Abortion Research Paper: Example, Outline, & Topics

The long-standing debate surrounding abortion has many opponents and advocates. Groups known as Pro-Choice and Pro-Life argue which approach is better, with no easy solution in sight. This ethical complexity is what makes abortion a popular topic for argumentative writing. As a student, you need to tackle it appropriately.

Our specialists will write a custom essay specially for you!

The picture shows statistics regarding the legal status of abortion.

If this task sounds daunting, read this guide by our custom-writing experts to get excellent writing tips on handling this assignment. You will also find here:

  • abortion topics and prompts,
  • a research paper outline,
  • a free essay sample.
  • 🤔 Why Is Abortion a Good Topic?
  • ☑️ Research Paper Prompts
  • 👨‍⚕️ Abortion Research Questions
  • 📚 Research Topics
  • 🔬 Before You Start
  • ✍️ Step-by-Step Writing Guide

📋 Abortion Research Paper Example

🔍 references, 🤔 why is abortion a good research topic.

Abortion studies are a vast area of research and analysis. It touches upon numerous domains of life, such as politics, medicine, religion, ethics, and human rights perspectives.

Like gun control or euthanasia, the abortion debate offers no evident answers to what kind of regulation is preferable. According to a recent survey, 61% of US adults are in favor of abortion , while 37% think it should be illegal. The arguments from both sides make sense, and there is no “yes-no” solution.

All this makes investigating the abortion debate a valuable exercise to hone your critical analysis skills. It will teach you to back up your claims with sound evidence while giving credit to counterarguments. Besides, expanding the body of abortion research is beneficial for the American community and women’s rights.

☑️ Abortion Research Paper Prompts

The first step to writing a successful paper is choosing an appropriate topic. Abortion is surrounded by numerous legal, medical, ethical, and social debates. That’s why the choice of ideas is virtually endless.

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Don’t know where to start? Check out the prompts and creative titles below.

Should Abortion Be Legal: Research Paper Prompt 

You can approach this question from several perspectives. For example, propose a new legal framework for regulating eligibility for abortion. Some states allow the procedure under certain circumstances, such as a threat to a woman’s health. Should it be made legal in less extreme situations, too?

Anti-Abortion Research Paper Prompt

The legal status of abortions is still disputed in many countries. The procedure’s most ardent opponents are Catholic religious groups. In an anti-abortion paper, you may list ethical or faith-based claims. Focus on the right-to-life arguments and give scientific evidence regarding embryo’s rights.

Abortion and Embryonic Stem Cell Research Prompt   

Stem cell research is a dubious issue that faces strong opposition from ethical and religious activists. Here are some great ideas for an essay on this topic:

  • Start by explaining what stem cells are.
  • Outline the arguments for and against their use in research.
  • Link this discussion to the status of abortion.

Abortion Law Research Paper Prompt

If you get an abortion-related assignment in your Legal Studies class, it’s better to take a legislative approach to this issue. Here’s what you can do:

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  • Study the evolution of abortion laws in the US or other countries.
  • Pinpoint legal gaps.
  • Focus on the laws’ strengths and weaknesses.

Abortion Breast Cancer Research Prompt

Increasing research evidence shows the link between abortion and breast cancer development . Find scholarly articles proving or refuting this idea and formulate a strong argument on this subject. Argue it with credible external evidence.

Abortion Ethics Research Paper Prompt 

Here, you can focus on the significance of the discussion’s ethical dimension. People who are against abortion often cite the ethics of killing an embryo. You can discuss this issue by quoting famous thinkers and the latest medical research. Be sure to support your argument with sound evidence.

👨‍⚕️ Questions about Abortion for Research Paper

  • How does technology reframe the abortion debate ?
  • Is there new ethics of abortion in the 21 st century?
  • How did the abortion debate progress before the Roe v. Wade decision?
  • How is the abortion debate currently being shaped on social media?
  • How do abortion rights advocates conceptualize the meaning of life ?
  • Can the abortion debate be called a culture war?
  • What are women’s constitutional abortion rights ?
  • How does abortion reshape the concept of a person?
  • How does the abortion debate fit in the post-Socialist transition framework of the European community?
  • Where does the abortion debate stand in the politics of sexuality?

📚 Abortion Topics for Research Paper

  • The changing legal rhetoric of abortion in the US .
  • Constructing abortion as a legal problem .
  • Regendering of the US’ abortion problem .
  • Evolution of public attitudes to abortion in the US.
  • Choice vs. coercion in the abortion debate.
  • Abortion and sin in Catholicism.
  • Artificial wombs as an innovative solution to the abortion debate.
  • Religious belief vs. reason in the abortion debate.
  • Introduction of pregnant women’s perspectives into the abortion debate: dealing with fetal abnormalities .
  • The role of ultrasound images in the evolution of women’s abortion intentions.

🔬 Research Papers on Abortions: Before You Start

Before discussing how to write an abortion paper, let’s focus on the pre-writing steps necessary for a stellar work. Here are the main points to consider.

The picture explains the difference between qualitative and quantitative research design.

Abortion Research Design 

Before you start exploring your topic, you need to choose between a qualitative and quantitative research design:

💬 Qualitative studies focus on words and present the attitudes and subjective meanings assigned to the concept of abortion by respondents.

Get an originally-written paper according to your instructions!

🧪 Quantitative studies , in turn, focus on numbers and statistics. They analyze objective evidence and avoid subjective interpretations.  

Pick a research design based on your research skills and the data you’re planning to analyze:

  • If you plan to gain insight into people’s opinions, attitudes, and life experiences related to abortion, it’s better to go for an interview and qualitative analysis.
  • If you have a survey and want to focus on descriptive statistics, it’s better to stick to quantitative methods .

Abortion Research Paper Outline Format

Next, it’s time to choose the format of your paper’s outline. As a rule, students use one of the 3 approaches:

You can learn more about these formats from our article on how to write an outline .

Choosing Headings & Subheadings

A strong title can save your paper, while a poor one can immediately kill the readers’ interest. That’s why we recommend you not to underestimate the importance of formulating an attention-grabbing, exciting heading for your text.

Here are our best tips to make your title and subheadings effective:

  • A good title needs to be brief. It’s up to 5 words, as a rule. Subheadings can be longer, as they give a more extended explanation of the content.
  • Don’t be redundant. Make sure the subheadings are not duplicating each other.
  • Mind the format. For instance, if your paper is in the APA format, you need to use proper font size and indentation. No numbering of headings and subheadings is necessary as in the outline. Ensure the reader understands the hierarchy with the help of heading level distinctions.

Components of an Effective Outline

According to academic writing conventions, a good outline should follow 4 essential principles:

  • Parallelism . All components of your outline need to have a similar grammatical structure. For example, if you choose infinitives to denote actions, stick to them and don’t mix them with nouns and gerunds.
  • Coordination . Divide your work into chunks with equal importance. This way, you will allocate as much weight to one point as to all the others. Your outline’s sections of similar hierarchy should have equal significance.
  • Subordination . The subheadings contained within one heading of a higher order should all be connected to the paper’s title.
  • Division . The minimum number of subheadings in each outline heading should be 2. If you have only one point under a heading, it’s worth adding another one.

Use this list of principles as a cheat sheet while creating your outline, and you’re sure to end up with well-organized and structured research!

Abortion Research Paper Outline Example

To recap and illustrate everything we’ve just discussed, let’s have a look at this sample abortion outline. We’ve made it in the decimal format following all effective outlining principles—check it out!

  • History of abortion laws in the USA.
  • Problem: recent legal changes challenge Roe vs. Wade .
  • Thesis statement: the right to abortion should be preserved as a constitutional right
  • The fundamental human right to decide what to do with their body.
  • Legal abortions are safer.
  • Fetuses don’t feel pain at the early stages of development.
  • Abortion is murder.
  • Fetuses are unborn people who feel pain at later stages.
  • Abortion causes lifelong psychological trauma for the woman.
  • Roe vs. Wade is a pro-choice case.
  • The constitutional right to privacy and bodily integrity.
  • Conclusion.

✍️ Abortion Research Paper: How to Write

Now, let’s proceed to write the paper itself. We will cover all the steps, starting with introduction writing rules and ending with the body and conclusion essentials.

Abortion Introduction: Research Paper Tips  

When you begin writing an abortion paper, it’s vital to introduce the reader to the debate and key terminology. Start by describing a broader issue and steadily narrow the argument to the scope of your paper. The intro typically contains the key figures or facts that would show your topic’s significance.

For example, suppose you plan to discuss the ethical side of abortion. In this case, it’s better to structure the paper like this:

  • Start by outlining the issue of abortion as a whole.
  • Introduce the arguments of pro-choice advocates, saying that this side of the debate focuses on the woman’s right to remove the fetus from her body or leave it.
  • Cite the latest research evidence about fetuses as living organisms, proceeding to debate abortion ethics.
  • End your introduction with a concise thesis statement .

The picture shows parts of an introduction in an abortion research paper.

Thesis on Abortion for a Research Paper

The final part of your introduction is a thesis—a single claim that formulates your paper’s main idea. Experienced readers and college professors often focus on the thesis statement’s quality to decide whether the text is worth reading further. So, make sure you dedicate enough effort to formulate the abortion research paper thesis well!

Don’t know how to do it? These pro tips will surely help you write a great thesis:

Abortion Research Paper Body

Now, it’s time to proceed to the main body of your paper. It should expand on the main idea in more detail, explaining the details and weighing the evidence for and against your argument.

The secret of effective writing is to go paragraph by paragraph . Your essay’s body will have around 2-5 of them, and the quality of each one determines the value of the whole text.

Here are the 4 easy steps that can help you excel in writing the main part of your essay:

  • Start each paragraph with a topic sentence. It functions as a mini-thesis statement and communicates the paragraph’s main idea.
  • Then, expand it with additional facts and evidence. It’s better to back that information with external sources, showing that it’s not your guesswork. Make sure you properly analyze the citations and show how they fit into your broader research.
  • A paragraph should end with a concise wrap-up. Write a concluding sentence restating the topic sentence or a transition linking to the next section.

Research Papers on Abortions: Conclusion

The conclusion of an abortion paper also plays a major role in the overall impression that your paper will produce. So, how do you make it interesting?

Instead of simply restating the thesis and enumerating your points, it’s better to do the following:

  • Focus on the broader implications of the issue you’ve just discussed.
  • Mention your study’s limitations and point out some directions for further research.
  • It’s also a good idea to include a call to action , which can help create a sense of urgency in the readers.

Abortion Articles for Research Paper & Other Sources

Every research paper ends with “works cited” or a reference page enumerating the sources used for the assignment. A rule of thumb is to cite credible, authoritative publications from governmental organizations and NGOs and academic articles from peer-reviewed journals. These sources will make your research more competent and professional, supporting your viewpoint with objective scientific information.

Here are some databases that can supply top-quality data to back the abortion-related claims in a research paper:

Feel free to check these databases for studies related to your subject. It’s best to conduct preliminary research to see whether your topic has enough supporting evidence. Also, make sure there are plenty of new studies to back your arguments! Abortion is a fast-changing field of research, so it’s best only to use publications no more than 5 years old.

To learn more about credible research sources, check out our guide on choosing reliable websites .

We’ve taught you all you need to write a well-researched and thoughtful abortion paper. Finally, we want to give you an example of an essay on the topic “ Should Abortion Rights Be Preserved? ” Check it out to gain inspiration.

Now you know all the details of abortion paper writing. Use our tips to choose a topic, develop sound arguments, and impress your professor with a stellar piece on this debatable subject!

❓ Abortion Research Paper FAQs

  • First, you need to pick a debatable topic about abortion and develop a thesis statement on that subject.
  • Next, choose the arguments to support your claim and use external evidence to back them up.
  • End the paper with a concise wrap-up.
  • Begin your introduction with a catchy fact or shocking statistics on the issue of abortion.
  • Ask a rhetorical question to boost your readers’ interest.
  • Cite a famous person’s words about the pros and cons of legal abortion.

To compose a strong opening for your abortion essay, make sure to provide some background and context for further discussion. Explain why the debate about abortions is so acute and what the roots of the problem are.

There are many interesting topics related to abortion, spanning the areas of sociology, ethics, and medicine. You can focus on the progression of the abortion debate along with civil rights or discuss abortion from a feminist perspective.

You can choose between qualitative and quantitative approaches for your abortion research. Hold a survey among women and report the findings of your qualitative study in a short report. Or, you can measure factual information in numbers and conduct quantitative research.

  • The Ultimate Guide to Writing a Research Paper: Grammarly
  • Scholarly Articles on Abortion: Gale
  • Unintended Pregnancy and Abortion Worldwide: Guttmacher Institute
  • Why Abortion Should Be Legal: News 24
  • Pro and Con: Abortion: Britannica
  • Organizing Academic Research Papers: The Introduction: Sacred Heart University
  • How to Write a Thesis Statement for a Research Paper: Steps and Examples: Research.com
  • Abortion: American Psychological Association
  • Writing a Research Paper: University of Wisconsin-Madison
  • Writing a Research Paper: Purdue University
  • A Process Approach to Writing Research Papers: University of California, Berkeley
  • What Is Qualitative vs. Quantitative Study?: Grand Canyon University
  • Decimal Outlines: Texas A&M University
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  • MJC Library & Learning Center
  • Research Guides
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Start Learning About Your Topic

Create research questions to focus your topic, featured current news, find articles in library databases, find web resources, find books in the library catalog, cite your sources, key search words.

Use the words below to search for useful information in books and articles .

  • birth control
  • pro-choice movement
  • pro-life movement
  • reproductive rights
  • Roe v. Wade
  • Dobbs v. Jackson Women's Health Organization (Dobbs v. Jackson)

Background Reading:

It's important to begin your research learning something about your subject; in fact, you won't be able to create a focused, manageable thesis unless you already know something about your topic.

This step is important so that you will:

  • Begin building your core knowledge about your topic
  • Be able to put your topic in context
  • Create research questions that drive your search for information
  • Create a list of search terms that will help you find relevant information
  • Know if the information you’re finding is relevant and useful

If you're working from off campus , you'll be prompted to sign in if you aren't already logged in to your MJC email or Canvas. If you are prompted to sign in, use the same credentials you use for email and Canvas. 

Most current background reading 

  • Issues and Controversies: Should Women in the United States Have Access to Abortion? June 2022 article (written after the Supreme Court overturned Roe v Wade) that explores both sides of the abortion debate.
  • Access World News: Abortion The most recent news and opinion on abortion from US newspapers.

More sources for background information

  • CQ Researcher Online This link opens in a new window Original, comprehensive reporting and analysis on issues in the news. Check the dates of results to be sure they are sufficiently current.
  • Gale eBooks This link opens in a new window Authoritative background reading from specialized encyclopedias (a year or more old, so not good for the latest developments).
  • Gale In Context: Global Issues This link opens in a new window Best database for exploring the topic from a global point of view.

Choose the questions below that you find most interesting or appropriate for your assignment.

  • Why is abortion such a controversial issue?
  • What are the medical arguments for and against abortion?
  • What are the religious arguments for and against abortion?
  • What are the political arguments for and against abortion?
  • What are the cultural arguments for and against abortion?
  • What is the history of laws concerning abortion?
  • What are the current laws about abortion?
  • How are those who oppose access to abortion trying to affect change?
  • How are those who support access to abortion trying to affect change?
  • Based on what I have learned from my research, what do I think about the issue of abortion?
  • State-by-State Abortion Laws Updated regularly by the Guttmacher Institute
  • What the Data Says About Abortion in the U.S. From the Pew Research Center in June 2022, a look at the most recent available data about abortion from sources other than public opinion surveys.

Latest News on Abortion from Google News

All of these resources are free for MJC students, faculty, & staff.

  • Gale Databases This link opens in a new window Search over 35 databases simultaneously that cover almost any topic you need to research at MJC. Gale databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
  • EBSCOhost Databases This link opens in a new window Search 22 databases simultaneously that cover almost any topic you need to research at MJC. EBSCO databases include articles previously published in journals, magazines, newspapers, books, and other media outlets.
  • Facts on File Databases This link opens in a new window Facts on File databases include: Issues & Controversies , Issues & Controversies in History , Today's Science , and World News Digest .
  • MEDLINE Complete This link opens in a new window This database provides access to top-tier biomedical and health journals, making it an essential resource for doctors, nurses, health professionals and researchers engaged in clinical care, public health, and health policy development.
  • Access World News This link opens in a new window Search the full-text of editions of record for local, regional, and national U.S. newspapers as well as full-text content of key international sources. This is your source for The Modesto Bee from January 1989 to the present. Also includes in-depth special reports and hot topics from around the country. To access The Modesto Bee , limit your search to that publication. more... less... Watch this short video to learn how to find The Modesto Bee .

Browse Featured Web Sites:

  • American Association of Pro-Life Obstetricians and Gynecologists Medical information and anti-abortion rights advocacy.
  • American Congress of Obstetricians and Gynecologists Use the key term "abortion" in the search box on this site for links to reports and statistics.
  • Guttmacher Institute Statistics and policy papers with a world-wide focus from a "research and policy organization committed to advancing sexual and reproductive health and rights worldwide."
  • NARAL Pro-Choice America This group advocates for pro-abortion rights legislation. Current information abortion laws in the U.S.
  • National Right to Life Committee This group advocates for anti-abortion rights legislation in the U.S.

Why Use Books:

Use books to read broad overviews and detailed discussions of your topic. You can also use books to find  primary sources , which are often published together in collections.  

Where Do I Find Books?

You'll use the library catalog to search for books, ebooks, articles, and more.  

What if MJC Doesn't Have What I Need?

If you need materials (books, articles, recordings, videos, etc.) that you cannot find in the library catalog , use our  interlibrary loan service .

Your instructor should tell you which citation style they want you to use. Click on the appropriate link below to learn how to format your paper and cite your sources according to a particular style.

  • Chicago Style
  • ASA & Other Citation Styles
  • Last Updated: Feb 14, 2024 12:41 PM
  • URL: https://libguides.mjc.edu/abortion

Except where otherwise noted, this work is licensed under CC BY-SA 4.0 and CC BY-NC 4.0 Licenses .

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Abortion Research Paper: Facts To Know Before Writing

Benjamin Oaks

Table of Contents

angles that you can use in your paper.

The issue of abortions is highly discussed among various groups of people and has lots of supporters and opponents.

The central aspect of arguing is the fact of interrupting an embryo’s life. Nowadays, even scientists still can’t agree on whether a fetus is a child, can it feel pain during the procedure and may the abortion be considered as a murder.

That is precisely why this topic is not only quite popular but also so newsworthy.

Who knows, maybe your work will push a breakthrough discovery?

Abortion research paper: what is it about?

According to the latest statistics from WHO (World Health Organization), there are approximately 45 million abortions done around the world yearly. This means that every day, roughly 125 000 women are doing an abortion.

As for any difficult decision, abortion has numerous personal reasons. The following list is the roster of most frequently reported reasons for abortion:

  • A woman wants to postpone bearing a child.
  • A woman or family is not financially covered.
  • A child doesn’t fit in the plans (education, career, etc.).
  • A woman considers herself to be too young for a child.
  • There’s a risk to woman’s health.
  • There’s a risk that a child will be born with severe abnormalities.
  • A woman needs to focus on her other children.
  • A woman doesn’t want a baby.

What is more, writing a research paper on abortion requires precise awareness not only of the procedure itself but also of its consequences.

Even when done by professionals, abortion has many risks. They include the chance of infections, incomplete abortion (which would require an additional operation), heavy bleeding (that may lead to death), negative impact on the subsequent pregnancies, and many others.

How to write a decent research paper on abortion?

As I’ve already said, writing a research paper requires lots of exploratory and analytical work. Remember that abortion is a medical topic, so you need to be accurate on everything you write.

To gain a general understanding of the topic, I advise you to search for information on the following questions:

  • What is abortion and how the procedure is performed?
  • The reasons why women choose abortion.
  • The risks for physical and mental health abortion may cause.

There are lots of debates around various aspects of this topic, like morality, humanity, legality, and others. That is why your work may be crucial for better vision of some questions, no matter what is your position towards it.

To write your research successfully, you should follow some basic instructions.

  • Follow the requirements for your task.
  • Avoid rip-off.
  • Check the final work for grammar and style mistakes.
  • Hold to word count limit.
  • Adhere to the specific format.

Abortion research paper topics

As the subject is vast and has a lot of aspects to discover, it is hard to write a research paper on a general question of “Abortion.”

You need to decide which side to join and do research that will prove your point of view.

To support you, here are some ideas of topics that are the most powerful within the issue. You may take one from the list below or just borrow the idea and compose something unique.

  • Adverse psychological effects on families that decided to do an abortion.
  • The life of children whose parents were unable to do an abortion.
  • The physical and psychological effect of abortion on a woman.
  • When abortion has no alternatives?
  • What would be the perfect legislation for abortion?
  • Abortion as an ethical problem.
  • Correlation between religion and abortion.
  • Abortion: a social problem or a way not to destroy society?
  • Whose right to live is more valid: of a woman or an unborn child?
  • Abortion always has a goal.

Research paper against abortion: ideas

If you made up your mind to stand against abortion, you need to think carefully about the reasons behind such a decision. They will be the key ideas of your work.

Keep in mind that the topic is so scrupulous that you have to mind your language not to offend somebody!

Here are some ideas and facts against abortion:

  • An embryo is a human being.
  • The fetus may suffer during the procedure.
  • A woman must be responsible for the sex she had.
  • Abortion is a sin.
  • The number of abortions may affect the birth rate.
  • Abortion may harm subsequent pregnancies.

Research paper on abortion pro-choice

If you’ve decided that you support the idea of abortion, you’ll have to seek for good arguments as a lot of people believe that it is immoral in all aspects.

Below are the best facts and statements that can be useful for your paper.

  • Everybody has a fundamental constitutional right to control own body.
  • Status of an embryo is a subjective thing.
  • Prohibition of abortion may have dreadful consequences.
  • The level of abortions and birth rate depend on different factors.
  • Abortion is a way to prevent overpopulation.
  • There are many cases when pregnancy is unwanted.

Don’t get upset if you can’t make up your mind which side to choose. Abortion is a very controversial issue and needs a severe approach.

Don’t hesitate to look for any necessary information on the topic or even read some abortion research paper examples!

How to craft an abortion research paper outline?

The structure of the research paper is constant, no matter what the topic is.

It usually consists of three parts:

  • Introduction (+ Thesis statement).
  • Conclusion.

In the introduction, you provide your reader with all the necessary background information and definitions on the topic. Here you also express your thesis, which is actually your point of view.

The main body is the research work itself. This is where you place all your ideas and thoughts on a chosen topic. Remember to structure the main body , break it into paragraphs, and put them in a logical order.

In the end, you write a conclusion, which is a short derivation of everything you said before.

At the very beginning, you may need to write an outline. For a general research paper it may look like:

Introduction

  • Hook sentence.
  • Thesis statement.
  • Transition to Main Body.
  • History of abortion.
  • Modern procedure of abortion.
  • Reasons and consequences of abortion.
  • The moral side of the problem.
  • Transition to Conclusion
  • Unexpected twist or a final argument
  • Food for thought

Writing an abortion research paper thesis

Writing a strong thesis can be a challenge. Considering the complexity of the topic , almost everything said about it may sound loud.

Remember that you have to express the idea in one sentence. Be as precise as possible.

Here are some prompts for your thesis:

  • Possible adverse effects of abortion aren’t comparable to the advantages it provides.
  • Criminalization of abortions will cause backstreet procedures which are dangerous for women.
  • Giving birth to a child and giving it up for adoption will help lots of families who can’t have children.
  • A child ought not to be unwanted.
  • Abortions have to be allowed only due to a neatly established number of reasons.

To sum up…

You need to know quite a lot before writing an abortion research paper. Follow the plan above, use the ideas, topics, and arguments in your work.

Research paper on abortion seems to be kinda dull? Luckily, our writers have tons of inspiration and strive to help you out! And they would most definitely complete it before the deadline…

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

50 Abortion Essay Topics: Researching Abortion-Related Subjects

abortion essay topics

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
  • Navigating the Ethical Labyrinth of Abortion: Life, Choice, and Consequences
  • Championing 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 and Well-being
  • The Impact of Abortion Restrictions on Poverty, Inequality, and Social Disparities
  • Addressing Racial and Ethnic Disparities in Abortion Access and Health Outcomes
  • Analyzing the Impact of Public Opinion and Voter Attitudes on Abortion Legislation
  • 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
  • Education and Counseling for Informed Abortion Choices
  • Media Representation and Abortion Perceptions

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.

  • Demystifying Abortion Statistics: Understanding the Global and Domestic Landscape
  • Abortion and Women's Rights: A Historical and Contemporary Perspective
  • Decoding the Impact of Abortion on Public Health and Social Welfare
  • Unveiling the Role of Media and Public Discourse in Shaping Abortion Perceptions
  • 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.

Argumentative Essays Topics

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how do i write a research paper for abortion

What can economic research tell us about the effect of abortion access on women’s lives?

Subscribe to the center for economic security and opportunity newsletter, caitlin knowles myers and caitlin knowles myers john g. mccullough professor of economics; co-director, middlebury initiative for data and digital methods - middlebury college @caitlin_k_myers morgan welch morgan welch senior research assistant & project coordinator - center on children and families, economic studies, brookings institution.

November 30, 2021

  • 21 min read

On September 20, 2021, a group of 154 distinguished economists and researchers filed an amicus brief to the Supreme Court of the United States in advance of the Mississippi case, Dobbs v. Jackson Women’s Health Organization . For a full review of the evidence that shows how causal inference tools have been used to measure the effects of abortion access in the U.S., read the brief here .

Introduction

Dobbs v. Jackson Women’s Health Organization considers the constitutionality of a 2018 Mississippi law that prohibits women from accessing abortions after 15 weeks of pregnancy. This case is widely expected to determine the fate of Roe v. Wade as Mississippi is directly challenging the precedent set by the Supreme Court’s decisions in Roe , which protects abortion access before fetal viability (typically between 24 and 28 weeks of pregnancy). On December 1, 2021, the Supreme Court will hear oral arguments in Dobbs v. Jackson . In asking the Court to overturn Roe , the state of Mississippi offers reassurances that “there is simply no causal link between the availability of abortion and the capacity of women to act in society” 1 and hence no reason to believe that abortion access has shaped “the ability of women to participate equally in the economic and social life of the Nation” 2 as the Court had previously held.

While the debate over abortion often centers on largely intractable subjective questions of ethics and morality, in this instance the Court is being asked to consider an objective question about the causal effects of abortion access on the lives of women and their families. The field of economics affords insights into these objective questions through the application of sophisticated methodological approaches that can be used to isolate and measure the causal effects of abortion access on reproductive, social, and economic outcomes for women and their families.

Separating Correlation from Causation: The “Credibility Revolution” in Economics

To measure the causal effect of abortion on women’s lives, one must differentiate its effects from those of other forces, such as economic opportunity, social mores, the availability of contraception. Powerful statistical methodologies in the causal inference toolbox have made it possible for economists to do just that, moving beyond the maxim “correlation isn’t necessarily causation” and applying the scientific method to figure out when it is.

This year’s decision by the Economic Sciences Prize Committee recognized the contributions 3 of economists David Card, Joshua Angrist, and Guido Imbens, awarding them the Nobel Prize for their pathbreaking work developing and applying the tools of causal inference in a movement dubbed “the credibility revolution” (Angrist and Pischke, 2010). The gold standard for establishing such credibility is a well-executed randomized controlled trial – an experiment conducted in the lab or field in which treatment is randomly assigned. When economists can feasibly and ethically implement such experiments, they do. However, in the social world, this opportunity is often not available. For instance, one cannot feasibly or ethically randomly assign abortion access to some individuals but not others. Faced with this obstacle, economists turn to “natural” or “quasi” experimental methods, ones in which they are able to credibly argue that treatment is as good as randomly assigned.

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Pioneering applications of this approach include work by Angrist and Krueger (1991) leveraging variation in compulsory school attendance laws to measure the effects of schooling on earnings and work by Card and Krueger (1994) leveraging minimum wage variation across state borders to measure the effects of the minimum wages on employment outcomes. The use of these methods is now widespread, not just in economics, but in other social sciences as well. Fueled by advances in computing technology and the availability of data, quasi-experimental methodologies have become as ubiquitous as they are powerful, applied to answer questions ranging from the effects of economic shocks on civil conflict (Miguel, Sayanath, and Sergenti, 2004), to the effects of the Clean Water Act on water pollution levels (Keiser and Shapiro, 2019), and effects of access to food stamps in childhood on later life outcomes (Hoynes, Schanzenbach, Almond 2016; Bailey et al., 2020).

Research demonstrates that abortion access does, in fact, profoundly affect women’s lives by determining whether, when, and under what circumstances they become mothers.

Economists also have applied these tools to study the causal effects of abortion access. Research drawing on methods from the “credibility revolution” disentangles the effects of abortion policy from other societal and economic forces. This research demonstrates that abortion access does, in fact, profoundly affect women’s lives by determining whether, when, and under what circumstances they become mothers, outcomes which then reverberate through their lives, affecting marriage patterns, educational attainment, labor force participation, and earnings.

The Effects of Abortion Access on Women’s Reproductive, Economic, and Social Lives

Evidence of the effects of abortion legalization.

The history of abortion legalization in the United States affords both a canonical and salient example of a natural experiment. While Roe v. Wade legalized abortion in most of the country in 1973, five states—Alaska, California, Hawaii, New York, and Washington—and the District of Columbia repealed their abortion bans several years in advance of Roe . Using a methodology known as “difference-in-difference estimation,” researchers compared changes in outcomes in these “repeal states” when they lifted abortion bans to changes in outcomes in the rest of the country. They also compared changes in outcomes in the rest of the country in 1973 when Roe legalized abortion to changes in outcomes in the repeal states where abortion already was legal. This difference-in-differences methodology allows the states where abortion access is not changing to serve as a counterfactual or “control” group that accounts for other forces that were impacting fertility and women’s lives in the Roe era.

Among the first to employ this approach was a team of economists (Levine, Staiger, Kane, and Zimmerman, 1999) who estimated that the legalization of abortion in repeal states led to a 4% to 11% decline in births in those states relative to the rest of the country. Levine and his co-authors found that these fertility effects were particularly large for teens and women of color, who experienced birth rate reductions that were nearly three times greater than the overall population as a result of abortion legalization. Multiple research teams have replicated the essential finding that abortion legalization substantially impacted American fertility while extending the analysis to consider other outcomes. 4 For example, Myers (2017) found that abortion legalization reduced the number of women who became teen mothers by 34% and the number who became teen brides by 20%, and again observed effects that were even larger for Black teens. Farin, Hoehn-Velasco, and Pesko (2021) found that abortion legalization reduced maternal mortality among Black women by 30-40%, with little impact on white women, offering the explanation that where abortion was illegal, Black women were less likely to be able to access safe abortions by traveling to other states or countries or by obtaining a clandestine abortion from a trusted health care provider.

The ripple effects of abortion access on the lives of women and their families

This research, which clearly demonstrates the causal relationship between abortion access and first-order demographic and health outcomes, laid the foundation for researchers ­to measure further ripple effects through the lives of women and their families. Multiple teams of authors have extended the difference-in-differences research designs to study educational and labor market outcomes, finding that abortion legalization increased women’s education, labor force participation, occupational prestige, and earnings and that all these effects were particularly large for Black women (Angrist and Evans, 1996; Kalist, 2004; Lindo, Pineda-Torres, Pritchard, and Tajali, 2020; Jones, 2021).

Additionally, research shows that abortion access has not only had profound effects on women’s economic and social lives but has also impacted the circumstances into which children are born. Researchers using difference-in-differences research designs have found that abortion legalization reduced the number of children who were unwanted (Bitler and Zavodny, 2002a, reduced cases of child neglect and abuse (Bitler and Zavodny, 2002b; 2004), reduced the number of children who lived in poverty (Gruber, Levine, and Staiger, 1999), and improved long-run outcomes of an entire generation of children by increasing the likelihood of attending college and reducing the likelihood of living in poverty and receiving public assistance (Ananat, Gruber, Levine, and Staiger, 2009).

Access to abortion continues to be important to women’s lives

The research cited above relies on variation in abortion access from the 1970s, and much has changed in terms of both reproductive technologies and women’s lives. Recent research shows, however, that even with the social, economic, and legal shifts that have occurred over the last few decades and even with expanded access to contraception, abortion access remains relevant to women’s reproductive lives. Today, nearly half of pregnancies are unintended (Finer and Zolna, 2016). About 6% of young women (ages 15-34) experience an unintended pregnancy each year (Finer, Lindberg, and Desai, 2018), and about 1.4% of women of childbearing age obtain an abortion each year (Jones, Witwer, and Jerman, 2019). At these rates, approximately one in four women will receive an abortion in their reproductive lifetimes. The fact is clear: women continue to rely on abortion access to determine their reproductive lives.

But what about their economic and social lives? While women have made great progress in terms of their educational attainment, career trajectories, and role in society, mothers face a variety of challenges and penalties that are not adequately addressed by public policy. Following the birth of a child, it’s well documented that working mothers face a “motherhood wage penalty,” which entails lower wages than women who did not have a child (Waldfogel, 1998; Anderson, Binder, and Krause, 2002; Kelven et al., 2019). Maternity leave may combat this penalty as it allows women to return to their jobs following the birth of a child – encouraging them to remain attached to the labor force (Rossin-Slater, 2017). However, as of this writing, the U.S. only offers up to 12 weeks of unpaid leave through the FMLA, which extends coverage to less than 60% of all workers. 5 And even if a mother is able to return to work, childcare in the U.S. is costly and often inaccessible for many. Families with infants can be expected to pay around $11,000 a year for childcare and subsidies are only available for 1 in 6 children that are eligible under the federal program. 6 Without a federal paid leave policy and access to affordable childcare, the U.S. lacks the infrastructure to adequately support mothers, and especially working mothers – making the prospect of motherhood financially unworkable for some.

This is relevant when considering that the women who seek abortions tend to be low-income mothers experiencing disruptive life events. In the most recent survey of abortion patients conducted by the Guttmacher Institute, 97% are adults, 49% are living below the poverty line, 59% already have children, and 55% are experiencing a disruptive life event such as losing a job, breaking up with a partner, or falling behind on rent (Jones and Jerman, 2017a and 2017b). It is not a stretch to imagine that access to abortion could be pivotal to these women’s financial lives, and recent evidence from “The Turnaway Study” 7 provides empirical support for this supposition. In this study, an interdisciplinary team of researchers follows two groups of women who were typically seeking abortions in the second trimester: one group that arrived at abortion clinics and learned they were just over the gestational age threshold for abortions and were “turned away” and a second that was just under the threshold and were provided an abortion. Miller, Wherry, and Foster (2020) match individuals in both groups to their Experian credit reports and observe that in the months leading up to the moment they sought an abortion, financial outcomes for both groups were trending similarly. At the moment one group is turned away from a wanted abortion, however, they began to experience substantial financial distress, exhibiting a 78% increase in past-due debt and an 81% increase in public records related to bankruptcies, evictions, and court judgments.

If Roe were overturned, the number of women experiencing substantial obstacles to obtaining an abortion would dramatically increase.

If Roe were overturned, the number of women experiencing substantial obstacles to obtaining an abortion would dramatically increase. Twelve states have enacted “trigger bans” designed to outlaw abortion in the immediate aftermath of a Roe reversal, while an additional 10 are considered highly likely to quickly enact new bans. 8 These bans would shutter abortion facilities across a wide swath of the American south and midwest, dramatically increasing travel distances and the logistical costs of obtaining an abortion. Economics research predicts what is likely to happen next. Multiple teams of economists have exploited natural experiments arising from mandatory waiting periods (Joyce and Kaestner, 2001; Lindo and Pineda-Torres, 2021; Myers, 2021) and provider closures (Quast, Gonzalez, and Ziemba, 2017; Fischer, Royer, and White, 2018; Lindo, Myers, Schlosser, and Cunningham, 2020; Venator and Fletcher, 2021; Myers, 2021). All have found that increases in travel distances prevent large numbers of women seeking abortions from reaching a provider and that most of these women give birth as a result. For instance, Lindo and co-authors (2020) exploit a natural experiment arising from the sudden closure of half of Texas’s abortion clinics in 2013 and find that an increase in travel distance from 0 to 100 miles results in a 25.8% decrease in abortions. Myers, Jones, and Upadhyay (2019) use these results to envision a post- Roe United States, forecasting that if Roe is overturned and the expected states begin to ban abortions, approximately 1/3 of women living in affected regions would be unable to reach an abortion provider, amounting to roughly 100,000 women in the first year alone.

Restricting, or outright eliminating, abortion access by overturning Roe v. Wade  would diminish women’s personal and economic lives, as well as the lives of their families.

Whether one’s stance on abortion access is driven by deeply held views on women’s bodily autonomy or when life begins, the decades of research using rigorous methods is clear: there is a causal link between access to abortion and whether, when, and under what circumstances women become mothers, with ripple effects throughout their lives. Access affects their education, earnings, careers, and the subsequent life outcomes for their children. In the state’s argument, Mississippi rejects the causal link between access to abortion and societal outcomes established by economists and states that the availability of abortion isn’t relevant to women’s full participation in society. Economists provide clear evidence that overturning Roe would prevent large numbers of women experiencing unintended pregnancies—many of whom are low-income and financially vulnerable mothers—from obtaining desired abortions. Restricting, or outright eliminating, that access by overturning Roe v. Wade would diminish women’s personal and economic lives, as well as the lives of their families.

Caitlin Knowles Myers did not receive financial support from any firm or person for this article. She has received financial compensation from Planned Parenthood Federation of America and the Center for Reproductive Rights for serving as an expert witness in litigation involving abortion regulations. She has not and will not receive financial compensation for her role in the amicus brief described here. Other than the aforementioned, she has not received financial support from any firm or person with a financial or political interest in this article. Caitlin Knowles Myers is not currently an officer, director, or board member of any organization with a financial or political interest in this article.

Abboud, Ali, 2019. “The Impact of Early Fertility Shocks on Women’s Fertility and Labor Market Outcomes.” Available from SSRN: https://ssrn.com/abstract=3512913

Anderson, Deborah J., Binder, Melissa, and Kate Krause, 2002. “The motherhood wage penalty: Which mothers pay it and why?” The American Economic Review 92(2). Retrieved from https://www.aeaweb.org/articles?id=10.1257/000282802320191606

Ananat, Elizabeth Oltmans, Gruber, Jonathan, Levine, Phillip and Douglas Staiger, 2009. “Abortion and Selection.” The Review of Economic Statistics 91(1). Retrieved from https://direct.mit.edu/rest/article-abstract/91/1/124/57736/Abortion-and-Selection?redirectedFrom=fulltext .

Angrist, Joshua D., and Alan B. Krueger, 1999. “Does Compulsory School Attendance Affect Schooling and Earnings?” The Quarterly Journal of Economics 106(4). Retrieved from https://doi.org/10.2307/2937954 .

Angrist, Joshua D., and William N. Evans, 1996. “Schooling and Labor Market Consequences of the 1970 State Abortion Reforms.” National Bureau of Economic Research Working Paper 5406. Retrieved from https://www.nber.org/papers/w5406 .

Angrist, Joshua D., and Jörn-Steffen Pischke, 2010. “The Credibility Revolution in Empirical Economics: How Better Research Design Is Taking the Con out of Econometrics.” Journal of Economic Perspectives 24(2). Retrieved from https://www.aeaweb.org/articles?id=10.1257/jep.24.2.3

Bailey, Martha J., Hoynes, Hilary W., Rossin-Slater, Maya and Reed Walker, 2020. “Is the Social Safety Net a Long-Term Investment? Large-Scale Evidence from the Food Stamps Program” National Bureau of Economic Research Working Paper 26942 , Retrieved from https://www.nber.org/papers/w26942

Bitler, Marianne, and Madeline Zavodny, 2002a. “Did Abortion Legalization Reduce the Number of Unwanted Children? Evidence from Adoptions.” Perspectives on Sexual and Reproductive Health, 34 (1): 25-33. Retrieved from https://www.jstor.org/stable/3030229?origin=JSTOR-pdf

Bitler, Marianne, and Madeline Zavodny, 2002b. “Child Abuse and Abortion Availability.” American Economic Review , 92 (2): 363-367. Retrieved from https://www.aeaweb.org/articles?id=10.1257/000282802320191624

Bitler, Marianne, and Madeline Zavodny, 2004. “Child Maltreatment, Abortion Availability, and Economic Conditions.” Review of Economics of the Household 2: 119-141. Retrieved from https://doi.org/10.1023/B:REHO.0000031610.36468.0e

Farin, Sherajum Monira, Hoehn-Velasco, Lauren, and Michael Pesko, 2021. “The Impact of Legal Abortion on Maternal Health: Looking to the Past to Inform the Present.” Retrieved from SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3913899

Finer, Lawrence B., and Mia R. Zolna, 2016. “Declines in Unintended Pregnancy in the United States, 2008–2011” New England Journal of Medicine 374. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26962904/

Finer, Lawrence B., Lindberg, Laura, D., and Sheila Desai. “A prospective measure of unintended pregnancy in the United States.” Contraception 98(6). Retrieved from https://pubmed.ncbi.nlm.nih.gov/29879398/

Fischer, Stefanie, Royer, Heather, and Corey White, 2017. “The Impacts of Reduced Access to Abortion and Family Planning Services on Abortion, Births, and Contraceptive Purchases.” National Bureau of Economic Research Working Paper 23634 . Retrieved from https://www.nber.org/papers/w23634

Gruber, Jonathan, Levine, Phillip, and Douglas Staiger, 1999. “Abortion Legalization and Child Living Circumstances: Who Is the ‘Marginal Child’?” Quarterly Journal of Economics 114. Retrieved from https://doi.org/10.1162/003355399556007

Guldi, Melanie, 2008. “Fertility effects of abortion and birth control pill access for minors.” Demography 45 . Retrieved from https://doi.org/10.1353/dem.0.0026

Hoynes, Hilary, Schanzenbach, Diane Whitmore, and Douglas Almond, 2016. “Long-Run Impacts of Childhood Access to the Safety Net.” American Economic Review 106(4). Retrieved from https://www.aeaweb.org/articles?id=10.1257/aer.20130375

Jones, Kelly, 2021. “At a Crossroads: The Impact of Abortion Access on Future Economic Outcomes.” American University Working Paper . Retrieved from https://doi.org/10.17606/0Q51-0R11 .

Jones, Rachel K., Witwer, Elizabeth, Jerman, Jenna, September 18, 2018. “Abortion Incidence and Service Availability in the United States, 2017.” Guttmacher Institute. Retrieved from https://www.guttmacher.org/sites/ default/files/report_pdf/abortion-inciden ce-service-availability-us-2017.

Jones Rachel K., and Janna Jerman, 2017a. ”Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014.”  American Journal of Public Health 107 (12). Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304042

Jones, Rachel K. and Jenna Jerman, 2017b. “Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions.” PLoS One . Retrieved from https://pubmed.ncbi.nlm.nih.gov/28121999/

Joyce, Ted, and Robert Kaestner, 2001. “The Impact of Mandatory Waiting Periods and Parental Consent Laws on the Timing of Abortion and State of Occurrence among Adolescents in Mississippi and South Carolina.” Journal of Policy Analysis and Management 20(2) . Retrieved from https://www.jstor.org/stable/3325799 .

Kalist, David E., 2004. “Abortion and Female Labor Force Participation: Evidence Prior to Roe v. Wade.” Journal of Labor Research 25 (3) .

Keiser, David, and Joseph Shapiro, 2019. “Consequences of the Clean Water Act and the Demand for Water Quality.” The Quarterly Journal of Economics 134 (1).

Kleven, Henrik, Landais, Camille, Posch, Johanna, Steinhauer, Andreas, and Josef Zweimuleler, 2019. “Child Penalties Across Countries: Evidence and Explanations.” AEA Papers and Proceedings 109. Retrieved from https://www.aeaweb.org/articles?id=10.1257/pandp.20191078/

Levine, Phillip, Staiger, Douglas, Kane, Thomas, and David Zimmerman, 1999. “Roe v. Wade and American Fertility.” American Journal Of Public Health 89(2) . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508542/

Lindo, Jason M., Myers, Caitlin Knowles, Schlosser, Andrea, and Scott Cunningham, 2020. “How Far Is Too Far? New Evidence on Abortion Clinic Closures, Access, and Abortions” Journal of Human Resources 55. Retrieved from http://jhr.uwpress.org/content/55/4/1137.refs

Lindo, Jason M., Pineda-Torres, Mayra, Pritchard, David, and Hedieh Tajali, 2020. “Legal Access to Reproductive Control Technology, Women’s Education, and Earnings Approaching Retirement.” AEA Papers and Proceedings 110. Retrieved from https://www.aeaweb.org/articles?id=10.1257/pandp.20201108

Lindo, Jason M., and Mayra Pineda-Torres, 2021. “New Evidence on the Effects of Mandatory Waiting Periods for Abortion.” J ournal of Health Econ omics. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34607119/

Miguel, Edward, Satyanath, Shanker, and Ernest Sergenti, 2004. “Economic Shocks and Civil Conflict: An Instrumental Variables Approach.” Journal of Political Economy 112(4). Retrieved from https://www.jstor.org/stable/10.1086/421174

Miller, Sarah, Wherry, Laura R., and Diana Greene Foster, 2020. “The Economic Consequences of Being Denied an Abortion.” National Bureau of  Economic Research, Working Paper 26662 . Retrieved from https://www.nber.org/papers/w26662 .

Myers, Caitlin Knowles, 2017. “The Power of Abortion Policy: Reexamining the Effects of Young Women’s Access to Reproductive Control” Journal of Political Economy 125(6) .  Retrieved from https://doi.org/10.1086/694293 .

Myers, Caitlin Knowles, Jones, Rachel, and Ushma Upadhyay, 2019. “Predicted changes in abortion access and incidence in a post-Roe world.” Contraception 100(5). Retrieved from https://pubmed.ncbi.nlm.nih.gov/31376381/

Myers, Caitlin Knowles, 2021. “Cooling off or Burdened? The Effects of Mandatory Waiting Periods on Abortions and Births.” IZA Institute of Labor Economics No. 14434. Retrieved from https://www.iza.org/publications/dp/14434/cooling-off-or-burdened-the-effects-of-mandatory-waiting-periods-on-abortions-and-births

Quast, Troy, Gonzalez, Fidel, and Robert Ziemba, 2017. “Abortion Facility Closings and Abortion Rates in Texas.” Inquiry: A Journal of Medical Care Organization, Provision and Financing 54 . Retrieved from https://journals.sagepub.com/doi/full/10.1177/0046958017700944

Rossin-Slater, Maya, 2017. “Maternity and Family Leave Policy.” National Bureau of Economic Research Working Paper 23069. Retrieved from https://www.nber.org/papers/w23069

Venator, Joanna, and Jason Fletcher, 2020. “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin.” Journal of Policy Analysis and Management 40(3). Retrieved from https://doi.org/10.1002/pam.22263

Waldfogel, Jane, 1998. “The family gap for young women in the United States and Britain: Can maternity leave make a difference?” Journal of Labor Economics 16(3).

  • Thomas E. Dobbs v. Jackson Women’s Health Organization. On Writ of Certiorari to the United States Court of Appeals for the Fifth Circuit, Brief in Support of Petitioners, No. 19-1392.
  • Thomas E. Dobbs v. Jackson Women’s Health Organization. On Writ of Certiorari to the United States Court of Appeals for the Fifth Circuit, Brief for Petitioners, No. 19-139, Retrieved from https://www.supremecourt.gov/DocketPDF/19/19-1392/184703/20210722161332385_19-1392BriefForPetitioners.pdf
  • The Nobel Prize. 2021. “Press release: The Prize in Economic Sciences 202.” Retrieved from https://www.nobelprize.org/prizes/economic-sciences/2021/press-release/
  • See Angrist and Evans (1996), Gruber et al. (1999), Ananat et al. (2009), Guldi (2008), Myers (2017), Abboud (2019), Jones (2021).
  • Brown, Scott, Herr, Jane, Roy, Radha , and Jacob Alex Klerman, July 2020. “Employee and Worksite Perspectives of the FMLA Who Is Eligible?” U.S. Department of Labor. Retrieved from https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA2018PB1WhoIsEligible_StudyBrief_Aug2020.pdf
  • Whitehurst, Grover J., April 19, 2018. “What is the market price of daycare and preschool?” Brookings Institution. Retrieved from https://www.brookings.edu/research/what-is-the-market-price-of-daycare-and-preschool/; Chien, Nina, 2021. “Factsheet: Estimates of Child Care Eligibility & Receipt for Fiscal Year 2018.” U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/sites/default/files/20 21-08/cy-2018-child-care-subsidy-eligibility.pdf
  • Advancing New Standards in Reproductive Health (NSIRH). “The Turnaway Study.” Retrieved from https://www.ansirh.org/research/ongoing/turnaway-study.
  • Center for Reproductive Rights, 2021. “What If Roe Fell?” Retrieved from https://maps.reproductiverights.org/what-if-roe-fell

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How to Write a Research Paper on Abortion

how to write a research paper on abortion

Table of Contents

Edited on April, 2021

How to start a research paper on abortion

Abortion is one ethical issue that falls under the category of ethical issues that are very much problematic to resolve because it coincides with different cultural and religious implications. The discourse on abortion reaches many levels and branches and it is broad in nature.  Writing a research paper  on abortion requires recognition of different perspectives in order to build a multifaceted discourse that would be well understood by different kinds of readers.

Tips on how to start

In starting a research paper on abortion, first, determine what specific topic about abortion you would want to research. This may be based on your interest or from reading various literature on abortion. What of this information that you know and you have read about sparks your interest?

Interest is however not enough. A topic needs to be researchable. One cannot actually choose any  topic on abortion  without examining if it is a good one to research. When we say a researchable topic, this means that your research questions may be answered by your research. Or that it should be able to be answered within the timeframe of your research.

After you have chosen a topic, you may start coming up with an outline of your research.

Example of an outline

An example outline for your research paper may be the following:

  • Introduction

A. Subject matter B. Statement of the problem C. History of the problem

A. Extent of the problem B. Related literature (Examples, stories, facts)

A. Cause and Effect B. Repercussions in contemporary times

A. Possible solutions

A. Relate back to the intro B. Restate thesis

Example of a good thesis statement for an abortion research paper

A thesis or hypothesis is the researcher’s perception of the result of the study. This is based on knowledge, observations, or other study results.

Examples may be:

  • The reason why women resort to abortion is mostly that they are not prepared for the pregnancy.
  • Most of the people resorting to abortion are teenagers.
  • Most women who go on abortion do the act by themselves.
  • The most common method used by women in abortion is by taking abortifacients.

Example of an introduction to an abortion research paper

Abortion is the termination of pregnancy before it is viable, usually before the pregnancy is before its 25th week. There are two types of abortion, spontaneous and induced. Spontaneous abortion is one that occurs naturally due to some complications during pregnancy or due to trauma occurring to the mother or the fetus. Induced abortion is one that was done intentionally. More and more teenagers opt to undergo induced abortion in the US. Trends in the number of abortions by females aged 13 to 18 show a significant increase from 2015 to 2016 ( this should be supported by statistical data from reliable source/s).

To be able to know why teenagers resort to this practice, the study has the following specific questions:

  • Determine the circumstances that lead to the pregnancy.
  • Determine the reasons why the respondents opted to terminate their pregnancy.
  • Identify the methodology they used to terminate their pregnancy.

How to write body paragraphs for a research paper on abortion

The body of the paper covers the methodology and the results from the data gathering. Paragraphs on the methodology part may be subdivided into the methodology to be used; how to do data gathering using the methodology; the number of respondents needed in the study and a description of the respondents; and how long the data gathering will be done.

For the results and discussion, the paragraphs may contain a little introduction on the general findings and then each paragraph will contain the answer to each question asked in the interview or survey and the results of the survey or interview. This is followed by an interpretation of the data gathered.

Tips on body writing

  • Determine the number of respondents that you need. Take only a few samples from the total number of possible respondents. A good number will help you get good data and also save you time.
  • Research on good methodologies to be used that match the type of research you are using. Some questions are answered by surveys, some by interviews, and some by observations.
  • Provide statistical data as well as observations on your presentation of data. If some of the respondents have stated something you know is good to include on the paper, then include it on the paper.
  • Be truthful with what you will write on the results even if it is different from what you have expected. You shouldn’t also plagiarize and provide proper citations if you need to support your findings with other researches from other authors. This is one of the ethics of research writing.
  • If you used many different methods and you have a lot of data, divide these per theme and then present it per theme to make your data presentation organized.

Example of the 1st body paragraph

For the first body paragraph on the presentation of data one may write the following:

There are various circumstances that lead to the pregnancy of the respondents, most answers were because of curiosity. However, some of the respondents got pregnant because of rape. In a nutshell, there is a number of other reasons among the most widespread.

Example of the 2nd body paragraph

There are various reasons that made the respondents opt to have their pregnancy terminated. Most of the answers are due to reasons that they are not yet ready for the pregnancy. Based on national statistics from research done by (mention author and year), most females aged 13-17 terminate their pregnancy also due to the same reason.

Example of the 3rd body paragraph

The methodologies used by the respondents to terminate their pregnancy were the use of abortifacients on their own, going to a licensed medical practitioner, going to an unlicensed abortionist, and doing it on their own with the help of a friend or partner. Most of them opted for the use of abortifacients. Most of them said that it is easy to buy such medicine online. Some respondents also sought medical help and a few respondents did the termination by themselves.

How to finish a research paper on abortion

To finish a research paper, write a concluding paragraph. This summarizes the findings, also still answering the research questions.

Tips on conclusion writing

In writing a conclusion, a writer may write one paragraph that summarizes all the findings. Make sure that the main answer to each research question should be stated in the conclusion. A student may write one or two sentence/s to provide an answer to each of the research questions.

Example of a conclusion

From data gathered in the research paper, the main reason that leads to pregnancy among teenage females in the US is curiosity. The main reason, on the other hand for terminating the pregnancy, is because they are not yet ready to face parental responsibilities. Thus, there should be a huge work done to inform teenage females about all the negative impacts of interrupting pregnancy so as to ensure that abortion was a well-thought-out decision.

Tips on research paper revision

Revising a research paper will be less taxing than starting one. The following should be taken note of.

  • Take note of the revisions suggested by the editor or adviser and do those revisions first.
  • Do revisions per section or per chapter so it will be easier.
  • Read more on additional sources that might be helpful for revisions.
  • Check your grammar as well when doing the revisions.
  • Read the write-up thoroughly after the revision to check if the flow is still well even after adding up more information.
  • It is also helpful to ask somebody to read your paper to check if it is understood by the reader and also to help proofread the paper.

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Important conclusions from abortion studies

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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.

  • Abortion, Induced*
  • Demography*
  • Evaluation Studies as Topic*
  • Family Planning Services
  • Prevalence*
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Persuasive Essay Guide

Persuasive Essay About Abortion

Caleb S.

Crafting a Convincing Persuasive Essay About Abortion

Published on: Feb 22, 2023

Last updated on: Nov 22, 2023

Persuasive Essay About Abortion

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Are you about to write a persuasive essay on abortion but wondering how to begin?

Writing an effective persuasive essay on the topic of abortion can be a difficult task for many students. 

It is important to understand both sides of the issue and form an argument based on facts and logical reasoning. This requires research and understanding, which takes time and effort.

In this blog, we will provide you with some easy steps to craft a persuasive essay about abortion that is compelling and convincing. Moreover, we have included some example essays and interesting facts to read and get inspired by. 

So let's start!

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How To Write a Persuasive Essay About Abortion?

Abortion is a controversial topic, with people having differing points of view and opinions on the matter. There are those who oppose abortion, while some people endorse pro-choice arguments. 

It is also an emotionally charged subject, so you need to be extra careful when crafting your persuasive essay .

Before you start writing your persuasive essay, you need to understand the following steps.

Step 1: Choose Your Position

The first step to writing a persuasive essay on abortion is to decide your position. Do you support the practice or are you against it? You need to make sure that you have a clear opinion before you begin writing. 

Once you have decided, research and find evidence that supports your position. This will help strengthen your argument. 

Check out the video below to get more insights into this topic:

Step 2: Choose Your Audience

The next step is to decide who your audience will be. Will you write for pro-life or pro-choice individuals? Or both? 

Knowing who you are writing for will guide your writing and help you include the most relevant facts and information.

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Step 3: Define Your Argument

Now that you have chosen your position and audience, it is time to craft your argument. 

Start by defining what you believe and why, making sure to use evidence to support your claims. You also need to consider the opposing arguments and come up with counter arguments. This helps make your essay more balanced and convincing.

Step 4: Format Your Essay

Once you have the argument ready, it is time to craft your persuasive essay. Follow a standard format for the essay, with an introduction, body paragraphs, and conclusion. 

Make sure that each paragraph is organized and flows smoothly. Use clear and concise language, getting straight to the point.

Step 5: Proofread and Edit

The last step in writing your persuasive essay is to make sure that you proofread and edit it carefully. Look for spelling, grammar, punctuation, or factual errors and correct them. This will help make your essay more professional and convincing.

These are the steps you need to follow when writing a persuasive essay on abortion. It is a good idea to read some examples before you start so you can know how they should be written.

Continue reading to find helpful examples.

Persuasive Essay About Abortion Examples

To help you get started, here are some example persuasive essays on abortion that may be useful for your own paper.

Short Persuasive Essay About Abortion

Persuasive Essay About No To Abortion

What Is Abortion? - Essay Example

Persuasive Speech on Abortion

Legal Abortion Persuasive Essay

Persuasive Essay About Abortion in the Philippines

Persuasive Essay about legalizing abortion

You can also read m ore persuasive essay examples to imp rove your persuasive skills.

Examples of Argumentative Essay About Abortion

An argumentative essay is a type of essay that presents both sides of an argument. These essays rely heavily on logic and evidence.

Here are some examples of argumentative essay with introduction, body and conclusion that you can use as a reference in writing your own argumentative essay. 

Abortion Persuasive Essay Introduction

Argumentative Essay About Abortion Conclusion

Argumentative Essay About Abortion Pdf

Argumentative Essay About Abortion in the Philippines

Argumentative Essay About Abortion - Introduction

Abortion Persuasive Essay Topics

If you are looking for some topics to write your persuasive essay on abortion, here are some examples:

  • Should abortion be legal in the United States?
  • Is it ethical to perform abortions, considering its pros and cons?
  • What should be done to reduce the number of unwanted pregnancies that lead to abortions?
  • Is there a connection between abortion and psychological trauma?
  • What are the ethical implications of abortion on demand?
  • How has the debate over abortion changed over time?
  • Should there be legal restrictions on late-term abortions?
  • Does gender play a role in how people view abortion rights?
  • Is it possible to reduce poverty and unwanted pregnancies through better sex education?
  • How is the anti-abortion point of view affected by religious beliefs and values? 

These are just some of the potential topics that you can use for your persuasive essay on abortion. Think carefully about the topic you want to write about and make sure it is something that interests you. 

Check out m ore persuasive essay topics that will help you explore other things that you can write about!

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Facts About Abortion You Need to Know

Here are some facts about abortion that will help you formulate better arguments.

  • According to the Guttmacher Institute , 1 in 4 pregnancies end in abortion.
  • The majority of abortions are performed in the first trimester.
  • Abortion is one of the safest medical procedures, with less than a 0.5% risk of major complications.
  • In the United States, 14 states have laws that restrict or ban most forms of abortion after 20 weeks gestation.
  • Seven out of 198 nations allow elective abortions after 20 weeks of pregnancy.
  • In places where abortion is illegal, more women die during childbirth and due to complications resulting from pregnancy.
  • A majority of pregnant women who opt for abortions do so for financial and social reasons.
  • According to estimates, 56 million abortions occur annually.

In conclusion, these are some of the examples, steps, and topics that you can use to write a persuasive essay. Make sure to do your research thoroughly and back up your arguments with evidence. This will make your essay more professional and convincing. 

Need the services of a professional essay writing service ? We've got your back!

MyPerfectWords.com is a persuasive essay writing service that provides help to students in the form of professionally written essays. Our persuasive essay writer can craft quality persuasive essays on any topic, including abortion. 

Frequently Asked Questions

What should i talk about in an essay about abortion.

When writing an essay about abortion, it is important to cover all the aspects of the subject. This includes discussing both sides of the argument, providing facts and evidence to support your claims, and exploring potential solutions.

What is a good argument for abortion?

A good argument for abortion could be that it is a woman’s choice to choose whether or not to have an abortion. It is also important to consider the potential risks of carrying a pregnancy to term.

Caleb S. (Marketing, Linguistics)

Caleb S. has been providing writing services for over five years and has a Masters degree from Oxford University. He is an expert in his craft and takes great pride in helping students achieve their academic goals. Caleb is a dedicated professional who always puts his clients first.

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National Academies Press: OpenBook

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

images

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.

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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.

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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.

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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

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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.

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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.

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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).

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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.

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Reproductive rights in America

Abortion pills that patients got via telehealth and the mail are safe, study finds.

Selena Simmons-Duffin

Selena Simmons-Duffin

how do i write a research paper for abortion

Access to the abortion drug mifepristone could soon be limited by the Supreme Court for the whole country. Here, a nurse practitioner works at an Illinois clinic that offers telehealth abortion. Jeff Roberson/AP hide caption

Access to the abortion drug mifepristone could soon be limited by the Supreme Court for the whole country. Here, a nurse practitioner works at an Illinois clinic that offers telehealth abortion.

In March, the Supreme Court will hear a case about mifepristone, one of two drugs used in medication abortions. A key question in that case is: Was the Food and Drug Administration correct when it deemed the drug safe to prescribe to patients in a virtual appointment?

A study published Thursday in Nature Medicine looks at abortion pills prescribed via telehealth and provides more support for the FDA's assessment that medication abortion is safe and effective.

Researchers examined the electronic medical records for more than 6,000 patients from three providers of abortion via telehealth. They also conducted an opt-in survey of 1,600 patients.

Some abortion patients talked to a provider over video, others used a secure chat platform, similar to texting. If patients were less than 10 weeks pregnant and otherwise found to be eligible, the providers prescribed two medications: mifepristone, which blocks a pregnancy hormone called progesterone, and misoprostol, which causes uterine contractions. Patients got both medicines via mail-order pharmacy.

Research at the heart of a federal case against the abortion pill has been retracted

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Research at the heart of a federal case against the abortion pill has been retracted.

"Then 3 to 7 days later, there was a clinical follow up," explains the study's lead author, Ushma Upadhyay of the University of California – San Francisco. "The provider checked in with the patient. 'Did you receive the medications? Did you take the medications?' They asked about symptoms. And then there was a clinical follow-up four weeks after the original intake."

The researchers found that the medication was effective – it ended the pregnancy without any additional follow-up care for 97.7% of patients. It was also found to be safe – 99.7% of abortions were not followed by any serious adverse events. The safety and efficacy was similar whether the patients talked to a provider over video or through secure chat.

"These results shouldn't be surprising," Upadhyay says. "It's consistent with the over 100 studies on mifepristone that have affirmed the safety and effectiveness of this medication."

The results also echo international research on telehealth abortion and studies of medication abortion dispensed in a clinic with an in-person appointment, she notes.

Rishi Desai of Harvard Medical School is a medication safety expert who was not involved in the study. He says it was "well-conducted," especially considering it can be difficult to track patients who only connect with providers remotely.

"I would say that this study provides reassuring data regarding safety of the medications, and this is very much in line with what we have seen in many previous studies," he says. "So it's good to see that safety findings hold up in this setting as well."

Still, whether mifepristone is safe and whether FDA has appropriately regulated how it is prescribed is a live legal question right now.

An anti-abortion rights group sued FDA in 2022, arguing that mifepristone is not safe and was improperly approved in 2000. Judge Matthew Kacsmaryk, a district court judge appointed to the federal bench by President Trump, ruled that mifepristone should be pulled from the market nationwide. Although his decision didn't take effect pending appeals, the appeals court ruled against the FDA in part, specifically rolling back telehealth abortion access. That is also on hold for now.

The Supreme Court hears arguments in the case on March 26. The decision could affect access to medication abortion nationwide and set a new precedent on challenges to the FDA's authority.

Recently, there's been a flurry of mifepristone research news. Last week, a paper that raised safety concerns about mifepristone was retracted . This study, released Thursday, affirms the FDA's position that the medicine can be safely prescribed remotely.

Upadhyay says she's been working on this research for years and that the timing of its publication weeks before the Supreme Court arguments is coincidental.

"I don't know if they can enter new evidence into the case at this point," she says. "But I do hope it impacts the perception of how safe this medication is."

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A Review of Exceptions in State Abortion Bans: Implications for the Provision of Abortion Services

Mabel Felix , Laurie Sobel , and Alina Salganicoff Published: May 18, 2023

  • Issue Brief

Key Takeaways

Abortion is currently banned in 14 states and many other states have attempted to ban or severely restrict access to abortion. Nearly all of these bans include exceptions, which generally fall into four categories: to prevent the death of the pregnant person, when there is risk to the health of the pregnant person, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly.

  • In practice, health and life exceptions to bans have often proven to be unworkable, except in the most extreme circumstances, and have sometimes prevented physicians from practicing evidence-based medicine.
  • Abortion bans and restrictions have led physicians to delay providing miscarriage management care. Many states allow for the removal of a dead fetus or embryo, but pregnant people who are actively miscarrying may be denied care if there is still detectable fetal cardiac activity or until the miscarriage puts the life of the pregnant person in jeopardy.
  • Mental health exceptions are rare despite the fact that 20% of pregnancy-related deaths are attributable to mental health conditions.
  • Law enforcement involvement is often required to document rape and incest, which often prevents survivors from accessing abortion care. Furthermore, survivors in states where abortion care is restricted can have difficulty finding an abortion provider.
  • In many states there is more than one abortion ban in the books, in some of those states, the exception provisions in the bans are often at odds with each other. These multiple bans and varying exceptions create confusion among patients and providers.

Introduction

Since the Supreme Court’s Dobbs decision overturning Roe v. Wade, state abortion bans and the exceptions they contain – or lack – have garnered significant attention. Conversations about these exceptions, however, often obscure the reality that many of these exceptions can be unworkable in practice. There are reports of people being unable to obtain abortions, despite the fact that their pregnancies fall into these broad exception categories. While there is no accurate estimate of the number of people seeking abortion care in circumstances that qualify for an exception in states than ban abortion, the number of people who have received abortion care post – Dobbs in states that have banned abortion is very low .  Many of the exceptions included in these bans use definitions that are vague, narrow, and non-clinical, and effectively remove the ability of health care providers to best manage the care of pregnant people, instead leaving that decision to the state or the clinician’s home institution. Further complicating matters, several states have multiple bans in effect, often with contradicting definitions, requirements, exceptions, and standards, creating ambiguity for clinicians and their patients. This brief analyzes the exceptions to abortion bans and discusses how their purported aims to provide life-saving care may not be achieved in practice.

What kinds of exceptions do abortion bans contain?

To prevent the death of the pregnant person.

All state abortion bans currently in effect contain exceptions to “prevent the death” or “preserve the life” of the pregnant person. As explained in further detail in the section below, these exceptions may create difficulties for physicians, as it is unclear how much risk of death or how close to death a pregnant patient may need to be for the exception to apply and the determination is not up to the physician treating the pregnant patient.

When there is risk to the health of the pregnant person

Most states with bans that contain a health exception permit abortion care when there is a serious risk of substantial and irreversible impairment of a major bodily function. These exceptions are limited by the lack of specific clinical definitions of the conditions qualifying for the exception. Only the Arizona ban explicitly defines the bodily functions that may be considered “major.”  The other states that use this language in their bans do not define what constitutes a “major bodily function,” nor what constitutes a “substantial impairment” to a major bodily function. This vague language puts physicians providing care to pregnant people in a difficult situation should their patients need an abortion to treat a condition jeopardizing their health and can leave the determination of whether an abortion can be legally provided to lawyers for the institution in which the clinician practices. For instance, in Ohio , where the abortion ban has a health exception, the law lists a couple of conditions that may fall under this exception, such as pre-eclampsia and premature rupture of the membranes, but with no further detail.  Using this language as guidance, it would be difficult for physicians to know if a significant health issue would fall under the exception. The difficulties presented by the simultaneous vagueness and narrowness of the exceptions are exacerbated by the lack of deference given to clinicians’ medical judgment under these bans.

In their lawsuit against the Ohio abortion ban, providers challenged the provisions of the health exception, arguing its vagueness makes it impossible to treat some patients presenting with serious health concerns. As an example, one provider detailed the case of a woman with stage III melanoma who was denied cancer treatment while pregnant and was also denied abortion care in Ohio because clinicians could not confirm whether the ban’s exceptions applied to her case. Instead, this woman left the state to terminate her pregnancy and receive cancer treatment.

However, even if these terms were defined more clearly, they would still exclude many health conditions pregnant people face. In Georgia , for example, where the health exception is slightly narrower than Ohio’s, providers challenging the ban note that the exceptions do not permit abortion care when it is needed to prevent: “(1) substantial but reversible physical impairment of a major bodily function, (2) less than ‘substantial’ but irreversible physical impairment of a major bodily function, or (3) substantial and irreversible physical impairment of a bodily function that is not ‘major.’” A medical condition may still be a significant health event, yet not qualify under the exceptions, even if their limits were more clearly defined.

In Texas ’ abortion ban, the health exception is limited to situations where there is “a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that […] poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced”. A condition needs to be “life-threatening” and “be aggravated by, caused by, or arising from the pregnancy” for a clinician to be able to intervene by providing abortion care. Many serious health conditions unrelated to the pregnancy may not qualify for an exception. In cases where terminating a pregnancy is necessary to begin medical treatment, it is difficult to ascertain if the pregnancy itself can be said to be aggravating the condition and therefore qualify for the exception.

MENTAL HEALTH

Mental health conditions account for over 20% of pregnancy-related deaths  in the US, yet almost all states with health exceptions limit them to conditions affecting physical health, with some going further and explicitly precluding emotional or psychological health conditions. Alabama , the only state that includes mental health concerns in its health exception, requires a psychiatrist to diagnose the pregnant person with a “serious mental illness” and document it is likely the person will engage in behavior that could result in her death or the death of the fetus that due to their mental health condition. The law does not define “serious mental illness” and does not allow physicians to determine what serious mental illnesses qualify for the exception.  In addition, abortion bans and restrictions in Georgia, Kentucky, Louisiana, Ohio, Tennessee, Idaho, Florida, Iowa, West Virginia, and Wyoming explicitly exclude mental/emotional health. Several other states (Texas, Oklahoma, Mississippi, the remaining Kentucky ban, and one of Arkansas’ total bans) limit their life and/or health exceptions to physical conditions, without explicitly calling out mental/emotional health exceptions.

ECTOPIC PREGNANCIES AND MISCARRIAGES

Some states’ abortion laws specify that care for ectopic pregnancies and pregnancy loss is not criminalized in its statutes. Most states with these provisions in their bans allow for the removal of a dead fetus or embryo, but not for miscarriage care, generally. This means that pregnant people who are actively miscarrying may be denied care if there is still detectable fetal cardiac activity. There have already been reports of such situations in Texas and Louisiana . In Louisiana, for example, a pregnant woman went to the hospital after experiencing sharp pain and bleeding. She was informed her fetus had likely stopped growing a few weeks prior, as its size did not correspond to the length of her pregnancy, and that it had very faint cardiac activity. Despite the pain and the blood loss she was experiencing, she could not receive the regimen of mifepristone and misoprostol commonly prescribed to pregnant patients who are miscarrying to ensure that the pregnancy is safely expelled from the body completely in a timely manner, thereby decreasing the risk of sepsis and infection. Instead, she had to wait for the miscarriage to progress without medical intervention, which would have expedited the process and reduced her medical risk.  In states where the abortion bans do not clarify that miscarriage care is not criminalized – even when there is still detectable cardiac activity – pregnant people may not be able to receive care to manage their pregnancy loss unless and until it becomes a medical emergency.

GREATER RISK TO THE HEALTH OF PREGNANT PEOPLE

In deciding whether or not to provide abortion care to preserve the health of a pregnant patient, physicians now face the risk of a jury or the state disagreeing with their judgment about the gravity of the health risk the pregnant person was experiencing, and as a result, face prison time, monetary fines, and loss of professional license. Prior to the Supreme Court’s decision in Dobbs , the decision to have an abortion pre-viability when facing a health risk was one the pregnant person would make in consultation with medical professionals. How much risk constituted too much risk was up to the pregnant person and their physician, taking into account the needs and overall health history of the pregnant patient.  In states with abortion bans, in deciding whether or not to provide abortion care to preserve the health of a pregnant patient, physicians now face the risk of a jury or the state disagreeing with their judgment about the gravity of the health risk the pregnant person was experiencing, and as a result, face prison time, monetary fines, and loss of professional license.

In state court challenges against the bans, providers have argued that the vagueness of the bans is unconstitutional, since it places them in a situation where it is unclear how they might follow the law. As a result, physicians may be more reluctant to provide abortion care when pregnant patients present with serious medical conditions and may deny abortion care to pregnant people with conditions that threaten their health until their condition deteriorates and the narrow exceptions inarguably apply. This delay in care, however, creates greater and avoidable risks to the health of the pregnant person. Additionally, many conditions that threaten the health of pregnant people are not included in all or most health exceptions.

The difficulties these bans and their unclear exceptions create may additionally deter physicians from practicing medicine in states that ban abortion. There have already been reports of physicians expressing reluctance or refusing to relocate to these states, as well as physicians leaving these states due to their restrictive laws. A substantial portion of these states’ residents already live in maternity deserts – areas where there are no obstetric providers or birth centers – and studies have shown that maternal mortality rates are higher in states that restrict abortion. Physicians being deterred from practicing in states with restrictive abortion laws may exacerbate these disparities in access to obstetric care and health outcomes.

  • Physician judgment should be granted deference in measuring the risk the pregnant person is facing,
  • Impairment of a “major bodily function” includes harm to fertility and the reproductive system,
  • Acute risk does not have to be already present or imminent for the exceptions to apply, and
  • Health exceptions apply in situations where treatment for a condition is unsafe during pregnancy and for fetal conditions and diagnoses that can increase the risk to a pregnant person’s health.

Plaintiffs argue the misapplication of the health exceptions violates state constitutional guarantees to fundamental and equal rights.

THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA)

The intersection of federal law requiring hospitals to provide stabilizing care and state abortion bans is another murky area hospitals and physicians must navigate. Enacted in 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) requires Medicare enrolled hospitals to perform an appropriate medical screening examination to any patient who presents to their dedicated emergency department. If a patient is identified as having an emergency medical condition, the hospital must provide stabilizing treatment within the hospital’s capability or transfer the patient to another medical facility.

HHS, through its Office of the Inspector General (OIG) may impose a civil monetary penalty on a hospital ($119,942 for hospitals with over 100 beds, $59,973 for hospital under 100 beds/ per violation) or physician ($119,942/violation).  HHS OIG may also exclude physicians from participating in Medicare and State health care programs. This is countered by the possibility that physicians could also face monetary penalties and prison time for violating state abortion bans, even if they determine that an emergency abortion is needed to stabilize the health of the patient.

As states were starting to implement abortion bans after the Dobbs decision, in July 2022, the Department of Health and Human Services (HHS) issued guidance regarding the enforcement of EMTALA that clarifies hospitals and physicians have obligations to provide stabilizing care, including abortion in medically appropriate circumstances, when a patient presenting at an emergency department is experience an emergency medical condition.

After HHS issued this guidance, two lawsuits were filed. HHS sued the State of Idaho to block enforcement of Idaho’s abortion ban to the extent it conflicts with EMTALA and the State of Texas sued to block enforcement of the HHS guidance in Texas .

These two cases have resulted in conflicting decisions in the federal district courts. In the Idaho case, the court concluded that because the Idaho law does not include exceptions for health or life, the law conflicts with EMATLA. The Idaho law only allows physicians to assert a defense to criminal prosecution if in their good faith medical judgment performing the abortion was “necessary to prevent the death of the pregnant woman.” There is no affirmative defense (see box below) if the physician performed the abortion to prevent serious harm to the patient, rather than to save her life. The district court has blocked Idaho from enforcing the abortion ban to the extent it conflicts with EMTALA while the litigation proceeds.

The federal district court in Texas reached the opposite decision and blocked HHS from enforcing its EMTALA guidance in Texas. The court highlighted that the HHS Guidance states that abortion may be required for medical conditions that are likely to become emergent. Texas law requires that life-threatening physical conditions to already be present. The court concluded that Texas is likely to succeed on their claim that the HHS Guidance exceeds HHS’s statutory authority: “The Guidance goes well beyond EMTALA’s text, which protects both mothers and unborn children, is silent as to abortion, preempts state law only when the two directly conflict. Since the statute is silent on the question, the Guidance cannot answer how doctors should weigh risks to both a mother and her unborn child.” The Biden Administration has appealed this decision to the 5 th Circuit Court of Appeals.

Exception vs. Affirmative Defense

Some state abortion bans lack exceptions but identify situations that may be used as an affirmative defense in court – among these are Tennessee’s 6-week LMP ban, Idaho’s total ban, Kentucky’s 15-week ban (but not the state’s earlier gestational bans), and all of Missouri’s bans.  An “affirmative defense” allows someone charged with a crime to show in court that their conduct was permissible even though the action itself is illegal. An affirmative defense does not make it legal to provide abortion care in the situations delineated in the law and means that a clinician who provided abortion care is open to prosecution – regardless of the reason they provided an abortion – and would bear the burden of proof to demonstrate that they provided care according to the conditions delineated as possible affirmative defenses in the abortion ban. Bans that rely on an affirmative defense leave physicians more vulnerable to criminal prosecution and they make it even riskier for physicians to provide abortion care in situations where the life or health of the pregnant person is at risk.

Sexual Assault Exceptions

A few of the state abortion bans contain exceptions for pregnancies resulting from rape or incest, generally requiring that the sexual assault be reported to law enforcement. Some states allow for a Child Protective Services (CPS) report in lieu of a law enforcement report for minors who are survivors of sexual assault or incest.

It is well documented that survivors are often afraid to report sexual violence to the police due to fear of retaliation, shame, reporting an incident to officials who will not respond adequately, not wanting friends or family to know, fear of the justice system, or other personal reasons. It is estimated that out of every 1000 sexual assaults , only 310 are reported to the police and 50 of these reports will lead to arrest, 28 of which will lead to a felony conviction. Even for survivors who do report to law enforcement, state abortion bans do not make clear exactly what information needs to be given to a provider to make it clear that the abortion would be legal in that state. Reporting requirements place barriers in the way of survivors seeking abortion care in these states.

Among the few sexual assault exceptions, some have specific gestational limits. For instance, the total ban currently in effect in West Virginia contains an exception for cases of rape or incest, but it is limited to 8 weeks from the last menstrual period (LMP) for adults and 14 weeks LMP for minors.

Although sexual assault exceptions are intended to protect survivors, experts agree that they rarely work. There is anecdotal evidence of survivors in states with rape exceptions and who have compiled the necessary documentation, but still not being able to access abortion because they couldn’t find any abortion providers in their state.

Hyde Amendment

The Hyde Amendment is a policy that restricts the use of federal funds to cover abortion, except in cases of rape or incest, or when the life of the pregnant person is endangered (Hyde Exceptions). The policy is not a permanent law, but rather has been attached as a temporary “rider” to the Congressional appropriations bill for the Department of Health and Human Services (HHS) and has been renewed annually by Congress. In the past, federal courts have interpreted the Hyde provisions to require states to pay for abortions that fall into the Hyde Exceptions and have blocked enforcement of state statutes that prohibit coverage for these cases. However, the enforceability of these requirements has been unclear since the Supreme Court’s decision in Dobbs . Although all bans currently in effect contain exceptions to safeguard the life of the pregnant person, most states with abortion bans do not have exceptions for cases of rape or incest, and therefore, would not allow for the provision or coverage of those services to Medicaid recipients, contrary to previous court orders. To date, no court or federal agency has issued orders or guidance on states’ obligation to provide coverage for Hyde Exceptions when their bans prohibit the provision of abortion in cases of rape or incest.

Lethal Fetal Anomaly Exceptions

Bans in several states contain exceptions for lethal fetal anomalies, usually limited to those anomalies that would result in the death of the baby at birth or soon after. As with health exceptions, lethal fetal anomaly exceptions are poorly defined and limited in statute. The only state with this kind of exception that has a comprehensive list of conditions that fall under this category is Louisiana , but since the state has multiple abortion bans in effect (one of which does not include exceptions for fatal fetal anomalies), the applicability of this exception is still unclear. Other states, like Indiana , provide some general criteria, such as how long after birth the baby can be expected to live for a pregnancy to fall under the fetal anomaly. Any condition that would result in a life expectancy shorter than three months fits under the exception. The religious freedom lawsuit against the state’s ban – Anonymous Plaintiffs v. Medical Licensing Board of Indiana — specifically challenges the narrow limits of the exception, arguing that other common conditions, such as Tay-Sachs disease would result in the death very early in childhood.

What happens in states with more than one abortion ban in effect?

In many states there is more than one abortion ban in the books, and in some of those states the exception provisions in the bans are at odds with each other. In Oklahoma , four bans are currently in effect, each with different exceptions. The state’s pre-Roe, total ban contains only an exception to preserve the life of the pregnant person. The total ban with criminal penalties enacted in 2022 contains exceptions to preserve the life of the pregnant person and clarifies that treatment to remove an ectopic pregnancy does not constitute an abortion. The state’s total ban with private, civil enforcement contains exceptions to preserve the life of the pregnant person in a medical emergency (but does not define what a medical emergency is), for cases of rape, sexual assault, or incest that have been reported to law enforcement, and in situations where federal law preempts state law. This ban also clarifies that treatment to remove an ectopic pregnancy is not an abortion. The state also has a 6-week LMP ban with private, civil enforcement that contains exceptions for medical emergencies (once again, without providing a definition for what constitutes a medical emergency) and where federal law preempts state law. The conflicting exceptions in the bans result in a situation where the only real exception in the state is for cases where an abortion is necessary to prevent the death of the pregnant person. Applying any other exception in the states’ other total bans would open physicians to criminal penalties and loss of license.

Mississippi is another state with multiple bans in effect that contain contradicting exceptions. The state’s total ban only has exceptions for cases when an abortion is necessary to preserve the life of the pregnant person or when the pregnancy was caused by rape (there is no exception for incest in the state). However, the state’s 15-week LMP ban contains exceptions for fatal fetal abnormalities and serious risk of substantial and irreversible impairment of a major bodily function, along with a life exception. In situations where there is more than one ban in effect, it might seem that the easiest way to follow the law would be to adhere to the abortion ban with the strictest gestational limit. This would not suffice in Mississippi, however, since the total ban contains an exception for pregnancies caused by rape, but the state’s 15-week LMP ban does not contain such an exception. Therefore, following any one of the state’s abortion bans would not remove the legal risk of providing abortion care in the state. Instead, providers must assess how the abortion bans and their exceptions work in conjunction.

Although a lot of attention has been devoted to debates about exceptions in abortion bans, many of these exceptions are not workable in practice. Outside of testimony from providers, it is difficult to assess how many people who qualify for abortion care under the exceptions are actually able to do so, since states do not report or underreport this information. However, it is apparent these bans create barriers to accessing abortion care, even in situations where the exceptions they outline should apply. Most importantly, these bans place the health and lives of pregnant people at risk by potentially preventing physicians from providing medically appropriate care. This inability to provide evidence-based care may additionally make physicians reluctant to practice medicine in restrictive states, amplifying already-existing discrepancies in ability to access obstetric care and adverse maternal and fetal outcomes.

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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.

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Charles M. Blow

Alabama’s I.V.F. Ruling Shows Our Slide Toward Theocracy

The facade of Alabama’s Supreme Court building.

By Charles M. Blow

Opinion Columnist

If you don’t think this country is sliding toward theocracy, you’re not paying attention.

The drumbeat of incidents moving us ever closer to the seemingly inescapable future is so steady and frequent that we’ve developed outrage fatigue — we’ve grown numb.

For instance, on Friday, the Alabama Supreme Court ruled that frozen embryos are children and that destruction of those embryos, even by accident, is subject to the state’s Wrongful Death of a Minor Act. In his concurring opinion, the chief justice, Tom Parker, wrote, “Even before birth, all human beings bear the image of God, and their lives cannot be destroyed without effacing his glory.”

The ruling could mean less access to reproductive care in Alabama if specialists in the field of in vitro fertilization simply choose to practice in states that don’t threaten their efforts.

There have been cases before in which embryos were destroyed as a result of negligence, but the Alabama decision significantly ups the ante. It essentially turns cryopreservation tanks into frozen nurseries.

The idea is absurd and unscientific. It is instead tied to a religious crusade to downgrade the personhood of women by conferring personhood on frozen embryos.

I called Sean Tipton, the chief advocacy and policy officer at the American Society for Reproductive Medicine, who told me: “One of the points in the abortion debate is, ‘Is it really about abortion or is it about controlling women and controlling sex?’ And this clearly exposes the idea that it’s not just about abortion.” He said, “There is no more pro-life medical treatment available, ever, than in vitro fertilization, and this decision clearly threatens the ability for that to continue.”

Control of women’s bodies is the endgame. And some religious conservatives won’t stop until that goal is achieved. For that reason, intervening victories — like the overturning of Roe v. Wade — will never be seen as enough; they will only intensify a blinding sense of righteousness.

There is an array of reproductive rights cases percolating around the country that could make their way to the Supreme Court — the same court that Donald Trump brags about transforming, having appointed a third of its justices. The legal and political battles over these issues are far from over, and the preservation of women’s remaining rights is far from certain.

The only thing that seems to be temporarily stopping congressional Republicans from pushing for a national abortion ban — after years of arguing that their goal was merely to allow individual states to make their own laws — is that the issue of reproductive choice is an electoral loser for their party.

But now Trump is reportedly talking privately about supporting a national 16-week abortion ban, with some exceptions.

This is what many of his supporters want, and many of them believe he has been singularly chosen by God to advance their theocratic aims. It’s one of the reasons that they overlook Trump’s glaring flaws and the fact that Trump himself is not a particularly religious man.

It’s worth noting that many of the right’s efforts, including on the issue of abortion, are led by men who want births but can’t give birth, reflecting an imbalance between power and expectation that may carry over to a younger generation. A fascinating new report from Pew Research found that although men and women 18 to 34 “are about equally likely to say they want to get married,” 57 percent of young men say they want children one day, compared to just 45 percent of young women.

Abortion is just one front on which this religious fight is being waged. As of last week, the A.C.L.U. was tracking 437 anti-L.G.B.T.Q. bills being considered by state legislatures.

Then there’s the alarming effort by conservative groups to transform and reshape the federal government in ways that curtail American freedoms, but also, according to Politico , to bring Christian nationalist ideas into a second Trump administration.

To those advancing these ideas, the will of God counts more than the will of the American people, even when Americans object or disagree.

Reportedly, one idea among the various proposals is invoking the Insurrection Act on Trump’s first day back in office to facilitate deployment of the military against protesters.

We are perilously close to all this becoming a reality, potentially aided and abetted by disaffected Democratic voters.

I’m talking about many Democrats with single-issue objections to President Biden — whether it’s opposition to his position on the Israel-Hamas war, disappointments about the overall state of the economy or concerns about the president’s age — who haven’t committed to supporting his re-election, who don’t seem to see that in November the country faces one of the most existential electoral decisions it ever has faced.

If these Democrats decide to punish Biden by sitting it out, they could wind up performing one of the greatest acts of self-immolation in recent political history: abandoning an administration committed to the protection of democracy and possibly allowing the ascension of a theocracy intent on destroying the very freedoms that progressives cherish.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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An earlier version of this article misstated when an Alabama Supreme Court ruling was issued. It was this past Friday, not Tuesday.

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Charles M. Blow is an Opinion columnist for The New York Times, writing about national politics, public opinion and social justice, with a focus on racial equality and L.G.B.T.Q. rights. @ CharlesMBlow • Facebook

February 21, 2024

Why Writing by Hand Is Better for Memory and Learning

Engaging the fine motor system to produce letters by hand has positive effects on learning and memory

By Charlotte Hu

Student handwriting notes in class

FG Trade/Getty Images

Handwriting notes in class might seem like an anachronism as smartphones and other digital technology subsume every aspect of learning across schools and universities. But a steady stream of research continues to suggest that taking notes the traditional way—with pen and paper or even stylus and tablet—is still the best way to learn, especially for young children. And now scientists are finally zeroing in on why.

A recent study in Frontiers in Psychology monitored brain activity in students taking notes and found that those writing by hand had higher levels of electrical activity across a wide range of interconnected brain regions responsible for movement, vision, sensory processing and memory. The findings add to a growing body of evidence that has many experts speaking up about the importance of teaching children to handwrite words and draw pictures.

Differences in Brain Activity

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The new research, by Audrey van der Meer and Ruud van der Weel at the Norwegian University of Science and Technology (NTNU), builds on a foundational 2014 study . That work suggested that people taking notes by computer were typing without thinking, says van der Meer , a professor of neuropsychology at NTNU. “It’s very tempting to type down everything that the lecturer is saying,” she says. “It kind of goes in through your ears and comes out through your fingertips, but you don’t process the incoming information.” But when taking notes by hand, it’s often impossible to write everything down; students have to actively pay attention to the incoming information and process it—prioritize it, consolidate it and try to relate it to things they’ve learned before. This conscious action of building onto existing knowledge can make it easier to stay engaged and grasp new concepts .

To understand specific brain activity differences during the two note-taking approaches, the NTNU researchers tweaked the 2014 study’s basic setup. They sewed electrodes into a hairnet with 256 sensors that recorded the brain activity of 36 students as they wrote or typed 15 words from the game Pictionary that were displayed on a screen.

When students wrote the words by hand, the sensors picked up widespread connectivity across many brain regions. Typing, however, led to minimal activity, if any, in the same areas. Handwriting activated connection patterns spanning visual regions, regions that receive and process sensory information and the motor cortex. The latter handles body movement and sensorimotor integration, which helps the brain use environmental inputs to inform a person’s next action.

“When you are typing, the same simple movement of your fingers is involved in producing every letter, whereas when you’re writing by hand, you immediately feel that the bodily feeling of producing A is entirely different from producing a B,” van der Meer says. She notes that children who have learned to read and write by tapping on a digital tablet “often have difficulty distinguishing letters that look a lot like each other or that are mirror images of each other, like the b and the d.”

Reinforcing Memory and Learning Pathways

Sophia Vinci-Booher , an assistant professor of educational neuroscience at Vanderbilt University who was not involved in the new study, says its findings are exciting and consistent with past research. “You can see that in tasks that really lock the motor and sensory systems together, such as in handwriting, there’s this really clear tie between this motor action being accomplished and the visual and conceptual recognition being created,” she says. “As you’re drawing a letter or writing a word, you’re taking this perceptual understanding of something and using your motor system to create it.” That creation is then fed back into the visual system, where it’s processed again—strengthening the connection between an action and the images or words associated with it. It’s similar to imagining something and then creating it: when you materialize something from your imagination (by writing it, drawing it or building it), this reinforces the imagined concept and helps it stick in your memory.

The phenomenon of boosting memory by producing something tangible has been well studied. Previous research has found that when people are asked to write, draw or act out a word that they’re reading, they have to focus more on what they’re doing with the received information. Transferring verbal information to a different form, such as a written format, also involves activating motor programs in the brain to create a specific sequence of hand motions, explains Yadurshana Sivashankar , a cognitive neuroscience graduate student at the University of Waterloo in Ontario who studies movement and memory. But handwriting requires more of the brain’s motor programs than typing. “When you’re writing the word ‘the,’ the actual movements of the hand relate to the structures of the word to some extent,” says Sivashankar, who was not involved in the new study.

For example, participants in a 2021 study by Sivashankar memorized a list of action verbs more accurately if they performed the corresponding action than if they performed an unrelated action or none at all. “Drawing information and enacting information is helpful because you have to think about information and you have to produce something that’s meaningful,” she says. And by transforming the information, you pave and deepen these interconnections across the brain’s vast neural networks, making it “much easier to access that information.”

The Importance of Handwriting Lessons for Kids

Across many contexts, studies have shown that kids appear to learn better when they’re asked to produce letters or other visual items using their fingers and hands in a coordinated way—one that can’t be replicated by clicking a mouse or tapping buttons on a screen or keyboard. Vinci-Booher’s research has also found that the action of handwriting appears to engage different brain regions at different levels than other standard learning experiences, such as reading or observing. Her work has also shown that handwriting improves letter recognition in preschool children, and the effects of learning through writing “last longer than other learning experiences that might engage attention at a similar level,” Vinci-Booher says. Additionally, she thinks it’s possible that engaging the motor system is how children learn how to break “ mirror invariance ” (registering mirror images as identical) and begin to decipher things such as the difference between the lowercase b and p.

Vinci-Booher says the new study opens up bigger questions about the way we learn, such as how brain region connections change over time and when these connections are most important in learning. She and other experts say, however, that the new findings don’t mean technology is a disadvantage in the classroom. Laptops, smartphones and other such devices can be more efficient for writing essays or conducting research and can offer more equitable access to educational resources. Problems occur when people rely on technology too much , Sivashankar says. People are increasingly delegating thought processes to digital devices, an act called “ cognitive offloading ”—using smartphones to remember tasks, taking a photo instead of memorizing information or depending on a GPS to navigate. “It’s helpful, but we think the constant offloading means it’s less work for the brain,” Sivashankar says. “If we’re not actively using these areas, then they are going to deteriorate over time, whether it’s memory or motor skills.”

Van der Meer says some officials in Norway are inching toward implementing completely digital schools . She claims first grade teachers there have told her their incoming students barely know how to hold a pencil now—which suggests they weren’t coloring pictures or assembling puzzles in nursery school. Van der Meer says they’re missing out on opportunities that can help stimulate their growing brains.

“I think there’s a very strong case for engaging children in drawing and handwriting activities, especially in preschool and kindergarten when they’re first learning about letters,” Vinci-Booher says. “There’s something about engaging the fine motor system and production activities that really impacts learning.”

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