Abortion Access

The right to choose abortion is essential to ensuring a woman can decide for herself if, when and with whom to start or grow a family.

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Abortion History

Massachusetts was the first state to make abortion, including attempted abortion, a criminal offense. This was in the mid-1800s. By 1900, almost all states had followed suit. There could be serious consequences for the provider, and potentially, for others as well. Although women were rarely convicted for having an abortion, the threat of prosecution often persuaded them to testify against the provider.

Illegal abortions were common. Many were unsafe, due to unhygienic conditions, lack of trained providers or women self-aborting by unsafe methods. Most public hospitals in large cities had three wards. The first two were for gynecology and obstetrics and the third was for women with septic abortions.

Minority and low-income women suffered the most. Many women died of post-unsafe abortion hemorrhaging or infection. Women with financial resources could generally find a way to have a therapeutic abortion. In the 1960s, the National Opinion Research Center found that hundreds of women were attempting to self-abort with coat hangers, knitting needles, and ballpoint pens, and by swallowing toxic chemicals like bleach and laundry detergent.

In 1970, abortion became legal in New York, without any residency requirement. Just over 100,000 women traveled from as far away as Arizona and Nevada to obtain a legal abortion in New York City. It was an option for affluent women only. A legal abortion was simply out of reach for many, especially minority and low-income women.

With the historic Supreme Court decision in 1973, Roe v. Wade, abortion became legal. Some question whether women still have their constitutional right to abortion with the increasing number of restrictions.

Medication Abortion vs. Surgical Abortion

How late a woman can get an abortion depends on the laws in her state and what doctor, abortion clinic, or health center she goes to. It may be harder to find a health care provider who will do an abortion after the 12th week of pregnancy, so it’s best to try to have an abortion as soon as possible.

Surgical Abortions are often called In-Clinic Abortions.  Most use a local anesthetic and gentle suction to empty the uterus without making an incision. It’s usually used until about 14-16 weeks after the beginning of a woman’s last period. 

Dilation and Evacuation (D&E) is another kind of in-clinic abortion procedure. It uses suction and medical tools to empty the uterus. A woman can get a D&E later in a pregnancy than aspiration abortion — usually if it has been 16 weeks or longer since your last period.  

Medication Abortions use two different medications to end a pregnancy: mifepristone and misoprostol. This results in ending the pregnancy by causing the lining of the uterus to shed.  It can happen 4-10 weeks after the last menstrual period

In the first step of a medication abortion, a woman takes a pill called mifepristone.  Mifepristone blocks the hormone progesterone which is needed for the normal growth of the pregnancy.  

The second step is for her to take a pill called misoprostol 6-48 hours after the first pill was taken.  This medicine causes cramping and bleeding to empty the uterus.  It is like a really heavy, crampy period, which can last 4-5 hours or longer.  The cramping and bleeding usually slow down after the pregnancy tissues have been released, but may continue for 1-2 more days.   

The third step is a follow up visit the health care provider to make sure the abortion was complete.  

Both types of abortions are safer than several other common medical procedures such as a colonoscopy, but it’s always good to have the support of a qualified health care provider if possible.  

Both medication and surgical abortions done within the first nine weeks are effective and safe. Complications are rare. They do not affect a woman’s ability to have a baby in the future.

Abortion Bans

Rather than an outright abortion ban, states have chosen to chip away at access to abortion. Bit by bit, legislatures have passed many requirements of abortion facilities with TRAP laws (Targeted Restrictions against Abortion Providers). They have mandated ultrasounds, waiting periods, and biased counseling before a woman can obtain an abortion. They have passed abortion bans, including unconstitutional bans at earlier weeks of pregnancy and non-surgical abortion bans.


6-Week Bans – “Heartbeat” Bills

Heartbeat bans attempt to outlaw abortions as soon as a heartbeat can be detected, which is often in the embryonic stage, as early as six weeks’ gestation, before many women even know they are pregnant. These laws, some of the most extreme in the country, are flatly unconstitutional because they seek to ban abortion months before the point at which a fetus is viable.


20-Week Bans

These laws nominally seek to ban abortion after or around 20 weeks’ gestation, though bills in several states effectively ban abortion at 18 weeks. Legal experts believe these laws are unconstitutional on their face because they undermine a key provision of Roe v. Wade, which established the right to an abortion in the United States up until fetal viability, generally determined by doctors to be around 24 weeks’ gestation.

According to the Centers for Disease Control and Prevention, roughly 1.3% of all abortions in the U.S. were after 20 weeks’ gestation. There are many reasons women need abortions at this stage. A number of fetal and genetic anomalies cannot be identified until later in pregnancy, and some women find themselves facing pregnancies gone terribly wrong. Health conditions that threaten the woman’s life or health can develop at any point during a pregnancy. 



The “personhood” movement has gained a foothold among anti-abortion activists. Personhood supporters advocate for laws that give full rights to fetuses. They aim to outlaw all abortions, along with in vitro fertilization, embryonic stem-cell research, and emergency contraception.

If passed, personhood measures could interfere with personal, private health care decisions regarding birth control and access to safe and legal abortion. Even though they have been rejected by courts and voters in many states, these measures are frequently introduced by anti-abortion activists.

For example, in Mississippi, even after a personhood ballot initiative was rejected by voters, state legislators said they will attempt to pass it again. The measure would have given full constitutional rights to a fertilized egg.


Attacks on Planned Parenthood

Margaret Sanger outside her birth control clinic in Brownsville, Brooklyn, Oct. 27, 1916. Nine days after its opening as Margaret Sanger was jailed for violating the Comstock obscenity laws.

There’s nothing really new about attacks on Planned Parenthood. Women’s reproductive health care has been controversial since the mid-19th century. Margaret Sanger and others led a movement for women’s access to birth control during the first half of the 20th century. She opened the first U.S.

birth control clinic in 1916. Planned Parenthood was formed in 1942 with the merger of two other organizations. It now is the largest single provider of reproductive health services, including abortion, in the U.S.

The development of the Pill and the legalization of abortion in 1973 drew the focus of the controversy to Planned Parenthood. Since the 1973 Roe v. Wade decision by the Supreme Court, Planned Parenthood, and other abortion providers have been the targets of multiple acts of extreme violence such as murders, bombings, arson, and acid attacks.

More recently attacks have been political in nature. They have focused on defunding Planned Parenthood through legislation put forward by extremist anti-abortion politicians. In 2007, Mike Pence introduced the first federal legislation aimed at removing federal funding from Planned Parenthood. Legions of women joined together to advocate for reproductive health care. Supported by President Obama, they defeated this legislation.

Then, in 2015, anti-abortion extremists released a series of deceptive videos that attacked Planned Parenthood. The videos claimed Planned Parenthood was selling fetal tissue. Even though the videos were found to be fake, anti-abortion zealots have continued to use them to defund Planned Parenthood at both the state and national levels. Anti-choicers describe Planned Parenthood as an “abortion industry.”  Yet, abortions represent only 3 percent of total services provided by Planned Parenthood. The group does receive federal funding, none of which is used for abortions.

“Defunding” legislation seeks to block Planned Parenthood clients from getting any services by focusing on federally-funded programs such as Medicaid coverage and Title X. These programs fund birth control for low-income women and teens. Restrictions proposed by the Department of Health and Human Services in 2018 threaten Planned Parenthood funding once again.

While the extremist claims against Planned Parenthood are false, some radical defunding campaigns at the state level have succeeded. They have had very real consequences for women who are deprived of services. For example, in 2011 the Texas legislature launched an attack on Planned Parenthood that cut the budget for family planning from $111 million to $38 million. After the cuts, 82 Texas family planning clinics either closed or had to stop providing birth control. The consequences of clinic closings include higher rates of unintended pregnancy, higher rates of unsafe abortions, fewer patients being served and increased barriers to accessing contraceptive care.

One thing we know for certain: there is no end in sight to attacks on Planned Parenthood. Zealous anti-choice politicians will continue trying to create barriers that prevent women from accessing reproductive health care. Activists must remain vigilant at the state and national levels to defend Planned Parenthood and all women’s health centers providing abortions.

Helms Amendment

The Helms Amendment to the Foreign Assistance Act does not allow the use of U.S. foreign aid funds for abortion “as a method of family planning.” It results in the denial of abortion care to women in medical settings around the world, including those in war-torn countries who are the victims of rape and incest.

Passed in 1973 in reaction to the Roe v. Wade decision, the Amendment greatly encouraged anti-abortion activists.

This amendment is especially harmful to women in foreign countries who are poor and who have been victims of rape and incest. It creates another burden for women in countries where abortion is legal who face other barriers to accessing health care such as economic hardship, geographic isolation, and few healthcare workers.

The Helms Amendment works against women’s health, particularly in conjunction with the global gag rule. The gag rule adds the prohibition on using abortion services, counseling or referrals, or advocating for abortion rights, on Non-Governmental Organizations who are trying to help.

The following circumstances of women in foreign countries add to the harsh impact of the Helm’s Amendment:

– One in three women in the world will face violence in her lifetime. For many violence will occur before the age of 18, sometimes involving as much as 70% of the population. Violence contributes to unintended pregnancy, unsafe abortion, and maternal deaths. This is especially true in parts of the world where health systems are weak and women and communities lack access to quality care.

– Rates of gender-based violence are very high in areas of conflict and crisis, where rape is used as a tool of war and women live in refugee camps.

– Young women are very vulnerable to both violence and unintended pregnancy, which forces many to give up school and/or become mothers before they are ready.

Hyde Amendment

“I certainly would like to prevent, if I could legally, anybody having an abortion. A rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the Medicaid bill.”
– Senator Henry Hyde, 1976.

The Hyde Amendment is a law first passed forty years ago which bars the use of federal funds to pay for abortion, except to save the life of the woman or in cases of incest or rape. The Hyde Amendment is particularly harmful to low-income women, women of color, young people and immigrants. Women in each of these groups are more likely to rely on Medicaid for their healthcare coverage –about 15.6 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).

When the Hyde Amendment was fully implemented in 1977, three years after the Supreme Court Roe v. Wade ruling, abortions funded by federal Medicaid dropped from 300,000 per year to a few thousand. When the state denies a women insurance to cover abortion care, she must either pay for the abortion herself, attempt to self-abort or carry the pregnancy to term. While there is no national data on self-abortion rates, a study by the state of Texas, where abortion care is limited, estimated that between 100,000 and 240,000 women of reproductive age in that state have attempted to end a pregnancy on their own and without medical assistance.

Hyde is one of the first major legislative gains by anti-abortion forces after Roe vs. Wade.  Congress then altered the Hyde Amendment several times and prohibited the use of federal funds for abortions “except where the life of the mother would be endangered if the fetus were carried to term.” On October 22, 1993, President Clinton signed into law the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 1994. The Act had a new version of the Hyde Amendment that expanded the category of abortions for which federal funds are available under Medicaid to include cases of rape and incest.

The Hyde Amendment has been reenacted every year since 1976. Currently, 17 states extend abortion coverage to women enrolled in Medicaid through their own budgets, and 6 states extend abortion coverage when a woman’s health is at risk. The remainder of the country abides by the Hyde Amendment. South Dakota expands the Hyde Amendment and restricts funding even in cases of rape or incest. As of 1994, federal law mandates all states to pay for abortion cases involving rape or incest, proving South Dakota’s actions to be problematic.

The amendment is passed annually as a rider to the yearly appropriations bill that Congress must pass in order to fund federal programs. If the ban were lifted, it could potentially provide federal support for abortion coverage for the 14.5 million reproductive-age women enrolled in Medicaid, as well as millions of others in similar federal programs.

On January 24, 2017, the House voted to make the Hyde Amendment permanent. In response, Speaker Paul Ryan (R-WI) stated that “We are a pro-life Congress,” and he reaffirmed the government’s commitment to restricting tax money to funding abortions.

Supreme Court

Ever since the 1973 landmark U.S. Supreme Court decision Roe v. Wade, which legalized abortion, the high court has been the scene of many precedent-setting cases.  This section reviews some of the Court’s most important and decisive cases on abortion.

Roe v. Wade

On January 22, 1973, the U.S. Supreme Court announced its decision in Roe v. Wade, a challenge to a Texas law that made it a crime to perform an abortion unless a woman’s life was at stake. The case had been led by “Jane Roe,” an unmarried woman who wanted to safely and legally end her pregnancy. The original defendant was a district attorney from Dallas County named Henry Wade. The law made it to the Supreme Court after years of wrangling in Texas and Florida. Siding with Roe, the court struck down the Texas law and recognized that the constitutional right to privacy “is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” (Roe v. Wade, 1973).

At the time, nearly all states outlawed abortion except to save a woman’s life or for limited reasons such as preserving the woman’s health, or instances of rape, incest, or fetal anomaly. Roe rendered these laws unconstitutional, making abortion services vastly safer and more accessible.

In Roe, the Supreme Court found that a woman’s right to make her own decisions about her pregnancy deserves the highest level of constitutional protection. The court also recognized that the right to privacy is not absolute and that a state has valid interests in safeguarding maternal health and protecting potential life. A state may — but is not required to — prohibit abortion after viability, except when it is necessary to protect a woman’s life or health.

Burwell v. Hobby Lobby Stores, Inc.

The devastating and precedent-setting Supreme Court ruling Burwell v. Hobby Lobby Stores, Inc. was about the Affordable Care Act’s (ACA) contraceptive mandate. It exempts closely-held, for-profit companies from abiding by the ACA’s requirement to pay for insurance coverage for contraception if it violates their religious beliefs. With this decision, the Court has encouraged many other employers who object to birth control to refuse to cover it. Coverage for all types of contraception is threatened by this decision, which results in making it less accessible for many women.

Two privately owned, for-profit companies, Conestoga Wood Specialties and the Hobby Lobby Stores, Inc., brought the case. They argued that the birth control benefit of the Affordable Care Act violated their religious beliefs. Both plaintiffs believed that life begins at conception. They opposed their businesses providing health insurance for contraception, including emergency contraception and intrauterine devices. They believed that these two methods cause abortion and are immoral.

The court limited oral arguments to the question of whether a for-profit corporation could deny its employees health coverage to which employees are entitled by federal law based on the religious objections of the corporation owners. The 5 to 4 majority decision for the plaintiffs found that regulations promulgated by the Department of Health and Human Services violate the Religious Freedom Restoration Act.

As a result of this ruling, for-profit corporations can deny women access to contraception and abortion because of religious beliefs.

Planned Parenthood v. Casey

Planned Parenthood v. Casey (1992) was a landmark U.S. Supreme Court case that upheld the right to abortion but permitted some new state restrictions. The five to four decision upheld parts of a Pennsylvania law that restricted access to abortion. The section of this law that was struck down required spousal awareness before an abortion was performed.

The Court’s plurality opinion reaffirmed the central holding of Roe v. Wade, stating that “matters involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the Fourteenth Amendment.” The ruling in this case also crafted the “undue burden” standard for abortion restrictions.

Applying this new standard of review, the Court upheld four parts of the Pennsylvania law. Those sections required a 24-hour waiting period before having an abortion; required parental consent for teenagers; defined medical emergencies that determine exceptions to these requirements; and required doctors and clinics to report to the state for statistical purposes. It nullified the requirement of spousal notification because it potentially exposed women to abuse by their husbands.

Crisis Pregnancy Centers

For decades, the anti-abortion movement has tried to restrict and control the information which women receive. One of the ways they do this is through a network of about 2,500 crisis pregnancy centers (CPCs) in the United States.

A CPC is a non-profit organization which:

  • Postures as a resource for women with unintended pregnancies.
  • Counsels women against having an abortion.
  • Gives false information about the health risks of abortion and other reproductive topics.
  • Lies about the effectiveness of birth control.

Conservative anti-abortion Christians manage most CPCs through three networks: Care Net; Heartbeat International; and Birthright International. Care Net, the largest of the three, states that its ultimate aim is “to share the love and truth of Jesus Christ in thought, word, and deed.”

CPCs use false advertising to lure in young and poor women. Some advertise abortion services, and others offer free pregnancy tests and sonograms.  They mislead women by locating near, or looking like, abortion clinics. They often use language similar to that of abortion providers such as “plan your parenthood.” One tactic they use is to refuse to answer any questions about abortion because “women have no right to information that will lead her to an abortion.”

Legal action has tried to curb false advertising by making CPCs tell women that they do not offer certain services nor have credentials required of health care providers.

Currently, there is a case before the United States Supreme Court that holds CPCs to a standard of truth in advertising. The case will be decided during the summer of 2018. It focuses on whether the state of California violates free speech by making CPCs say that the state offers birth control and abortion care.

NARAL Pro-Choice America has a campaign to remove CPCs’ false advertising from the major search engines, Google and Yahoo. Both companies now have much data about how CPCs’ ads violate truth-in-advertising policies. As a result, Google has removed two-thirds of these ads. NARAL continues to monitor the situation and work with the search engines to ensure that CPC ads do not return.




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