9 questions about abortion in America, answered
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It’s been one year since the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that there was no constitutional right to an abortion in the US — a decision that overturned Roe v. Wade and 49 years of precedent.
Since then, states have moved to restrict abortion rights. People seeking to end pregnancies across a wide geographic swath of America have wholly or nearly lost the right to do so. Doctors have said that the restrictions endanger their ability to care for patients. New battlegrounds have emerged over medication abortion, the most common form of abortion in the United States. And abortion, always a contentious political and social issue, has become a defining issue in national politics.
The 2022 Dobbs decision and subsequent court cases have also generated enormous confusion across the country about abortion and the legal status of abortion access. That uncertainty isn’t surprising, since abortion laws vary widely and are still changing as bans and other restrictions work their way through state and federal courts.
Here are some common questions people might have about abortion and the state of abortion access, and their actions.
1) What is abortion?
Medically speaking, this might seem like a basic question. Abortion occurs when a pregnancy ends before the birth of a baby.
But the reality is a lot more complicated than that. While abortions, and the right to choose them, are closely associated with unwanted pregnancies, not all abortions happen for that reason. The same procedure is also part of how health care providers treat pregnancy complications, and it’s often done when a pregnancy threatens the life of a pregnant person, or when there is little chance that a pregnancy will end in a living baby. And it can be initiated by the body all by itself — in fact, the medical term for a miscarriage is “spontaneous abortion.”
Abortion is also less separate from other medical procedures than you might think. Many of the medications, tools, and techniques used in the course of performing abortions are also used to treat other medical conditions. The drugs used to perform medication abortions also treat uterine fibroids and stomach bleeding, for example, and there’s a lot of overlap between in-clinic abortion procedures and the treatment of uterine bleeding and certain uterine cancers. —Keren Landman
2) How do people get abortions?
There are two types of abortion: medication abortion and in-clinic abortion (which is also called “surgical” abortion, although it doesn’t typically involve cutting tissue or getting stitches). Medication abortion, which is the most common, can be done at home any time within the first 10 weeks of pregnancy. Typically, patients take two different medicines, mifepristone and misoprostol. As of 2022, more than half of all abortions in the US — about 54 percent — were medication abortions. These medications are currently only available by prescription (although some health care providers think they should be available over the counter).
Abortion pills can also be shipped through the mail through a range of telehealth services. US telehealth providers are subject to some of the same restrictions that brick-and-mortar providers are: Online pharmacies won’t mail pills to addresses in states where the procedure is not legal. That means this form of access has not made abortions easier to get in states with abortion bans.
But that may be changing soon: A New York state law passed this week would allow the state’s abortion providers to prescribe and mail the pills to people in states with abortion bans. (As of June 22, the law was awaiting signature by New York Gov. Kathy Hochul.) And some providers ship to all 50 states anyway, such as the overseas provider Aid Access; Plan C and Mayday Health provide additional information on how people in the US access medication abortion online.
In-clinic abortions usually involve a procedure that’s done in a medical facility. The procedures themselves typically take around 5 to 10 minutes. These methods can be used at any time until the beginning of the 24th week of pregnancy. They generally involve having a health care provider remove the pregnancy tissue from the uterus through the cervix, which is the opening to the uterus that sits at the end of the vagina. This is usually done by inserting a thin tube into the cervix and sucking out the contents of the uterus through it (aspiration abortion), although sometimes, providers need to use medical tools to take out the pregnancy tissue (dilation and evacuation, D&E, sometimes called dilation and curettage, D&C).
Most states prohibit abortion after 24 weeks, and few abortion providers offer abortions in this later stage of pregnancy.
Crisis pregnancy centers are facilities that market themselves as offering reproductive health care but that actually try to dissuade people from getting abortions. These facilities often obscure the fact that they do not provide abortion care, but resources like the Crisis Pregnancy Center Map can help abortion seekers identify them. —KL
3) Is abortion safe?
Abortion — for which safety has been closely scrutinized for decades — is an extraordinarily low-risk procedure. It’s safer than giving birth or getting a colonoscopy.
An extensive 2018 review by the National Academies of Sciences, Engineering, and Medicine concluded that complications of abortion are extremely rare. When they do happen, they take place in less than 1 percent of people who get abortions: In medication abortions, prolonged heavy bleeding happens in only one to three of every 1,000 people, and infection in one to five of every 10,000 people. Rarely — in about 2 percent of cases — people who get a medication abortion need to have an in-clinic procedure to complete the abortion.
In-clinic abortions are also very safe. Complications that lead to hospital admission, surgery, or blood transfusions happen in only one to two of every 1,000 aspiration procedures.
Death due to abortion is extraordinarily rare. Fewer than one of every 100,000 people who get an abortion die of a complication of the procedure — lower than the number who die from giving birth, getting a colonoscopy, or having some plastic surgery procedures.
The safety consequences of denying abortion, meanwhile, are dire. In the Turnaway Study, which followed 1,000 women from around the US over five years, those who gave birth after being denied abortions had higher rates of life-threatening pregnancy complications and more economic hardship than those who received abortions. They were likelier to stay in contact with a violent partner, and their children were more likely to grow up in poverty with developmental challenges. Notably, despite some claims from anti-abortion groups, the mental health of women who had abortions was no worse than that of women who didn’t. —KL
4) Where is abortion legal?
Broadly, the legal landscape around abortion in America now breaks down into a few categories: states where abortion is prohibited (generally with exceptions to save the life of the pregnant person, and sometimes for rape or incest), states where access is limited (for example, by a 12-week ban), and states where abortion is legal with few restrictions.
People living in states where abortion is banned can still travel to another state for the procedure; no bans currently criminalize crossing state lines for an abortion (though Idaho has made it a crime to help a minor leave the state for the procedure without a parent’s consent). In his concurring opinion in Dobbs, Supreme Court Justice Brett Kavanaugh stated that he believed banning interstate travel for the purpose of abortion would be unconstitutional.
Someone who is actively seeking abortion care can visit INeedAnA.com or AbortionFinder.org to learn about options in their area, said Elisabeth Smith, senior staff attorney at the Center for Reproductive Rights. For people who want to understand the larger legal landscape, the center maintains an interactive map of state laws. The New York Times, KFF (formerly the Kaiser Family Foundation), and the Guttmacher Institute also maintain trackers that list current abortion laws in each state.
Two states, South Carolina and Nevada, explicitly ban self-managed abortion, in which people take pills at home using medication ordered online. In other states, prosecutors have used laws against mishandling human remains and other crimes to prosecute people suspected of self-managing abortions. “The important thing for people to consider is who they are sharing information with, how they are sharing information,” Smith said. “Information about self-managed abortion that is shared with law enforcement is the way that those prosecutions have happened.”
People with legal questions about self-managed abortion can contact the If/When/How legal helpline or the Abortion Defense Network. —Anna North
5) Who gets abortions in America?
Historically, abortion has been a very common procedure in America. According to a 2017 analysis by the Guttmacher Institute, nearly one in four women in the US (23.7 percent) will have an abortion by age 45.
Pre-Dobbs research can give us some basic information about who is most likely to get an abortion. The majority of abortion patients are already parents — 60 percent have at least one child, according to 2019 data from the Centers for Disease Control and Prevention. “One of the main reasons people report wanting to have an abortion is so they can be a better parent to the kids they already have,” Ushma Upadhyay, a professor at Advancing New Standards in Reproductive Health at the University of California San Francisco, told the New York Times.
Most are also in their first trimester of pregnancy, with 43 percent of abortions taking place within the first six weeks, shortly after most people find out they’re pregnant, and 92 percent occurring in the first 13 weeks. However, abortion rights advocates say they are concerned that the increasing number of bans and other restrictions will force more patients to delay their procedures until later in pregnancy, when they can carry a higher risk of severe side effects.
Most people who get abortions are in their 20s — 57 percent, according to the CDC, compared with just 9 percent who are in their teens and about 35 percent who are over 30. They are also disproportionately likely to be low-income and to be women of color, largely because of inequities in access to birth control.
Low-income patients and people of color are also most likely to be affected by abortion bans. Black women, in particular, are likely to face multiple overlapping impacts, because they are disproportionately likely to have unintended pregnancies and to live in states with bans, and are less likely to be able to afford travel to states where the procedure is legal, as Vox’s Fabiola Cineas has reported. Black women are also three times more likely than white women to die from pregnancy-related causes; one 2021 study found that a nationwide abortion ban could increase Black maternal deaths by 33 percent. —AN
6) What do Americans think about abortion?
Unpacking public opinion on abortion can be tricky, especially post-Roe, as Americans continue to learn more about the non-hypothetical consequences of losing access to abortion. Sometimes views Americans express in surveys appear to be contradictory, and there’s also a fundamental difference between support for abortion and support for abortion rights. Many people who identify as pro-choice, meaning they believe people should have the right to make the choice for themselves, say they personally are against the procedure.
Polls conducted over the past few months indicate that voters seem to have grown even more supportive of abortion rights than they were before Dobbs. Experts say it will be important to continue tracking public opinion in the coming months and years to see how the loss of Roe informs public sentiment, and that so far we don’t have a clear picture.
Broadly speaking, though, most Americans tell researchers that they support access to legal abortion, though they also support some restrictions on its availability. Americans are most supportive of abortion for women who have been raped or who face a serious health concern if they continue their pregnancy. Americans are also more supportive of abortion during the first trimester.
But pollsters also find respondents are generally opposed to politicians passing abortion bans, and say pregnant women should be able to make decisions about abortion in consultation with their doctor. —Rachel M. Cohen
7) What do we know about the prevalence of abortion since Roe was overturned?
No one knows exactly how many fewer abortions occurred after the Dobbs decision because self-managed abortions are not tracked in the same way as abortions obtained through the formal US health care system.
In other words, while a woman living in Arkansas might have ended her pregnancy in 2021 at a local abortion clinic, in 2023, with that option no longer available to her, she may have ordered or obtained pills internationally, from activist networks in Mexico, the European-based organization Aid Access, or some of the other online suppliers based in India. Researchers who track incidences of abortion generally do not have great access to that data, and even if someone orders pills online, it’s not clear if they actually took the medication. And some people order pills as an insurance policy, to store at home in case they, or a friend, need them for an unwanted pregnancy in the future, complicating counts further.
There is data, however, that suggests abortions done in US clinics and hospitals, or with pills taken at home prescribed by a US doctor, declined since Dobbs. The Society of Family Planning, a group that supports abortion rights, launched a national reporting effort to try to evaluate changes in abortion access and estimated these kinds of abortions declined by more than 24,200 between July 2022 and March 2023, compared to a pre-Dobbs baseline. Some states’ data also shows an increase in out-of-state abortions in the last year, meaning more people are traveling across state lines to get their care. For example, there were 38 percent more non-Floridians who ended pregnancies in Florida in 2022 compared to 2021.
There has also been some anecdotal reporting of women who wanted to end their pregnancies in states where it’s now banned but couldn’t afford the cost of traveling to a state where it’s legal, and so ended up giving birth instead. It will be important for researchers to try and gather more information about how many people fall into this category. —RC
8) Does Europe really restrict abortion more than the United States?
In the Dobbs Supreme Court hearing, Chief Justice John Roberts claimed a 15-week ban on abortion mirrors “the standard that the vast majority of other countries have.” In his majority opinion, Justice Samuel Alito cited a study published by a leading anti-abortion group that argued the US was out of step with the rest of the world in terms of abortion after 20 weeks.
The study, published by the think tank arm of the Susan B. Anthony Pro-Life America, said 47 out of 50 European nations limit “elective” abortion before 15 weeks, meaning before then doctors are not required to attest to a particular justification for the abortion.
But differences between the US and European countries are more complex than that simple comparison suggests. In practice, abortion limits in the United States are far more restrictive than what exists in most of the Western world, including in nations with gestational age limits at 12 weeks, like Germany, Denmark, Belgium, and Italy.
Moreover, European countries that have 12-week limits on “elective” abortions still make it fairly easy for women to get abortions later on, with relatively broad exceptions for mental health or socioeconomic circumstances. Republicans have aggressively fought similar exceptions, and in particular have worked to bar consideration of mental health risk — even the risk of suicide if a pregnancy continues — as a factor.
And in other ways, European countries make it easier to get an abortion than in even relatively permissive jurisdictions in the United States. Across Europe, abortion services are covered under national health insurance, meaning the cost of accessing care is a far lower barrier for pregnant people facing time constraints.
By contrast, in the US, cost is one of the biggest hurdles to ending a pregnancy. Even though more than 90 percent of abortions occur within the first 13 weeks, roughly 75 percent of all US abortion patients are low-income, according to 2014 numbers, and researchers find Americans needing abortion care in the second trimester tend to be those with less education, Black women, and women who have experienced “multiple disruptive events” in the past year, such as losing a job.
Across the globe, the clear trend has been to expand access to abortion, decriminalize the procedure, and loosen restrictions. While restrictive policies, including earlier gestational limits, still present barriers for international abortion care, per the Center for Reproductive Rights, nearly 60 countries have liberalized their laws and policies on abortion since 1994. Only four — the US, El Salvador, Nicaragua, and Poland — have further restricted rights.
Even with earlier gestational limits, abortion in Europe is broadly affordable and accessible. This is not the paradigm Republicans are proposing in the United States. They are fighting to keep abortion expensive, particularly for low-income patients who rely on Medicaid; to limit the reasons, like mental health, for which patients can access legal abortion; and to restrict access to care, all while imposing bans on telemedicine, ramping up criminal penalties for providers, and shortening the legal timeline for pregnant people to raise funds, arrange travel, and book mandatory medical appointments. —RC
9) What happens next? Is Roe v. Wade ever coming back?
Dobbs is not the end of the road on abortion in America — opponents of the procedure continue to work toward more and broader restrictions, while reproductive rights advocates are backing efforts to shore up access in states where it remains legal, as well as keeping options open for patients in states with bans.
On the anti-abortion side, advocates are working to restrict the use of abortion medication. A federal lawsuit by the anti-abortion Alliance for Hippocratic Medicine seeks to rescind Food and Drug Administration approval of mifepristone, one of the two drugs most commonly used in abortions in the US. However, mifepristone remains available as the case works its way through the courts. Abortion opponents are also working on legislation targeting websites that offer abortion medication, out-of-state doctors who prescribe the pills, and private citizens who help people obtain them.
Dobbs also opens up the possibility of a nationwide ban on abortion, and in September 2022, Sen. Lindsey Graham (R-SC) introduced a bill that would ban the procedure across the country after 15 weeks. However, Republican leaders in the House as well as Republican presidential candidates have declined to endorse a nationwide ban, likely a reflection of the fact that such legislation would be both difficult to pass and politically unpopular.
Meanwhile, abortion rights advocates are working on ways to maintain or expand access. At least 15 states and the District of Columbia have passed “shield” laws that protect abortion providers and patients from investigation or prosecution by authorities in states with bans; an increasing number of states specifically shield doctors who prescribe abortion medication by telehealth to patients in states where the procedure is banned. Authorities in several states, including Washington, have also amassed stockpiles of mifepristone in case it becomes unavailable. Other states and localities are expanding funding or insurance coverage for abortion.
At the federal level, Democrats in Congress have introduced legislation to codify the right to an abortion in law, though it has so far been unable to pass. Some reproductive rights advocates believe Dobbs could one day be reversed by the Supreme Court. “The text of the decision is really an outlier, and so some future court would really easily be able to overrule Dobbs and distinguish it from the history of liberty and privacy rights that the court has decided,” Smith said. However, that would most likely require a liberal majority on the Court — something that would require Democrats to win several presidential elections in a row and hold on to the Senate, as Vox’s Ian Millhiser has written.
Some abortion rights advocates remain optimistic for the long term, even while expressing deep concern for the coming months and years. “There will be a new federal right, either through statute or a future court decision,” Smith said. “The question is really how much pain and suffering and loss will occur in the states that have banned abortion between now and then.” —AN
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