman’s life or severely threaten her health, and in cases of fetal impairment.

The overall number of nonhospital facilities providing abortions—especially specialty abortion clinics—is declining. The greatest proportional decline is in states that have enacted abortion-specific regulations ( Jones and Jerman, 2017a ). In 2014, there were 272 abortion clinics in the United States, 17 percent fewer than in 2011. The greatest decline (26 percent) was among large clinics with annual caseloads of 1,000–4,999 patients and clinics in the Midwest (22 percent) and the South (13 percent). In 2014, approximately 39 percent of U.S. women aged 15 to 44 resided in a U.S. county without an abortion provider (90 percent of counties overall) ( Jones and Jerman, 2017a ). Twenty-five states have five or fewer abortion clinics; five states have one abortion clinic ( Jones and Jerman, 2017a ). A recent analysis 17 by Guttmacher evaluated geographic disparities in access to abortion by calculating the distance between women of reproductive age (15 to 44) and the nearest abortion-providing facility in 2014 ( Bearak et al., 2017 ). Figure 1-5 highlights the median distance to the nearest facility by county.

17 The analysis was limited to facilities that provided at least 400 abortions per year and those affiliated with Planned Parenthood that performed at least 1 abortion during the period of analysis.

The majority of facilities offer early medication and aspiration abortions. In 2014, 87 percent of nonhospital facilities provided early medication abortions; 23 percent of all nonhospital facilities offered this type of abortion ( Jones and Jerman, 2017a ). Fewer facilities offer later-gestation procedures, and availability decreases as gestation increases. In 2012, 95 percent of all abortion facilities offered abortions at 8 weeks’ gestation, 72 percent at 12 weeks’ gestation, 34 percent at 20 weeks’ gestation, and 16 percent at 24 weeks’ gestation ( Jerman and Jones, 2014 ).

STUDY APPROACH

Conceptual framework.

The committee’s approach to this study built on two foundational developments in the understanding and evaluation of the quality of health

care services: Donabedian’s (1980) structure-process-outcome framework and the IOM’s (2001) six dimensions of quality health care. Figure 1-6 illustrates the committee’s adaptation of these concepts for this study’s assessment of abortion care in the United States.

Structure-Process-Outcome Framework

In seminal work published almost 40 years ago, Donabedian (1980) proposed that the quality of health care be assessed by examining its structure, process, and outcomes ( Donabedian, 1980 ):

• Structure refers to organizational factors that may create the potential for good quality. In abortion care, such structural factors as the availability of trained staff and the characteristics of the clinical setting may ensure—or inhibit—the capacity for quality.
• Process refers to what is done to and for the patient. Its assessment assumes that the services patients receive should be evidence based and correlated with patients’ desired outcomes—for example, an early and complete abortion for women who wish to terminate an unintended pregnancy.
• Outcomes are the end results of care—the effects of the intervention on the health and well-being of the patient. Does the procedure achieve its objective? Does it lead to serious health risks in the short or long term?

Six Dimensions of Health Care Quality

The landmark IOM report Crossing the Quality Chasm: A New Health System for the 21st Century ( IOM, 2001 ) identifies six dimensions of health care quality—safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The articulation of these six dimensions has guided public and private efforts to improve U.S. health care delivery at the local, state, and national levels since that report was published ( AHRQ, 2016 ).

In addition, as with other health care services, women should expect that the abortion care they receive meets well-established standards for objectivity, transparency, and scientific rigor ( IOM, 2011a , b ).

Two of the IOM’s six dimensions—safety and effectiveness—are particularly salient to the present study. Assessing both involves making relative judgments. There are no universally agreed-upon thresholds for defining care as “safe” versus “unsafe” or “effective” versus “not effective,” and decisions about safety and effectiveness have a great deal to do with the context of the clinical scenario. Thus, the committee’s frame of reference for evaluating safety, effectiveness, and other quality domains is of necessity a

relative one—one that entails not only comparing the alternative abortion methods but also comparing these methods with other health care services and with risks associated with not achieving the desired outcome.

Safety—avoiding injury to patients—is often assessed by measuring the incidence and severity of complications and other adverse events associated with receiving a specific procedure. If infrequent, a complication may be characterized as “rare”—a term that lacks consistent definition. In this report, “rare” is used to describe outcomes that affect fewer than 1 percent of patients. Complications are considered “serious” if they result in a blood transfusion, surgery, or hospitalization.

Note also that the term “effectiveness” is used differently in this report depending on the context. As noted in Box 1-3 , effectiveness as an attribute of quality refers to providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively). Elsewhere in this report, effectiveness denotes the clinical effectiveness of a procedure, that

is, the successful completion of an abortion without the need for a follow-up aspiration.

Finding and Assessing the Evidence

The committee deliberated during four in-person meetings and numerous teleconferences between January 2017 and December 2017. On March 24, 2017, the committee hosted a public workshop at the Keck Center of the National Academies of Sciences, Engineering, and Medicine in Washington, DC. The workshop included presentations from three speakers on topics related to facility standards and the safety of outpatient procedures. Appendix C contains the workshop agenda.

Several committee workgroups were formed to find and assess the quality of the available evidence and to draft summary materials for the full committee’s review. The workgroups conducted in-depth reviews of the epidemiology of abortions, including rates of complications and mortality, the safety and effectiveness of alternative abortion methods, professional standards and methods for performing all aspects of abortion care (as described in Figure 1-1 ), the short- and long-term physical and mental health effects of having an abortion; and the safety and quality implications of abortion-specific regulations on abortion.

The committee focused on finding reliable, scientific information reflecting contemporary U.S. abortion practices. An extensive body of research on abortion has been conducted outside the United States. A substantial proportion of this literature concerns the delivery of abortion care in countries where socioeconomic conditions, culture, population health, health care resources, and/or the health care system are markedly different from their U.S. counterparts. Studies from other countries were excluded from this review if the committee judged those factors to be relevant to the health outcomes being assessed.

The committee considered evidence from randomized controlled trials comparing two or more approaches to abortion care; systematic reviews; meta-analyses; retrospective cohort studies, case control studies, and other types of observational studies; and patient and provider surveys (see Box 1-4 ).

An extensive literature documents the biases common in published research on the effectiveness of health care services ( Altman et al., 2001 ; Glasziou et al., 2008 ; Hopewell et al., 2008 ; Ioannidis et al., 2004 ; IOM, 2011a , b ; Plint et al., 2006 ; Sackett, 1979 ; von Elm et al., 2007 ). Thus, the committee prioritized the available research according to conventional principles of evidence-based medicine intended to reduce the risk of bias in a study’s conclusions, such as how subjects were allocated to different types of abortion care, the comparability of study populations, controls

for confounding factors, how outcome assessments were conducted, the completeness of outcome reporting, the representativeness of the study population compared with the general U.S. population, and the degree to which statistical analyses helped reduce bias ( IOM, 2011b ). Applying these principles is particularly important with respect to understanding abortion’s

long-term health effects, an area in which the relevant literature is vulnerable to bias (as discussed in Chapter 4 ).

The committee’s literature search strategy is described in Appendix D .

ORGANIZATION OF THE REPORT

Chapter 2 of this report describes the continuum of abortion care including current abortion methods (question 1 in the committee’s statement of task [ Box 1-1 ]); reviews the evidence on factors affecting their safety and quality, including expected side effects and possible complications (questions 2 and 3), necessary safeguards to manage medical emergencies (question 6), and provision of pain management (question 7); and presents the evidence on the types of facilities or facility factors necessary to provide safe and effective abortion care (question 4).

Chapter 3 summarizes the clinical skills that are integral to safe and high-quality abortion care according to the recommendations of leading national professional organizations and abortion training curricula (question 5).

Chapter 4 reviews research examining the long-term health effects of undergoing an abortion (question 2).

Finally, Chapter 5 presents the committee’s conclusions regarding the findings presented in the previous chapters, responding to each of the questions posed in the statement of task. Findings are statements of scientific evidence. The report’s conclusions are the committee’s inferences, interpretations, or generalizations drawn from the evidence.

ACNM (American College of Nurse-Midwives). 2011. Position statement: Reproductive health choices . http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000087/Reproductive_Choices.pdf (accessed August 1, 2017).

ACNM. 2016. Position statement: Access to comprehensive sexual and reproductive health care services . http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000087/Access-to-Comprehensive-Sexual-and-Reproductive-Health-Care-Services-FINAL-04-12-17.pdf (accessed August 1, 2017).

ACOG (American College of Obstetricians and Gynecologists). 2013. Practice Bulletin No. 135: Second-trimester abortion. Obstetrics & Gynecology 121(6):1394–1406.

ACOG. 2014. Practice Bulletin No. 143: Medical management of first-trimester abortion (reaffirmed). Obstetrics & Gynecology 123(3):676–692.

AHRQ (Agency for Healthcare Research and Quality). 2016. The six domains of health care quality. https://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/create/sixdomains.html (accessed May 3, 2017).

Altman, D. G., K. F. Schulz, D. Moher, M. Egger, F. Davidoff, D. Elbourne, P. C. Gøtzsche, and T. Lang. 2001. The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Annals of Internal Medicine 134(8):663–694.

Ashok, P. W., A. Templeton, P. T. Wagaarachchi, and G. M. Flett. 2004. Midtrimester medical termination of pregnancy: A review of 1002 consecutive cases. Contraception 69(1):51–58.

Autry, A. M., E. C. Hayes, G. F. Jacobson, and R. S. Kirby. 2002. A comparison of medical induction and dilation and evacuation for second-trimester abortion. American Journal of Obstetrics and Gynecology 187(2):393–397.

Bartlett, L. A., C. J. Berg, H. B. Shulman, S. B. Zane, C. A. Green, S. Whitehead, and H. K. Atrash. 2004. Risk factors for legal induced abortion-related mortality in the United States. Obstetrics & Gynecology 103(4):729–737.

Bearak, J. M., K. L. Burke, and R. K. Jones. 2017. Disparities and change over time in distance women would need to travel to have an abortion in the USA: A spatial analysis. The Lancet Public Health 2(11):e493–e500.

Borgatta, L. 2011. Labor induction termination of pregnancy. Global library for women’s medicine . https://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443 (accessed September 13, 2017).

Borkowski, L., J. Strasser, A. Allina, and S. Wood. 2015. Medication abortion. Overview of research & policy in the United States . http://publichealth.gwu.edu/sites/default/files/Medication_Abortion_white_paper.pdf (accessed January 25, 2017).

Bracken, M. B., D. H. Freeman, Jr., and K. Hellenbrand. 1982. Hospitalization for medical-legal and other abortions in the United States 1970–1977. American Journal of Public Health 72(1):30–37.

Bryant, A. G., D. A. Grimes, J. M. Garrett, and G. S. Stuart. 2011. Second-trimester abortion for fetal anomalies or fetal death: Labor induction compared with dilation and evacuation. Obstetrics & Gynecology 117(4):788–792.

Cates, Jr., W., K. F. Schulz, D. A. Grimes, A. J. Horowitz, F. A. Lyon, F. H. Kravitz, and M. J. Frisch. 1982. Dilatation and evacuation procedures and second-trimester abortions. The role of physician skill and hospital setting. Journal of the American medical Association 248(5):559–563.

Cates, Jr., W., D. A. Grimes, and K. F. Schulz. 2000. Abortion surveillance at CDC: Creating public health light out of political heat. American Journal of Preventive Medicine 19(1, Suppl. 1):12–17.

CDC (Centers for Disease Control and Prevention). 1983. Surveillance summary abortion surveillance: Preliminary analysis, 1979–1980—United States. MMWR Weekly 32(5): 62–64. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001243.htm (accessed September 18, 2017).

CDC. 2017. CDC’s abortion surveillance system FAQs . https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm (accessed June 22, 2017).

Chen, M. J., and M. D. Creinin. 2015. Mifepristone with buccal misoprostol for medical abortion: A systematic review. Obstetrics & Gynecology 126(1):12–21.

Cleland, K., M. D. Creinin, D. Nucatola, M. Nshom, and J. Trussell. 2013. Significant adverse events and outcomes after medical abortion. Obstetrics & Gynecology 121(1):166–171.

Costescu, D., E. Guilbert, J. Bernardin, A. Black, S. Dunn, B. Fitzsimmons, W. V. Norman, H. Pymar, J. Soon, K. Trouton, M. S. Wagner, and E. Wiebe. 2016. Medical abortion. Journal of Obstetrics and Gynaecology Canada 38(4):366–389.

Donabedian, A. 1980. The definition of quality and approaches to its assessment. In Explorations in quality assessment and monitoring. Vol. 1. Ann Arbor, MI: Health Administration Press.

Edelman, D. A., W. E. Brenner, and G. S. Berger. 1974. The effectiveness and complications of abortion by dilatation and vacuum aspiration versus dilatation and rigid metal curettage. American Journal of Obstetrics and Gynecology 119(4):473–480.

Elam-Evans, L. D., L. T. Strauss, J. Herndon, W. Y. Parker, S. V. Bowens, S. Zane, and C. J. Berg. 2003. Abortion surveillance—United States, 2000. MMWR Surveillance Summaries 52(SS-12):1–32. https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5212a1.htm (accessed September 18, 2017).

FDA (U.S. Food and Drug Administration). 2016. MIFEPREX ® : Highligh ts of prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf (accessed September 11, 2017).

Finer, L. B., and S. K. Henshaw. 2003. Abortion incidence and services in the United States in 2000. Perspectives on Sexual and Reproductive Health 35(1):6–15.

Finer, L. B., and S. K. Henshaw. 2006. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health 38(2):90–96.

Finer, L. B., and M. R. Zolna. 2016. Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine 374(9):843–852.

Finer, L. B., L. F. Frohwirth, L. A. Dauphinee, S. Singh, and A. M. Moore. 2006. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception 74(4):334–344.

Frick, A. C., E. A. Drey, J. T. Diedrich, and J. E. Steinauer. 2010. Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications. Obstetrics & Gynecology 115(4):760–764.

Gary, M. M., and D. J. Harrison. 2006. Analysis of severe adverse events related to the use of mifepristone as an abortifacient. Annals of Pharmacotherapy 40(2):191–197.

Glasziou, P., E. Meats, C. Heneghan, and S. Shepperd. 2008. What is missing from descriptions of treatment in trials and reviews? British Medical Journal 336(7659):1472–1474.

Grimes, D. A., and G. Stuart. 2010. Abortion jabberwocky: The need for better terminology. Contraception 81(2):93–96.

Grimes, D. A., S. M. Smith, and A. D. Witham. 2004. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: A pilot randomised controlled trial. British Journal of Obstetrics & Gynaecology 111(2):148–153.

Grossman, D., K. Blanchard, and P. Blumenthal. 2008. Complications after second trimester surgical and medical abortion. Reproductive Health Matters 16(31 Suppl.):173–182.

Grossman, D., K. Grindlay, T. Buchacker, K. Lane, and K. Blanchard. 2011. Effectiveness and acceptability of medical abortion provided through telemedicine. Obstetrics & Gynecology 118(2 Pt. 1):296–303.

Guttmacher Institute. 2017a. Fact sheet: Induced abortion in the United States. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states (accessed November 10, 2017).

Guttmacher Institute. 2017b. Bans on specific abortion methods used after the first trimester. https://www.guttmacher.org/state-policy/explore/bans-specific-abortion-methods-used-after-first-trimester (accessed September 12, 2017).

Guttmacher Institute. 2017c. Counseling and waiting periods for abortion. https://www.guttmacher.org/state-policy/explore/counseling-and-waiting-periods-abortion (accessed September 12, 2017).

Guttmacher Institute. 2017d. Medication abortion. https://www.guttmacher.org/state-policy/explore/medication-abortion (accessed September 12, 2017).

Guttmacher Institute. 2017e. An overview of abortion laws. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws (accessed September 12, 2017).

Guttmacher Institute. 2017f. Requirements for ultrasound. https://www.guttmacher.org/state-policy/explore/requirements-ultrasound (accessed September 12, 2017).

Guttmacher Institute. 2017g. State funding of abortion under Medicaid. https://www.guttmacher.org/state-policy/explore/state-funding-abortion-under-medicaid (accessed September 12, 2017).

Guttmacher Institute. 2017h. State policies on later abortions. https://www.guttmacher.org/state-policy/explore/state-policies-later-abortions (accessed September 12, 2017).

Guttmacher Institute. 2017i. Targeted regulation of abortion providers. https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers (accessed September 12, 2017).

Guttmacher Institute. 2018a. Abortion reporting requirements. https://www.guttmacher.org/state-policy/explore/abortion-reporting-requirements (accessed January 22, 2018).

Guttmacher Institute. 2018b. Restricting insurance coverage of abortion. https://www.guttmacher.org/state-policy/explore/restricting-insurance-coverage-abortion (accessed January 24, 2018).

Hopewell, S., M. Clarke, D. Moher, E. Wager, P. Middleton, D. G. Altman, K. F. Schulz, and the CONSORT Group. 2008. CONSORT for reporting randomized controlled trials in journal and conference abstracts: Explanation and elaboration. PLoS Medicine 5(1):e20.

Ioannidis, J. P., S. J. Evans, P. C. Gøtzsche, R. T. O’Neill, D. G. Altman, K. Schulz, D. Moher, and the CONSORT Group. 2004. Better reporting of harms in randomized trials: An extension of the CONSORT statement. Annals of Internal Medicine 141(10):781–788.

IOM (Institute of Medicine). 1975. Legalized abortion and the public health . Washington, DC: National Academy Press.

IOM. 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

IOM. 2011a. Clinical practice guidelines we can trust. Washington, DC: The National Academies Press.

IOM. 2011b. Finding what works in health care: Standards for systematic reviews. Washington, DC: The National Academies Press.

Ireland, L. D., M. Gatter, and A. Y. Chen. 2015. Medical compared with surgical abortion for effective pregnancy termination in the first trimester. Obstetrics & Gynecology 126(1):22–28.

Jatlaoui, T. C., A. Ewing, M. G. Mandel, K. B. Simmons, D. B. Suchdev, D. J. Jamieson, and K. Pazol. 2016. Abortion surveillance—United States, 2013. MMWR Surveillance Summaries 65(No. SS-12):1–44.

Jerman, J., and R. K. Jones. 2014. Secondary measures of access to abortion services in the United States, 2011 and 2012: Gestational age limits, cost, and harassment. Women’s Health Issues 24(4): e419–e424.

Jerman J., R. K. Jones, and T. Onda. 2016. Characteristics of U.S. abortion patients in 2014 and changes since 2008 . https://www.guttmacher.org/sites/default/files/report_pdf/characteristics-us-abortion-patients-2014.pdf (accessed October 17, 2016).

Jerman, J., L. Frohwirth, M. L. Kavanaugh, and N. Blades. 2017. Barriers to abortion care and their consequences for patients traveling for services: Qualitative findings from two states. Perspectives on Sexual and Reproductive Health 49(2):95–102.

Jones, R. K., and H. D. Boonstra. 2016. The public health implications of the FDA update to the medication abortion label. New York: Guttmacher Institute. https://www.guttmacher.org/article/2016/06/public-health-implications-fda-update-medication-abortion-label (accessed October 27, 2017).

Jones, R. K., and J. Jerman. 2017a. Abortion incidence and service availability in the United States, 2014. Perspectives on Sexual and Reproductive Health 49(1):1–11.

Jones, R. K., and J. Jerman. 2017b. Characteristics and circumstances of U.S. women who obtain very early and second trimester abortions. PLoS One 12(1):e0169969.

Jones, R. K., and M. L. Kavanaugh. 2011. Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion. Obstetrics & Gynecology 117(6):1358–1366.

Jones, R. K., L. B. Finer, and S. Singh. 2010. Characteristics of U.S. abortion patients, 2008. New York: Guttmacher Institute.

Kahn, J. B., J. P. Bourne, J. D. Asher, and C. W. Tyler. 1971. Technical reports: Surveillance of abortions in hospitals in the United States, 1970. HSMHA Health Reports 86(5):423–430.

Kelly, T., J. Suddes, D. Howel, J. Hewison, and S. Robson. 2010. Comparing medical versus surgical termination of pregnancy at 13–20 weeks of gestation: A randomised controlled trial. British Journal of Obstetrics & Gynaecology 117(12): 1512–1520.

Koonin, L. M., and J. C. Smith. 1993. Abortion surveillance—United States, 1990. MMWR Surveillance Summaries 42(SS-6):29–57. https://www.cdc.gov/mmwr/preview/mmwrhtml/00031585.htm (accessed September 18, 2017).

Kost, K. 2015. Unintended pregnancy rates at the state level: Estimates for 2010 and trends since 2002. New York: Guttmacher Institute.

Kulier, R., N. Kapp, A. M. Gulmezoglu, G. J. Hofmeyr, L. Cheng, and A. Campana. 2011. Medical methods for first trimester abortion. The Cochrane Database of Systematic Reviews (11):CD002855.

Lawson, H. W., H. K. Atrash, A. F. Saftlas, L. M. Koonin, M. Ramick, and J. C. Smith. 1989. Abortion surveillance, United States, 1984–1985. MMWR Surveillance Summaries 38(SS-2):11–15. https://www.cdc.gov/Mmwr/preview/mmwrhtml/00001467.htm (accessed September 18, 2017).

Lean, T. H., D. Vengadasalam, S. Pachauri, and E. R. Miller. 1976. A comparison of D & C and vacuum aspiration for performing first trimester abortion. International Journal of Gynecology and Obstetrics 14(6):481–486.

Lichtenberg, E. S., and M. Paul. 2013. Surgical abortion prior to 7 weeks of gestation. Contraception 88(1):7–17.

Lohr, A. P., J. L. Hayes, and K. Gemzell Danielsson. 2008. Surgical versus medical methods for second trimester induced abortion. Cochrane Database of Systematic Reviews (1):CD006714.

Low, N., M. Mueller, H. A. Van Vliet, and N. Kapp. 2012. Perioperative antibiotics to prevent infection after first-trimester abortion. Cochrane Database of Systematic Reviews (3):CD005217.

Mauelshagen, A., L. C. Sadler, H. Roberts, M. Harilall, and C. M. Farquhar. 2009. Audit of short term outcomes of surgical and medical second trimester termination of pregnancy. Reproductive Health 6(1):16.

NAF (National Abortion Federation). 2017. 2017 Clinical policy guidelines for abortion care . Washington, DC: NAF.

Nash, E., R. B. Gold, L. Mohammed, O. Cappello, and Z. Ansari-Thomas. 2017. Laws affecting reproductive health and rights: State policy trends at midyear, 2017 . Washington, DC: Guttmacher Institute. https://www.guttmacher.org/article/2017/07/laws-affecting-reproductive-health-and-rights-state-policy-trends-midyear-2017 (accessed September 21, 2017).

Ngoc, N. T., T. Shochet, S. Raghavan, J. Blum, N. T. Nga, N. T. Minh, V. Q. Phan, B. Winikoff. 2011. Mifepristone and misoprostol compared with misoprostol alone for second-trimester abortion: A randomized controlled trial. Obstetrics & Gynecology 118(3):601–608.

Ohannessian, A., K. Baumstarck, J. Maruani, E. Cohen-Solal, P. Auquier, and A. Agostini. 2016. Mifepristone and misoprostol for cervical ripening in surgical abortion between 12 and 14 weeks of gestation: A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology 201:151–155.

Pazol, K., A. A. Creanga, and S. B. Zane. 2012. Trends in use of medical abortion in the United States: Reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001–2008. Contraception 86(6):746–751.

Pazol, K., A. A. Creanga, and D. J. Jamieson. 2015. Abortion surveillance—United States, 2012. Morbidity and Mortality Weekly Report 64(SS-10):1–40.

Peterson, W. F., F. N. Berry, M. R. Grace, and C. L. Gulbranson. 1983. Second-trimester abortion by dilatation and evacuation: An analysis of 11,747 cases. Obstetrics & Gynecology 62(2):185–190.

Plint, A. C., D. Moher, A. Morrison, K. Schulz, D. G. Altman, C. Hill, and I. Gaboury. 2006. Does the CONSORT checklist improve the quality of reports of randomised controlled trials? A systematic review. Medical Journal of Australia 185(5):263–267.

Ranji, U., A. Salganicoff, L. Sobel, C. Rosenzweig, and I. Gomez. 2017. Financing family planning services for low-income women: The role of public programs. https://www.kff.org/womens-health-policy/issue-brief/financing-family-planning-services-for-low-income-women-the-role-of-public-programs (accessed September 9, 2017).

Raymond, E. G., C. Shannon, M. A. Weaver, and B. Winikoff. 2013. First-trimester medical abortion with mifepristone 200 mg and misoprostol: A systematic review. Contraception 87(1):26–37.

RCOG (Royal College of Obstetricians and Gynaecologists). 2011. The care of women requesting induced abortion (Evidence-based clinical guideline number 7). London, UK: RCOG Press. https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf (accessed July 27, 2017).

RCOG. 2015. Best practice in comprehensive abortion care (Best practice paper no. 2). London, UK: RCOG Press. https://www.rcog.org.uk/globalassets/documents/guidelines/best-practice-papers/best-practice-paper-2.pdf (accessed September 11, 2017).

Roblin, P. 2014. Vacuum aspiration. In Abortion care, edited by S. Rowlands. Cambridge, UK: Cambridge University Press.

Sackett, D. L. 1979. Bias in analytic research. Journal of Chronic Diseases 32(1–2):51–63.

Sonalkar, S., S. N. Ogden, L. K. Tran, and A. Y. Chen. 2017. Comparison of complications associated with induction by misoprostol versus dilation and evacuation for second-trimester abortion. International Journal of Gynaecology & Obstetrics 138(3):272–275.

Strauss, L. T., S. B. Gamble, W. Y. Parker, D. A. Cook, S. B. Zane, and S. Hamdan. 2007. Abortion surveillance—United States, 2004. MMWR Surveillance Summaries 56 (SS-12):1–33.

Upadhyay, U. D., S. Desai, V. Zlidar, T. A. Weitz, D. Grossman, P. Anderson, and D. Taylor. 2015. Incidence of emergency department visits and complications after abortion. Obstetrics & Gynecology 125(1):175–183.

von Elm, E., D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbrouke. 2007. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine 4(10):e296.

White, K., E. Carroll, and D. Grossman. 2015. Complications from first-trimester aspiration abortion: A systematic review of the literature. Contraception 92(5):422–438.

WHO (World Health Organization). 2012. Safe abortion: Technical and policy guidance for health systems (Second edition). http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf (accessed September 12, 2017).

WHO. 2014. Clinical practice handbook for safe abortion. Geneva, Switzerland: WHO Press. http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf?ua=1&ua=1 (accessed November 15, 2016).

Wildschut, H., M. I. Both, S. Medema, E. Thomee, M. F. Wildhagen, and N. Kapp. 2011. Medical methods for mid-trimester termination of pregnancy. The Cochrane Database of Systematic Reviews (1):Cd005216.

Woodcock, J. 2016. Letter from the director of the FDA Center for Drug Evaluation and Research to Donna Harrison, Gene Rudd, and Penny Young Nance. Re: Docket No. FDA-2002-P-0364. Silver Spring, MD: FDA.

Zane, S., A. A. Creanga, C. J. Berg, K. Pazol, D. B. Suchdev, D. J. Jamieson, and W. M. Callaghan. 2015. Abortion-related mortality in the United States: 1998–2010. Obstetrics & Gynecology 126(2):258–265.

Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed.

The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research.

READ FREE ONLINE

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

Switch between the Original Pages , where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

• Dissertation
• PowerPoint Presentation
• Book Report/Review
• Research Proposal
• Math Problems
• Proofreading
• Movie Review
• Cover Letter Writing
• Personal Statement
• Nursing Paper
• Argumentative Essay
• Research Paper
• Discussion Board Post

How to Write Abortion Research Paper Homework?

Table of Contents

Looking for easy tips on how to write a research paper on abortion? We’ve got you covered!

Abortion is probably the most controversial subject in modern society. It includes a number of complex questions concerning ethical, moral, legal, medical, philosophical, and religious issues related to the deliberate ending of pregnancy before normal childbirth.

Public opinions are polarized; they have strong feelings for or against this subject. That’s why writing a good abortion research paper with work cited requires in-depth research of existing literature. Students have to find a decent amount of relevant arguments (statistics, facts) about positive and negative aspects of the problem and create a convincing piece.

Abortion research paper specifics

Abortion research paper is a piece of academic writing based on original research performed by a writer. The author’s task is to analyze and interpret research findings on a particular topic.

Although research paper assignments may vary widely, there are two common types – analytical and argumentative.

• In argumentative essay students have to establish their position in a thesis statement and convince their audience to adopt this point of view.
• In analytical essay students state a research question, take a neutral stance on a topic, presenting information in a form of well-supported critical analysis without persuading the audience to adopt any particular point of view.

Thorough writing a college research paper on the subject is critical – it can help students develop their own opinions and build a strong argument.

Research paper on abortion: writing hints & tips

Abortion is among political and moral issues on which Americans are genuinely split. Their opinions on this controversial issue remain unchanged since 1995. There are two primary moral and legal questions related to the abortion debate, which divides public opinion for generations:

• Are abortions morally wrong?
• Should they be legal or banned?

Although these questions seem straightforward, they are more complex than students think. There are two separate camps. People who favor the “pro-choice” stance support the right of women to choose whether she carries a pregnancy to term or not. They think that abortions are acceptable.

People who take the strict religious “pro-life” stance think that abortions are always wrong because the fetus has rights and we should treat it the same way as any other human being.

If you have to write an argumentative research paper, you must choose either “pro-life” or “pro-choice” stance and develop a convincing argument to persuade readers.

If your research paper is analytical, you should examine both sides of the issue, evaluate the most important arguments, provide a balanced overview of both approaches, analyzing their weak and strong points.

Religion plays a great role in the debate but there are a lot of non-religious issues. Here are the most important ethical and legal issues, involving the rights of women and the rights of a fetus.

• Is fetus a human being and does it have the basic legal right to live?
• Does life begin at conception?
• Should we consider the fetus a separate being or is it a part of its mother?
• Does the fetus’ right to life have a priority over the woman’s right to control her body?
• Under what circumstances is it acceptable to terminate the fetus’ life?
• Can the removing of a fetus be considered as a murder?
• Is it better to abort an unwanted child or allow it to be neglected by parents?
• Can adoption be alternative to termination of pregnancy?
• Is it possible to find a balance between the rights of a mother and those of a fetus?

A lot of arguments in favor of this procedure are based on respect for women’s reproductive rights.

“Pro-choice” camp argues that a woman is a person with her own rights and not a fetus’ carrier.

They say that governmental or religious authorities shouldn’t limit a woman’s right to control her own body. Besides, the fetus can’t be regarded as a separate entity because it can’t exist outside a woman’s womb.

Opponents of this procedure speak about respect for all forms of life, fetus’ right to life, and argue that it is actually the kill of an innocent human being.

Best abortion research paper topics

The first step in writing a research paper is selecting a good manageable topic that interests you and defining a research question or a thesis statement.

Wondering where to find powerful abortion research paper topics? Here is a short list of interesting ideas. Feel free to pick any of them for creating your own writings. You may also use them as a source of inspiration and further research of a specific issue.

• Impact of legalizing abortions on the birth rate.
• How terminations of pregnancies are regulated around the world.
• How termination of pregnancy is considered within moral terms.
• Analyze regional differences in Americans’ attitude to termination of pregnancy.
• Examine the generation gap in abortion support.
• Feminist beliefs and abortion rights supporters.
• What is the future of abortion politics?
• Give an overview of the legislation on the termination of pregnancies around the world.
• The medical complications of pregnancy termination.
• Discuss the abortion debate and human rights.
• How having an abortion affects a woman’s life.
• Will the abortion debate ever end?
• How can we reduce the demand for termination of pregnancy?
• Moral aspects of pregnancy termination.
• Legal aspects of the abortion conflict.
• Should termination of pregnancy be treated as a health issue?
• Electoral politics and termination of pregnancy.
• Is the termination of pregnancy a human issue or a gender issue?
• Philosophical aspects of the abortion debate.
• Liberal views on the termination of pregnancy.
• Abortion demographics: race, poverty, and choice.
• Why does the public support for legal termination of pregnancy remains high?
• Should men be allowed to discuss the termination of pregnancy?
• Is the abortion a “women’s only” issue?
• Woman’s mental health after abortion.

How to write an abortion research paper outline?

Now let’s discuss how to write an abortion research paper outline. First, you have to write a thesis statement that summarizes the main point of your paper and outlines supporting points. The thesis will help you organize your structure and ensure that you stay focused while working on your project. Make a thesis statement strong, specific, and arguable.

After defining the thesis statement, you need to brainstorm ideas that are supporting the thesis in the best way. When it comes to the level of detail in an outline, you should take into account the length of a college project. You should choose the most suitable subtopics and arrange them logically. Decide which order is the most effective in arguing your thesis. Your paper should include at least 3 parts: an introduction, main body, and conclusion.

Have a look at simple abortion research paper outline example .

Introduction

• Hook sentence
• Thesis statement
• Transition to Main Body
• History of abortion
• Abortion demographics in countries where it is legal
• Impact of legal termination of pregnancy on women’s life and health
• Negative consequences of illegal termination of pregnancy
• What measures should be taken to reduce the number of abortions?
• Transition to Conclusion
• Unexpected twist or a final argument
• Food for thought

Academic writing is very challenging, especially if it involves complex controversial topics . Writing an abortion research paper is a time-consuming and arduous task, which involves a lot of researching, reading, writing, revising, rewriting, editing, and proofreading. Make sure you are ready to create several drafts and then improve the content and style to make your paper perfect.

We hope that our quick tips will help you get started. But if you are new to academic writing, a good idea is to find well-written abortion research paper examples. Read and analyze them to have a better idea about proper paper structure, academic writing style, references, and different approaches to organizing thoughts.

How about we take care of your abortion research paper, while you enjoy your free time? Several clicks and we’re on!

Definition of beauty essay sample

How to Write Your Dissertation Chapter 3?

Best Apps for Your iPhone

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Cell Rep Med
• v.4(1); 2023 Jan 17

Abortion bans and their impacts: A view from the United States

Laura j. frye.

1 Gynuity Health Projects, New York, NY, USA

Beverly Winikoff

A retrospective study of abortion facilities in and around Texas by White et al. 1 and a spatial analysis by Rader et al. 2 are combined to illustrate the detrimental effects of abortion bans enacted in the United States.

Abortion restrictions have been introduced in various forms across many states for years, but since June 2022, when the right to abortion was no longer federally protected, we have seen a rapid increase in these restrictions. We are just starting to quantify and qualify their effects. Two recent studies published in JAMA offer early indications of the effects of draconian bans.

In “Association of Texas’ 2021 Ban on Abortion in Early Pregnancy with the Number of Facility-Based Abortion in Texas and Surrounding States,” White et al. used a large dataset containing information before and after the passage of SB8 in September 2021. 1 This bill banned most abortions after 6 weeks in the state of Texas. The data presented in this article allow for a careful examination of the law’s effects, and the authors paint a picture of how rapidly destabilizing such bans can be. The study clearly shows that, in the immediate aftermath of SB8’s implementation, there was both an absolute drop in documented abortions and a shift in the location of abortions as Texans went to neighboring states for medical care.

The paper explicitly examines abortions after 12 weeks as an important indicator of change, not because of the small decrease in safety and efficacy with increasing gestational durations, but rather because of the major increase in burdens to affected individuals (cost, time, travel) and to clinics (resources, scheduling) with gestations beyond this point.

A clearer and more detailed sense of how these patient travel dynamics play out can be found in the “Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women’s Health Decision” by Rader et al., which uses simulation and spatial analysis to measure changes in surface travel time to the closest abortion facility before and after the June 2022 Dobbs decision. 2

The average travel time to reach the nearest abortion facility significantly increased in the simulated post-Dobbs world, and, while the median change from 11 to 17 min is not jaw dropping, the spread of the data and the extremes of the curve are where the biggest problems lie. The authors show a doubling of the number of individuals who must travel more than 60 min to access abortion care. Then, through sensitivity analyses on geographic heterogeneity, they illustrate some of the extreme increases in travel time for people in the South, as in Texas, with a mean increase of over 7 h.

While the White paper notes that their data did not include individual-level demographic information (and thus was not able to explore the disparate effects of the ban on various subpopulations), the Raden paper is able to shed some light on the disproportionate impacts of abortion restrictions by use of census data. The latter paper shows that longer travel times occur more frequently in populations without insurance, with lower incomes, and who are racial and ethnic minorities. Documentation of these effects is important for advocacy, policy change, and resource allocation.

The White et al. paper wisely uses care in describing the data they have as “documented facility-based abortions,” acknowledging the now-frequent practice of non-facility-based self-managed abortion with pills. Similarly, Rader et al. note that their data are predicated on the idea of traveling to a physical facility and do not account for the mailing of pills to a person’s home. The TelAbortion study from 2016 to 2021 provided evidence on the safety and efficacy of direct-to-patient telemedicine abortion with mailing of pills, 3 , 4 and the FDA now allows for this method of abortion pill provision. We also know that self-managed abortion can be a safe and effective option 5 and is currently common in the United States. 6 , 7 There is increasing interest in determining its role in the care landscape. 8 , 9 , 10 Moving forward, it would be beneficial to see more information on how remote provision of care and self-management play into the dynamics illustrated in these articles.

These two papers, used together, can help prepare clinics in protective states for the influx of affected individuals as additional oppressive laws are passed in other states. The lessons documented only grow in relevance as the map of the United States darkens with more and more states passing restrictive abortion laws. We can use these data both to decry the negative and disproportionate effect of these bans and to call for action to prepare receiving clinics in protective states as they take on the care of more people who are denied medical services in their home states.

Declaration of interests

The authors declare no competing interests.

Numbers, Facts and Trends Shaping Your World

Read our research on:

Full Topic List

Regions & Countries

• Publications
• Our Methods
• Short Reads
• Tools & Resources

Read Our Research On:

• America’s Abortion Quandary
• 1. Americans’ views on whether, and in what circumstances, abortion should be legal

Table of Contents

• Public views of what would change the number of abortions in the U.S.
• A majority of Americans say women should have more say in setting abortion policy in the U.S.
• How do certain arguments about abortion resonate with Americans?
• In their own words: How Americans feel about abortion 
• 3. How the issue of abortion touches Americans personally
• Acknowledgments
• Methodology

As the long-running debate over abortion reaches another  key moment at the Supreme Court  and in  state legislatures across the country , a majority of U.S. adults continue to say that abortion should be legal in all or most cases. About six-in-ten Americans (61%) say abortion should be legal in “all” or “most” cases, while 37% think abortion should be  illegal  in all or most cases. These views have changed little over the past several years: In 2019, for example, 61% of adults said abortion should be legal in all or most cases, while 38% said it should be illegal in all or most cases.    Most respondents in the new survey took one of the middle options when first asked about their views on abortion, saying either that abortion should be legal in  most  cases (36%) or illegal in  most  cases (27%). 

Respondents who said abortion should either be legal in  all  cases or illegal in  all  cases received a follow-up question asking whether there should be any exceptions to such laws. Overall, 25% of adults initially said abortion should be legal in all cases, but about a quarter of this group (6% of all U.S. adults) went on to say that there should be some exceptions when abortion should be against the law.

One-in-ten adults initially answered that abortion should be illegal in all cases, but about one-in-five of these respondents (2% of all U.S. adults) followed up by saying that there are some exceptions when abortion should be permitted. 

Altogether, seven-in-ten Americans say abortion should be legal in some cases and illegal in others, including 42% who say abortion should be generally legal, but with some exceptions, and 29% who say it should be generally illegal, except in certain cases. Much smaller shares take absolutist views when it comes to the legality of abortion in the U.S., maintaining that abortion should be legal in all cases with no exceptions (19%) or illegal in all circumstances (8%). 

There is a modest gender gap in views of whether abortion should be legal, with women slightly more likely than men to say abortion should be legal in all cases or in all cases but with some exceptions (63% vs. 58%). 

Younger adults are considerably more likely than older adults to say abortion should be legal: Three-quarters of adults under 30 (74%) say abortion should be generally legal, including 30% who say it should be legal in all cases without exception. 

But there is an even larger gap in views toward abortion by partisanship: 80% of Democrats and Democratic-leaning independents say abortion should be legal in all or most cases, compared with 38% of Republicans and GOP leaners.  Previous Center research  has shown this gap widening over the past 15 years. 

Still, while partisans diverge in views of whether abortion should mostly be legal or illegal, most Democrats and Republicans do not view abortion in absolutist terms. Just 13% of Republicans say abortion should be against the law in all cases without exception; 47% say it should be illegal with some exceptions. And while three-in-ten Democrats say abortion should be permitted in all circumstances, half say it should mostly be legal – but with some exceptions. 

There also are sizable divisions within both partisan coalitions by ideology. For instance, while a majority of moderate and liberal Republicans say abortion should mostly be legal (60%), just 27% of conservative Republicans say the same. Among Democrats, self-described liberals are twice as apt as moderates and conservatives to say abortion should be legal in all cases without exception (42% vs. 20%).

Regardless of partisan affiliation, adults who say they personally know someone who has had an abortion – such as a friend, relative or themselves – are more likely to say abortion should be legal than those who say they do not know anyone who had an abortion.

Views toward abortion also vary considerably by religious affiliation – specifically among large Christian subgroups and religiously unaffiliated Americans. 

For example, roughly three-quarters of White evangelical Protestants say abortion should be illegal in all or most cases. This is far higher than the share of White non-evangelical Protestants (38%) or Black Protestants (28%) who say the same. 

Despite  Catholic teaching on abortion , a slim majority of U.S. Catholics (56%) say abortion should be legal. This includes 13% who say it should be legal in all cases without exception, and 43% who say it should be legal, but with some exceptions. 

Compared with Christians, religiously unaffiliated adults are far more likely to say abortion should be legal overall – and significantly more inclined to say it should be legal in all cases without exception. Within this group, atheists stand out: 97% say abortion should be legal, including 53% who say it should be legal in all cases without exception. Agnostics and those who describe their religion as “nothing in particular” also overwhelmingly say that abortion should be legal, but they are more likely than atheists to say there are some circumstances when abortion should be against the law.

Although the survey was conducted among Americans of many religious backgrounds, including Jews, Muslims, Buddhists and Hindus, it did not obtain enough respondents from non-Christian groups to report separately on their responses.

Abortion at various stages of pregnancy 

As a  growing number of states  debate legislation to restrict abortion – often after a certain stage of pregnancy – Americans express complex views about when   abortion should generally be legal and when it should be against the law. Overall, a majority of adults (56%) say that how long a woman has been pregnant should matter in determining when abortion should be legal, while far fewer (14%) say that this should  not  be a factor. An additional one-quarter of the public says that abortion should either be legal (19%) or illegal (8%) in all circumstances without exception; these respondents did not receive this question.

Among men and women, Republicans and Democrats, and Christians and religious “nones” who do not take absolutist positions about abortion on either side of the debate, the prevailing view is that the stage of the pregnancy should be a factor in determining whether abortion should be legal.

Americans broadly are more likely to favor restrictions on abortion later in pregnancy than earlier in pregnancy. Many adults also say the legality of abortion depends on other factors at every stage of pregnancy. 

Overall, a plurality of adults (44%) say that abortion should be legal six weeks into a pregnancy, which is about when cardiac activity (sometimes called a fetal heartbeat) may be detected and before many women know they are pregnant; this includes 19% of adults who say abortion should be legal in all cases without exception, as well as 25% of adults who say it should be legal at that point in a pregnancy. An additional 7% say abortion generally should be legal in most cases, but that the stage of the pregnancy should not matter in determining legality. 1

One-in-five Americans (21%) say abortion should be  illegal  at six weeks. This includes 8% of adults who say abortion should be illegal in all cases without exception as well as 12% of adults who say that abortion should be illegal at this point. Additionally, 6% say abortion should be illegal in most cases and how long a woman has been pregnant should not matter in determining abortion’s legality. Nearly one-in-five respondents, when asked whether abortion should be legal six weeks into a pregnancy, say “it depends.” 

Americans are more divided about what should be permitted 14 weeks into a pregnancy – roughly at the end of the first trimester – although still, more people say abortion should be legal at this stage (34%) than illegal (27%), and about one-in-five say “it depends.”

Fewer adults say abortion should be legal 24 weeks into a pregnancy – about when a healthy fetus could survive outside the womb with medical care. At this stage, 22% of adults say abortion should be legal, while nearly twice as many (43%) say it should be  illegal . Again, about one-in-five adults (18%) say whether abortion should be legal at 24 weeks depends on other factors. 

Respondents who said that abortion should be illegal 24 weeks into a pregnancy or that “it depends” were asked a follow-up question about whether abortion at that point should be legal if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Most who received this question say abortion in these circumstances should be legal (54%) or that it depends on other factors (40%). Just 4% of this group maintained that abortion should be illegal in this case.

This pattern in views of abortion – whereby more favor greater restrictions on abortion as a pregnancy progresses – is evident across a variety of demographic and political groups. 

Democrats are far more likely than Republicans to say that abortion should be legal at each of the three stages of pregnancy asked about on the survey. For example, while 26% of Republicans say abortion should be legal at six weeks of pregnancy, more than twice as many Democrats say the same (61%). Similarly, while about a third of Democrats say abortion should be legal at 24 weeks of pregnancy, just 8% of Republicans say the same. 

However, neither Republicans nor Democrats uniformly express absolutist views about abortion throughout a pregnancy. Republicans are divided on abortion at six weeks: Roughly a quarter say it should be legal (26%), while a similar share say it depends (24%). A third say it should be illegal. 

Democrats are divided about whether abortion should be legal or illegal at 24 weeks, with 34% saying it should be legal, 29% saying it should be illegal, and 21% saying it depends. 

There also is considerable division among each partisan group by ideology. At six weeks of pregnancy, just one-in-five conservative Republicans (19%) say that abortion should be legal; moderate and liberal Republicans are twice as likely as their conservative counterparts to say this (39%). 

At the same time, about half of liberal Democrats (48%) say abortion at 24 weeks should be legal, while 17% say it should be illegal. Among conservative and moderate Democrats, the pattern is reversed: A plurality (39%) say abortion at this stage should be illegal, while 24% say it should be legal. 

Christian adults are far less likely than religiously unaffiliated Americans to say abortion should be legal at each stage of pregnancy.  

Among Protestants, White evangelicals stand out for their opposition to abortion. At six weeks of pregnancy, for example, 44% say abortion should be illegal, compared with 17% of White non-evangelical Protestants and 15% of Black Protestants. This pattern also is evident at 14 and 24 weeks of pregnancy, when half or more of White evangelicals say abortion should be illegal.

At six weeks, a plurality of Catholics (41%) say abortion should be legal, while smaller shares say it depends or it should be illegal. But by 24 weeks, about half of Catholics (49%) say abortion should be illegal. 

Among adults who are religiously unaffiliated, atheists stand out for their views. They are the only group in which a sizable majority says abortion should be  legal  at each point in a pregnancy. Even at 24 weeks, 62% of self-described atheists say abortion should be legal, compared with smaller shares of agnostics (43%) and those who say their religion is “nothing in particular” (31%). 

As is the case with adults overall, most religiously affiliated and religiously unaffiliated adults who originally say that abortion should be illegal or “it depends” at 24 weeks go on to say either it should be legal or it depends if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Few (4% and 5%, respectively) say abortion should be illegal at 24 weeks in these situations.

Abortion and circumstances of pregnancy 

The stage of the pregnancy is not the only factor that shapes people’s views of when abortion should be legal. Sizable majorities of U.S. adults say that abortion should be legal if the pregnancy threatens the life or health of the pregnant woman (73%) or if pregnancy is the result of rape (69%). 

There is less consensus when it comes to circumstances in which a baby may be born with severe disabilities or health problems: 53% of Americans overall say abortion should be legal in such circumstances, including 19% who say abortion should be legal in all cases and 35% who say there are some situations where abortions should be illegal, but that it should be legal in this specific type of case. A quarter of adults say “it depends” in this situation, and about one-in-five say it should be illegal (10% who say illegal in this specific circumstance and 8% who say illegal in all circumstances). 

There are sizable divides between and among partisans when it comes to views of abortion in these situations. Overall, Republicans are less likely than Democrats to say abortion should be legal in each of the three circumstances outlined in the survey. However, both partisan groups are less likely to say abortion should be legal when the baby may be born with severe disabilities or health problems than when the woman’s life is in danger or the pregnancy is the result of rape. 

Just as there are wide gaps among Republicans by ideology on whether how long a woman has been pregnant should be a factor in determining abortion’s legality, there are large gaps when it comes to circumstances in which abortions should be legal. For example, while a clear majority of moderate and liberal Republicans (71%) say abortion should be permitted when the pregnancy is the result of rape, conservative Republicans are more divided. About half (48%) say it should be legal in this situation, while 29% say it should be illegal and 21% say it depends.

The ideological gaps among Democrats are slightly less pronounced. Most Democrats say abortion should be legal in each of the three circumstances – just to varying degrees. While 77% of liberal Democrats say abortion should be legal if a baby will be born with severe disabilities or health problems, for example, a smaller majority of conservative and moderate Democrats (60%) say the same. 

White evangelical Protestants again stand out for their views on abortion in various circumstances; they are far less likely than White non-evangelical or Black Protestants to say abortion should be legal across each of the three circumstances described in the survey. 

While about half of White evangelical Protestants (51%) say abortion should be legal if a pregnancy threatens the woman’s life or health, clear majorities of other Protestant groups and Catholics say this should be the case. The same pattern holds in views of whether abortion should be legal if the pregnancy is the result of rape. Most White non-evangelical Protestants (75%), Black Protestants (71%) and Catholics (66%) say abortion should be permitted in this instance, while White evangelicals are more divided: 40% say it should be legal, while 34% say it should be  illegal  and about a quarter say it depends. 

Mirroring the pattern seen among adults overall, opinions are more varied about a situation where a baby might be born with severe disabilities or health issues. For instance, half of Catholics say abortion should be legal in such cases, while 21% say it should be illegal and 27% say it depends on the situation. 

Most religiously unaffiliated adults – including overwhelming majorities of self-described atheists – say abortion should be legal in each of the three circumstances. 

Parental notification for minors seeking abortion

Seven-in-ten U.S. adults say that doctors or other health care providers should be required to notify a parent or legal guardian if the pregnant woman seeking an abortion is under 18, while 28% say they should not be required to do so.  

Women are slightly less likely than men to say this should be a requirement (67% vs. 74%). And younger adults are far less likely than those who are older to say a parent or guardian should be notified before a doctor performs an abortion on a pregnant woman who is under 18. In fact, about half of adults ages 18 to 24 (53%) say a doctor should  not  be required to notify a parent. By contrast, 64% of adults ages 25 to 29 say doctors  should  be required to notify parents of minors seeking an abortion, as do 68% of adults ages 30 to 49 and 78% of those 50 and older. 

A large majority of Republicans (85%) say that a doctor should be required to notify the parents of a minor before an abortion, though conservative Republicans are somewhat more likely than moderate and liberal Republicans to take this position (90% vs. 77%). 

The ideological divide is even more pronounced among Democrats. Overall, a slim majority of Democrats (57%) say a parent should be notified in this circumstance, but while 72% of conservative and moderate Democrats hold this view, just 39% of liberal Democrats agree. 

By and large, most Protestant (81%) and Catholic (78%) adults say doctors should be required to notify parents of minors before an abortion. But religiously unaffiliated Americans are more divided. Majorities of both atheists (71%) and agnostics (58%) say doctors should  not  be required to notify parents of minors seeking an abortion, while six-in-ten of those who describe their religion as “nothing in particular” say such notification should be required. 

Penalties for abortions performed illegally 

Americans are divided over who should be penalized – and what that penalty should be – in a situation where an abortion occurs illegally. 

Overall, a 60% majority of adults say that if a doctor or provider performs an abortion in a situation where it is illegal, they should face a penalty. But there is less agreement when it comes to others who may have been involved in the procedure. 

While about half of the public (47%) says a woman who has an illegal abortion should face a penalty, a nearly identical share (50%) says she should not. And adults are more likely to say people who help find and schedule or pay for an abortion in a situation where it is illegal should  not  face a penalty than they are to say they should.

Views about penalties are closely correlated with overall attitudes about whether abortion should be legal or illegal. For example, just 20% of adults who say abortion should be legal in all cases without exception think doctors or providers should face a penalty if an abortion were carried out in a situation where it was illegal. This compares with 91% of those who think abortion should be illegal in all cases without exceptions. Still, regardless of how they feel about whether abortion should be legal or not, Americans are more likely to say a doctor or provider should face a penalty compared with others involved in the procedure. 

Among those who say medical providers and/or women should face penalties for illegal abortions, there is no consensus about whether they should get jail time or a less severe punishment. Among U.S. adults overall, 14% say women should serve jail time if they have an abortion in a situation where it is illegal, while 16% say they should receive a fine or community service and 17% say they are not sure what the penalty should be. 

A somewhat larger share of Americans (25%) say doctors or other medical providers should face jail time for providing illegal abortion services, while 18% say they should face fines or community service and 17% are not sure. About three-in-ten U.S. adults (31%) say doctors should lose their medical license if they perform an abortion in a situation where it is illegal.

Men are more likely than women to favor penalties for the woman or doctor in situations where abortion is illegal. About half of men (52%) say women should face a penalty, while just 43% of women say the same. Similarly, about two-thirds of men (64%) say a doctor should face a penalty, while 56% of women agree.

Republicans are considerably more likely than Democrats to say both women and doctors should face penalties – including jail time. For example, 21% of Republicans say the woman who had the abortion should face jail time, and 40% say this about the doctor who performed the abortion. Among Democrats, far smaller shares say the woman (8%) or doctor (13%) should serve jail time.  

White evangelical Protestants are more likely than other Protestant groups to favor penalties for abortions in situations where they are illegal. Fully 24% say the woman who had the abortion should serve time in jail, compared with just 12% of White non-evangelical Protestants or Black Protestants. And while about half of White evangelicals (48%) say doctors who perform illegal abortions should serve jail time, just 26% of White non-evangelical Protestants and 18% of Black Protestants share this view.

• Only respondents who said that abortion should be legal in some cases but not others and that how long a woman has been pregnant should matter in determining whether abortion should be legal received questions about abortion’s legality at specific points in the pregnancy.  ↩

Sign up for our weekly newsletter

Fresh data delivery Saturday mornings

Sign up for The Briefing

Weekly updates on the world of news & information

• Christianity
• Evangelicalism
• Political Issues
• Politics & Policy
• Protestantism
• Religion & Abortion
• Religion & Politics
• Religion & Social Values

War in Ukraine: Wide Partisan Differences on U.S. Responsibility and Support

Key facts about u.s. poll workers, key facts about americans and guns, how americans get local political news, joe biden, public opinion and his withdrawal from the 2024 race, most popular, report materials.

901 E St. NW, Suite 300 Washington, DC 20004 USA (+1) 202-419-4300 | Main (+1) 202-857-8562 | Fax (+1) 202-419-4372 |  Media Inquiries

Research Topics

• Email Newsletters

ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

© 2024 Pew Research Center

Advertisement

Supported by

Pressured by Their Base on Abortion, Republicans Strain to Find a Way Forward

Some in the party are urging compromise, warning of dire electoral consequences for 2024, while other stances, on guns and gay rights, also risk turning off moderates.

• Share full article

By Jonathan Weisman

Republican leaders have followed an emboldened base of conservative activists into what increasingly looks like a political cul-de-sac on the issue of abortion — a tightly confined absolutist position that has limited their options ahead of the 2024 election season, even as some in the party push for moderation.

Last year’s Supreme Court decision overturning a woman’s constitutionally protected right to an abortion was supposed to send the issue of abortion access to the states, where local politicians were supposed to have the best sense of the electorate’s views. But the decision on Friday by a conservative judge in Texas, invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone, showed the push for nationwide restrictions on abortion has continued since the high court’s nullification of Roe v. Wade.

Days earlier, abortion was the central theme in a liberal judge’s landslide victory for a contested and pivotal seat on the state Supreme Court in Wisconsin. Some Republicans are warning that the uncompromising position of their party’s activist base could be leading them over an electoral cliff next year.

“If we can show that we care just a little bit, that we have some compassion, we can show the country our policies are reasonable, but because we keep going down these rabbit holes of extremism, we’re just going to keep losing,” said Representative Nancy Mace, Republican of South Carolina, who has repeatedly called for more flexibility on first-term abortions and exceptions for rape, incest and the life and health of the mother. “I’m beside myself that I’m the only person who takes this stance.”

She is far from the only one.

The chairwoman of the Republican National Committee, Ronna McDaniel, has been showing polling to members of her party demonstrating that Americans largely accept abortion up to 15 weeks into a pregnancy and support the same exemptions that Ms. Mace wants. Dan O’Donnell, a conservative radio host in Wisconsin, wrote after the lopsided conservative defeat in the state Supreme Court contest that abortion was driving young voters to the polls in staggering numbers and that survival of the party dictated compromise.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

Project 2025 decried as racist. Some contributors have trail of racist writings, activity

They include richard hanania, whose pseudonymous writings for white supremacist sites were uncovered last year..

Former President Donald Trump has spent weeks distancing himself from Project 2025, a sprawling 900-plus page manifesto that seeks to create a blueprint for the next Trump presidency.

Billed as a vision built by conservatives for conservatives, the effort “dismantles the unaccountable Deep State, taking power away from Leftist elites and giving it back to the American people and duly-elected President,” according to its website.  

But for months commentators and academics have been sounding the alarm on Project 2025. The effort, they say, is a deeply racist endeavor that actually is aimed at dismantling many protections and aid programs for Americans of color.

“Really, it's kind of a white supremacist manifesto,” said Michael Harriot, a writer and historian who wrote an article earlier this month titled: “I read the entire Project 2025. Here are the top 10 ways it would harm Black America.”

And a closer look at the named contributors to Project 2025 adds to the concern: A USA TODAY analysis found at least five of them have a history of racist writing or statements, or white supremacist activity.

They include Richard Hanania, who for years wrote racist essays for white supremacist publications under a pseudonym until he was unmasked by a Huffington Post investigation last year. 

Failed Virginia GOP Senate candidate Corey Stewart, another named contributor, has long associated with white supremacists and calls himself a protector of America’s Confederate history tasked with “taking back our heritage.” 

One Project 2025 contributor wrote in his PhD dissertation that immigrants have lower IQs than white native citizens, leading to “underclass behavior.” Another dropped out of contention for a prestigious role at the Federal Reserve amid controversy over a racist joke about the Obamas. 

The presence of contributors to Project 2025 who have published racist or offensive tropes comes as no surprise to academics and commentators who have been sounding the alarm on the endeavor for months.

The plan calls for the abolition of diversity, equity and inclusion programs in the federal government. It would severely limit the mailing of abortion pills and disband the Department of Education. It would replace the Department of Homeland Security with a new, more powerful border and immigration enforcement agency to choke immigration . It would also curtail or disband programs that experts say greatly benefit communities of color, including the Food Stamp and Head Start programs. 

“Project 2025 is a plan about how to regulate and control people of color, including how they organize, work, play and live,” said Arjun Sethi, a civil rights lawyer and adjunct professor of law at Georgetown Law. “It seeks to regulate what they do with their bodies, how they advocate for their rights, and how they build family and community — all while disregarding the historical injustices and contemporary persecution they have experienced.”

What is Project 2025? Inside the conservative plan Trump claims to have 'no idea' about.

It’s not clear how much influence the contributors USA TODAY identified had on the creation of the Project 2025 manifesto. They are listed among scores of contributors to the document, and none would agree to an interview for this story.

But even among the broader collection of think tanks, nonprofits and pundits on the author list, others have past controversies on the issue of race. Seven of the organizations on Project 2025’s Advisory Board have been designated as extremist or hate groups by the Southern Poverty Law Center, according to a May report from Accountable.us, a nonpartisan organization that tracks interest groups in Washington, D.C. 

This proliferation of organizations and individuals with racist modus operandi is by design, not accident, Harriot said.

“One of the things that you see when you read Project 2025 is not just the racist dog whistles, but some ideas that were exactly lifted from some of the most extreme white supremacists ever,” Harriot said. 

After multiple requests from USA TODAY, the Heritage Foundation declined to address questions about the Project 2025 contributors and their past statements.

Project 2025 contributor wrote for white supremacist websites

Hanania is a right-wing author and pundit who has built a reputation among Republicans as an “anti-woke crusader.” 

Before he became a favorite of prominent conservatives – including Sen. JD Vance, R-Ohio, who is now Trump’s pick for vice president – Hanania was pushing a far more extreme version of his right-wing views.    

An investigation last year by the Huffington Post unmasked Hanania as having written under a pseudonym for websites connected to the “alt-right,” the white supremacist movement that flared up before and during the first Trump presidency.

In the early 2010s, writing under the pen name “Richard Hoste,” Hanania “identified himself as a ‘race realist.’” Huffington Post reported last August. “He expressed support for eugenics and the forced sterilization of ‘low IQ’ people, who he argued were most often Black. He opposed ‘miscegenation’ and ‘race-mixing.’ And once, while arguing that Black people cannot govern themselves, he cited the neo-Nazi author of ‘The Turner Diaries,’ the infamous novel that celebrates a future race war.”

Hanania acknowledged writing the posts under a pseudonym and, since then, has only partly renounced his past. Two days after the Huffington Post exposé, in a post on his website titled “Why I Used to Suck, and (Hopefully) No Longer Do,” Hanania wrote “When I was writing anonymously, there was no connection between the flesh and blood human being who would smile at a cashier or honk at someone in traffic, and the internet ‘personality’ who could just grow more rabid over time.”

Vance’s connection to Hanania was documented in a 2021 interview with conservative talk show host David Rubin — two years before Hanania began denouncing his racist past — when Vance described Hanania as a “friend” and a “really interesting thinker.”

Vance and Hanania have also interacted several times on X, formerly known as Twitter, liking and commenting on each other’s posts.

Richard Spencer, a white supremacist credited with creating the alt-right moniker, published several of Hanania’s articles on the website AlternativeRight.com, including one in which Hanania wrote “If the races are equal, why do whites always end up near the top and blacks at the bottom, everywhere and always?”  

In an interview this month, Spencer told USA TODAY that while Hanania may have moderated some of his views, “I think it’s very clear that Richard is a race realist and eugenicist.” The term eugenicist refers to proponents of eugenics, the belief that the genetic quality of the human race can be improved through certain practices — practices viewed by many as scientific racism.

Hanania did not respond to repeated requests for comment.

A Confederate cheerleader and promoting the ‘Great Replacement’ theory

In a 2017 speech at the “Old South Ball” in Danville, Va., Stewart, an attorney who would become the 2018 Republican candidate for the U.S. Senate, told the assembled crowd he was proud to stand next to a Confederate flag: 

“That flag is not about racism, folks, it’s not about hatred, it’s not about slavery, it is about our heritage,” Stewart said. At the same event, he called Virginia “the state of Robert E. Lee and Stonewall Jackson.”

According to a 2018 New York Times profile of Stewart, white supremacists volunteered on the then-Senate candidate’s campaign. “Several of his aides and advisers have used racist or anti-Muslim language, or maintained links to outspoken racists like Jason Kessler ” – who helped organize the white supremacist Unite The Right rally in Charlottesville, Virginia – the Times reported. 

Stewart did not respond to an email seeking comment. Kessler did not respond to a phone call.

At least three contributors to Project 2025 have supported the racist “Great Replacement” theory, which contends that powerful Democrats and leftists are conspiring to change the demographics of the United States by turning a blind eye to, or even encouraging, illegal immigration. 

Michael Anton, a former senior national security official in the Trump administration, wrote in a pseudonymous essay published in 2016 that “The ceaseless importation of Third World foreigners with no tradition of, taste for, or experience in liberty means that the electorate grows more left, more Democratic, less Republican, less republican, and less traditionally American with every cycle. As does, of course, the U.S. population.”     

Anton has also written several essays, including one for USA TODAY, arguing to end birthright citizenship. His arguments have been widely criticized as factually incorrect and misleading. In an opinion piece for the Washington Post, Tufts University politics professor Daniel Drezner called them “ very racist .”  

Anton did not respond to a request for comment.

Another contributor is Stephen Moore, who in 2019 withdrew his name for consideration for the Federal Reserve Board amid scrutiny for his misogynistic and racist jokes and commentary.

Moore, who had made a joke about Trump removing the Obamas from public housing when he took office, was widely mocked when he later tried to clear up the joke in a television interview. The fallout, combined with concerns about Moore’s history of writing articles viewed as disparaging toward women, led him to withdraw his name for consideration.   

Moore did not respond to a request for comment.

The 2009 PhD thesis of Project 2025 contributor Jason Richwine was titled, “ IQ and Immigration Policy .” The thesis includes statements such as: “No one knows whether Hispanics will ever reach IQ parity with whites, but the prediction that new Hispanic immigrants will have low-IQ children and grandchildren is difficult to argue against.”

Richwine resigned from his position at the Heritage Foundation in 2013 amid controversy over his research. He now works at  the Center For Immigration Studies. The paper, and Richwine’s defense of it, were widely decried as racist , bigoted and scientifically incorrect .   

It didn’t help Richwine that his thesis was uncovered in the midst of controversy over an immigration study he co-authored that was roundly criticized by liberals and conservatives alike.  

“Had he not just argued, in an extremely tendentious fashion, that Hispanic immigrants are, on the whole, parasites, he might have endured public criticism of his dissertation,” read an analysis in The Economist . “Had he not in his dissertation argued that Hispanic immigration ought to be limited on grounds of inferior Hispanic intelligence, he would have endured the firestorm over the risible Heritage immigration study.”

Richwine did not respond to a request for comment.

“The fact that they consulted individuals with such abhorrent views to develop this plan is further evidence of just how un-American these proposals are,” Tony Carrk, executive director of Accountable.us told USA TODAY. “The idea that the next conservative administration might replace 50,000 government experts with extremists like this should concern every American.”

Trump’s connections to Project 2025

At a campaign rally in Michigan earlier this month, Trump told the crowd that Project 2025 is “seriously extreme.”

“Some on the severe right, came up with this Project 25,” Trump said. “ I don’t even know, some of them I know who they are, but they’re very, very conservative. They’re sort of the opposite of the radical left.”

In a post on his social media platform Truth Social, Trump had previously distanced himself from the effort.

“I have no idea who is behind it,” he wrote on July 5. “I disagree with some of the things they’re saying, and some of the things they’re saying are absolutely ridiculous and abysmal.”

But reports show at least 31 of the 38 official authors and editors of Project 2025 have a connection to the former president and GOP presidential candidate. 

Vance, who Trump announced as his running mate earlier this month, also has connections to Project 2025. He wrote the foreword for a book being released later this year by Kevin Roberts, one of the manifesto's key architects.

“Never before has a figure with Roberts’s depth and stature within the American Right tried to articulate a genuinely new future for conservatism,” Vance wrote in a review of the book,  published on Amazon, which has since been removed.

Trump has pointed to his own policy manifesto – “ Agenda 47 ,” so named because the next U.S. president will be its 47th – as evidence that he doesn’t plan to use Project 2025 if he wins in November. Agenda 47 focuses on the same broad issues as Project 2025: Education, immigration and crime, and also tackles the LGBTQ+ community and welfare programs. 

The plans differ in some ways. Agenda 47 doesn’t mention abortion once, for example, while abortion is a focus of Project 2025, which calls on the FDA to reverse its approval of abortion drugs and severely limit the mailing of abortion pills. 

Harriot, the author who has closely studied the document, described Project 2025 as the “employee manual” for a future Trump administration. Agenda 47 is the public-facing statement of the former president’s political intentions, Harriot said, but Project 2025 is where the details are.

“There’s some cognitive dissonance,” Harriot said. “Trump doesn’t get elected by people who are just outwardly racist, and being associated with Project 2025 would dismantle his plausible deniability, because it's so blatantly racist.”  

Haleluya Hadero, Associated Press Haleluya Hadero, Associated Press

Eric Tucker, Associated Press Eric Tucker, Associated Press

Leave your feedback

• Copy URL https://www.pbs.org/newshour/nation/doj-accuses-tiktok-of-collecting-u-s-user-views-on-issues-like-abortion-and-gun-control

DOJ accuses TikTok of collecting U.S. user views on issues like abortion and gun control

WASHINGTON (AP) — In a fresh broadside against one of the world’s most popular technology companies, the Justice Department is accusing TikTok of harnessing the capability to gather bulk information on users based on views on divisive social issues like gun control, abortion and religion.

Government lawyers wrote in documents filed late Friday to the federal appeals court in Washington that TikTok and its Beijing-based parent company ByteDance used an internal web-suite system called Lark to enable TikTok employees to speak directly with ByteDance engineers in China.

TikTok employees used Lark to send sensitive data about U.S. users, information that has wound up being stored on Chinese servers and accessible to ByteDance employees in China, federal officials said.

One of Lark’s internal search tools, the filing states, permits ByteDance and TikTok employees in the U.S. and China to gather information on users’ content or expressions, including views on sensitive topics, such as abortion or religion. Last year, the Wall Street Journal reported TikTok had tracked users who watched LGBTQ content through a dashboard the company said it had since deleted.

The new court documents represent the government’s first major defense in a consequential legal battle over the future of the popular social media platform, which is used by more than 170 million Americans. Under a law signed by President Joe Biden in April, the company could face a ban in a few months if it doesn’t break ties with ByteDance.

READ MORE: These countries have already banned TikTok

The measure was passed with bipartisan support after lawmakers and administration officials expressed concerns that Chinese authorities could force ByteDance to hand over U.S. user data or sway public opinion towards Beijing’s interests by manipulating the algorithm that populates users’ feeds.

”’Intelligence reporting further demonstrates that ByteDance and TikTok Global have taken action in response to (Chinese government) demands to censor content outside of China,” Casey Blackburn, a senior U.S. intelligence official, wrote in a filing that supported the government’s arguments.

The Justice Department warned, in stark terms, of the potential for what it called “covert content manipulation” by the Chinese government, saying the algorithm could be designed to shape content that users receive.

“By directing ByteDance or TikTok to covertly manipulate that algorithm, China could for example further its existing malign influence operations and amplify its efforts to undermine trust in our democracy and exacerbate social divisions,” the brief states.

The concern, the Justice Department said, is more than theoretical, alleging that TikTok and ByteDance employees are known to engage in a practice called “heating” in which certain videos are promoted in order to receive a certain number of views. While this capability enables TikTok to curate popular content and disseminate it more widely, U.S. officials posit it can also be used for nefarious purposes.

Federal officials are asking the court to allow a classified version of the legal brief, which would not be accessible to the two companies.

Nothing in the redacted brief “changes the fact that the Constitution is on our side,” TikTok spokesperson Alex Haurek said in a statement.

“The TikTok ban would silence 170 million Americans’ voices, violating the 1st Amendment,” Haurek said. “As we’ve said before, the government has never put forth proof of its claims, including when Congress passed this unconstitutional law. Today, once again, the government is taking this unprecedented step while hiding behind secret information. We remain confident we will prevail in court.”

In the redacted version of the court documents, the Justice Department said another tool triggered the suppression of content based on the use of certain words. Certain policies of the tool applied to ByteDance users in China, where the company operates a similar app called Douyin that follows Beijing’s strict censorship rules.

But Justice Department officials said other policies may have been applied to TikTok users outside of China. TikTok was investigating the existence of these policies and whether they had ever been used in the U.S. in, or around, 2022, officials said.

The government points to the Lark data transfers to explain why federal officials do not believe that Project Texas, TikTok’s $1.5 billion mitigation plan to store U.S. user data on servers owned and maintained by the tech giant Oracle, is sufficient to guard against national security concerns.

In its legal challenge against the law, TikTok has heavily leaned on arguments that the potential ban violates the First Amendment because it bars the app from continued speech unless it attracts a new owner through a complex divestment process. It has also argued divestment would change the speech on the platform because it would create a version of TikTok lacking the algorithm that has driven its success.

READ MORE: TikTok sues U.S. to block law that could ban the social media platform

In its response, the Justice Department argued TikTok has not raised any valid free speech claims, saying the law addresses national security concerns without targeting protected speech, and argues that China and ByteDance, as foreign entities, aren’t shielded by the First Amendment.

TikTok has also argued the U.S. law discriminates on viewpoints, citing statements from some lawmakers critical of what they viewed as an anti-Israel tilt on the platform during the war in Gaza.

Justice Department officials disputes that argument, saying the law at issue reflects their ongoing concern that China could weaponize technology against U.S. national security, a fear they say is made worse by demands that companies under Beijing’s control turn over sensitive data to the government. They say TikTok, under its current operating structure, is required to be responsive to those demands.

Oral arguments in the case is scheduled for September.

Support Provided By: Learn more

Educate your inbox

Subscribe to Here’s the Deal, our politics newsletter for analysis you won’t find anywhere else.

Thank you. Please check your inbox to confirm.