by Nela Kolčáková
Abortion is a serious and complex issue. As a complex issue, it has many nuances and can be viewed from a myriad of perspectives. Hence, laws pertaining to abortion should handle the issue delicately. Since the decision from the case of Roe vs. Wade (1973), which practically made the right to have an abortion a constitutional right in the United States, was overturned on the 24th of June 2022, various states have adopted strict abortion laws. Having laws that regulate abortion is not an uncommon thing; after all, only four countries in the world have no laws restricting abortion (Shaw and Norman 50). Abortion laws are mostly about the balance between the rights of the pregnant person and the rights of the unborn child. Thus, making an abortion law too strict, tipping the balance in favor of the potential life too much, is likely to have a severe negative impact on the people who are already alive. On the other hand, the unborn child has a right to live which should be protected. Additionally, there are other effects of abortion laws that need to be considered. For example, lifting abortion restrictions may have a negative impact on birth rates (Levine et al. 202), which may be perceived as a problem by some. The complexity of this issue is why this essay shall take a closer look at the abortion laws in the US and what their possible consequences may be. Many of the state laws that restrict abortion in the United States have problematic wording and are the cause of many concerns and potential future trouble.
History has shown us that it is not possible to ban abortion altogether, only legal abortion. This sentiment was, expressed, for example, by Calderone when she notes that women who want to undergo abortion will obtain it legally or illegally no matter the impositions from the state (950). Regardless of whether one believes it is moral or not, abortion has been around for a long time. Focusing on the American continent, there is evidence that Native American tribes practiced abortion even before any European colonizers came (Whittum and Rapkin 320). Fast-forwarding a few centuries, antiabortion laws that banned any form of abortion at any time during the pregnancy started to be passed across the United States in the second half of the 19th century due to the influence of the American Medical Association (Whittum and Rapkin 320-321). After abortion was criminalized, people turned to dangerous and illegal means of terminating their pregnancies, often doing it at home themselves. Those dangerous means included taking drugs which cause hemorrhage or using various instruments such as “knitting needles, crochet hooks, hairpins, scissors, and button hooks” (Reagan 43). This caused a spike in maternal mortality due to abortions (Whittum and Rapkin 321). The rate of maternal mortality changed after the Roe vs. Wade decision in 1973. There was a significantly lower number of maternal deaths due to illegal abortion in 1974 in comparison to 1972 (Cates and Rochat 87).
However, the USA at the turn of the 20th century is far from the only case of people getting abortions despite it being illegal. For example, abortions were illegal during the Edwardian era in the history of Great Britain, yet it was a “common [and] accepted part of the working-class life” and “there was probably a good deal of discreet middle-class abortion” (Knight 57-58). The women ingested drugs, often containing lead which led to widespread lead poisoning, or used instruments, such as knitting needles, as a means of abortion (Knight 60). All the methods employed often caused health issues or even death. Furthermore, Calderone notes that involving properly trained physicians in the process of abortion lowers maternal mortality (949). It could be argued that in the past, medical care was worse and less effective, and medical knowledge was not widespread, so the danger of at-home abortions and the rate of maternal mortality would not be so high nowadays. Raymond and Grimes found that childbirth is more dangerous than abortion with “the risk of death associated with childbirth [being] approximately 14 times higher than that with [legal induced] abortion” (216). This not only shows that legal abortion methods today are safe for pregnant people, but it also shows how complicated and dangerous childbirth can be. Laws restricting abortion are making the safe means of abortion less accessible. So, as historical examples show, indeed it can be said that it is impossible to ban and stop all abortions because, without other alternatives, people will turn to illegal and unsafe means of abortion. That is why strict abortion laws have a dual effect – they protect the life of the baby, but also endanger the life of the person who is pregnant – and why they can be viewed as problematic and concerning.
History has shown us that it is not possible to ban abortion altogether, only legal abortion.
There are other medical concerns related to the abortion laws. One of the issues is that often the wording of the law is not exact enough. For example, the Texas Heartbeat Act prohibits abortion after cardiac activity is detected with the exception “if a physician believes a medical emergency exists that prevents compliance” (Texas Senate, House). Proponents of this law believe this is enough to ensure the health of pregnant women (Zernike) and, indeed, the law also seems to take mental health into account by making exceptions for pregnancies conceived by rape or incest (Texas Senate, House). However, what constitutes a medical emergency is not clearly defined, and thus getting an abortion becomes something of a legal battle. Hospitals have started to employ lawyers who advise whether the situation is enough of an emergency for the doctors not to be sued when they perform an abortion (Meyer, Zernike). The doctors themselves feel like they cannot provide proper care to their patients (Meyer). For example, if there is a complication that is not urgent enough, the patient gets sent home to wait a few days until the issue worsens and becomes a life-threatening emergency (Zernike). In the modern era where preventive medicine is the goal, this seems like a huge leap backward. Additionally, it puts the patients at more risk and can cause them preventable pain (Meyer). A study shows that maternal morbidity was higher in the two selected hospitals in Texas than in hospitals in states without restrictive abortion legislation (Nambiar et al. 649). This seems to establish a clear connection between the health of the person giving birth and abortion restrictions. It could be argued that the study’s results are not relevant or should be taken with a large grain of salt since only 28 women were included in the study (Nambiar et al. 649) and it is easier to find a statistically significant difference with a small sample size. However, the small sample size does not mean that the results, paired with reports of other individual cases, should be completely disregarded.
Additionally, the laws are affecting even patients who do not seek abortion. In a joint statement, The American Medical Association, American Pharmacists Association, American Society of Health-System Pharmacists, and National Community Pharmacists Association expressed their concerns about unclear wording, especially when it comes to drugs used to induce abortion. Those drugs have other uses than abortion and the patients that need them now face problems with accessing them (“Statement”). The vague wording of the abortion laws prevents medical professionals from providing proper care to their patients and that is why the abortion laws are a concern from a medical point of view.
Moreover, there is a high probability that restricting and banning abortion will have a disproportionately negative impact on groups which are already vulnerable. For example, racial and ethnic minorities, like African Americans and Latinos, already face worse conditions when it comes to healthcare (Institute of Medicine 5). One component of the issue is implicit bias. Physicians are more likely to perceive African Americans as untrustworthy or less intelligent (James 5). It can be thus theorized that by taking away the means to have a legal abortion, African Americans and Latinos are more likely to have negative outcomes. One hypothetical scenario will be used to illustrate possible issues. If a physician does not trust their patient, they may decide that the bleeding or the pain is less severe than what the patient is reporting. In fact, it has been shown that African American patients often do not get adequate treatment for their pain, because of racial bias (Hoffman et al. 4300). Thus the doctor in the hypothetical scenario decides that the patient’s condition is not a medical emergency, and they do not intervene. In this way, minorities’ access to abortion may become even more limited than the access of white people, and their health may be at risk.
Both the rights of the baby and the person giving birth must be taken into consideration.
Furthermore, there are other vulnerable groups, for example, trans men and non-binary people. Prior to surgical intervention, trans men can become pregnant and give birth even when they take testosterone (Light et al. 1123). Some of them became pregnant even while amenorrhoeic, i.e. not having a menstrual cycle (Light et al. 1121). Based on this, it is logical to assume that trans people would be less likely to notice they are pregnant, especially early on, since they often do not have regular menstrual cycles. Laws which severely limit the time frame for getting an abortion are then more likely to prevent trans men and assigned female-at-birth non-binary people from having access to abortion. Unplanned pregnancy and giving birth may trigger gender dysphoria and cause severe psychological distress (Greenfield and Darwin 206-7). Additionally, there is evidence of a discrepancy in relation to the effect of banning abortion occurring in the past. Whittum and Rapkin claim that during the era of strictly criminalized abortions, “poor and low-income women were disproportionately affected by restrictive laws” (321). These are just some of the many examples of vulnerable groups that are likely to experience excessive negative effects related to access to abortion. These examples serve as a demonstration of some of the problems that may arise with the US laws restricting abortion.
A comparison with a country that does not regulate abortions by law may provide further insights into the issue. Canada decriminalized abortion in 1988 and has been treating it “like any other medical procedure (. . .) governed by provincial/territorial and medical regulations” (“History in Canada”) ever since. Canada is a great example to compare with the United States since the two countries are close to each other geographically, economically, and in other aspects as well. Additionally, Canada has quite a long history of not restricting abortion, which is a perfect contrast to the laws being passed in the US. There may be worries that without any legal regulation, the number of abortions would skyrocket. However, in Canada, there has been a “steady incidence” (Shaw and Norman 54) of abortions since 1988 with most of the abortions occurring during the first trimester (Shaw and Norman 54). While there may be a concern related to how the number of abortions jumped from around 70,000 in 1987 to around 100,000 after decriminalization, some of the increase can certainly be attributed to the fact that illegal abortions were not properly reported (Shaw and Norman 54). These statistics indicate that there is no uncontrollable abortion mania going on in Canada. The example of Canada shows that it is possible for a country to exist even without having any laws restricting abortion.
Abortion is certainly a difficult topic and there does not exist one ideal, universal answer to the question of restricting it. Both the rights of the baby and the person giving birth must be taken into consideration. Some countries, for example, Canada, decided not to limit abortion at all, and yet they do not face serious problems. However, the abortion laws in the US that started appearing after the repeal of Roe vs. Wade do not deal with the issue in a wholly satisfying way. Despite often being criminalized, the deliberate termination of pregnancy has been present throughout the history of humankind, and the illegal ways of obtaining abortion have proven to be dangerous for the person pregnant. It is not unreasonable to assume that laws banning or severely restricting abortion today will force at least some people to undergo unsafe at-home abortions. The ones who are most likely to suffer these consequences are vulnerable groups, like minorities or people who are not doing well economically. The US healthcare system is already plagued by some issues of inequality, since African Americans, Latinos, and trans people have worse experiences when it comes to medical care than white cis people. It is plausible that prohibiting abortion in the way most states are doing it will worsen these issues. Moreover, medical professionals themselves have voiced concerns when it comes to these laws. They believe the possible vague interpretations of the laws prevent them from giving all their patients the best care possible, sometimes even in cases unrelated to terminating pregnancy. All in all, it would be irresponsible to claim that everything about the abortion laws in the US is terrible and wrong, however, there are some problematic aspects, and the concerns arising from what impact those laws could have are legitimate.
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