Abortion In The United States
Abortion is legal throughout the United States and its territories, although restrictions and accessibility vary from state to state. Abortion is a controversial and divisive issue in the society, culture and politics of the U.S., and various anti-abortion laws have been in force in each state since at least 1900. The Democratic Party has generally defended access to abortion, whereas the Republican Party has generally sought to restrict abortion access or criminalize abortion.
Before the Supreme Court of the United States decisions of Roe v. Wade and Doe v. Bolton decriminalized abortion nationwide in 1973, abortion was already legal in several states, but the decision in the former case imposed a uniform framework for state legislation on the subject. It established a minimal period during which abortion is legal (with more or fewer restrictions throughout the pregnancy). That basic framework, modified in Planned Parenthood v. Casey (1992), remains nominally in place, although the effective availability of abortion varies significantly from state to state, as many counties have no abortion providers. Planned Parenthood v. Casey held that a law cannot place legal restrictions imposing an undue burden for "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus."
The abortion rate has continuously fallen from a peak in 1980 of 30 per 1,000 women of childbearing age (15–44), to 12 per 1,000 by 2016. In 2016, 66% of abortions were performed at 8 weeks or less gestation, and 91% of abortions were performed at 13 weeks or less gestation.
The main actors in the abortion debate are often framed as pro-choice, believing that a woman is entitled to choose whether to continue her pregnancy, versus pro-life, believing that the fetus has a sacred right to live, though most Americans are found to agree with some positions of each side. A 2018 Gallup survey found the percentages of "pro-choice" or "pro-life" respondents were equal (at 48%), but more considered abortion morally wrong (48%) than morally acceptable (43%). The poll results also indicated that Americans harbor diverse and shifting opinions on the legal right to abortion. The survey found that 29% of respondents believed that abortion should be legal in all circumstances, 50% that it should be legal under some circumstances, and 20% that it should be illegal in all circumstances. As of 2007[update], polling results found that 34% of Americans were satisfied with abortion laws.
Terminology
The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense. Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.
In medical parlance, "abortion" can refer to either miscarriage or abortion until the fetus is viable. After viability, doctors call an abortion a "termination of pregnancy".
History
Rise of anti-abortion legislation
When the United States first became independent, most states applied English common law to abortion. This meant it was not permitted after quickening, or the start of fetal movements, usually felt 15–20 weeks after conception.
Abortion has existed in America since European colonization. The earliest settlers would often encourage abortions before the "quickening" stage in the pregnancy. There were many reasons given for this, including not having resources to bear children. It was not until the late 1800s when states began to make abortions illegal. One reason given for the legislation was that abortions had been performed with dangerous methods and were often surgical. Because of this, many states decided to forbid abortions. As technology advanced and abortion methods improved, abortions still remained illegal. Women would resort to illegal unsafe methods, also known as "back alley" abortions.
Abortions became illegal by statute in Britain in 1803 with Lord Ellenborough's Act. Various anti-abortion statutes that codified or expanded common law began to appear in the United States in the 1820s. In 1821, a Connecticut law targeted apothecaries who sold "poisons" to women for purposes of inducing an abortion, and New York made post-quickening abortions a felony and pre-quickening abortions a misdemeanor in 1829. Other legal scholars have pointed out that some of the early laws punished not only the doctor or abortionist, but also the woman who hired them.
A number of other factors likely played a role in the rise of anti-abortion laws. Physicians, who were the leading advocates of abortion criminalization laws, appear to have been motivated at least in part by advances in medical knowledge. Science had discovered that conception inaugurated a more or less continuous process of development, which would produce a new human being if uninterrupted. Quickening was found to be neither more nor less crucial in the process of gestation than any other step. Many physicians concluded that if society considered it unjustifiable to terminate pregnancy after the fetus had quickened, and if quickening was a relatively unimportant step in the gestation process, then it was just as wrong to terminate a pregnancy before quickening as after quickening. Ideologically, the Hippocratic Oath and the medical mentality of that age to defend the value of human life as an absolute played a significant role in molding opinions about abortion. Doctors were also influenced by practical reasons to advocate anti-abortion laws. For one, abortion providers tended to be untrained and not members of medical societies. In an age where the leading doctors in the nation were attempting to standardize the medical profession, these "irregulars" were considered a nuisance to public health. The more formalized medical profession disliked the "irregulars" because they were competition, often at a cheaper cost.
Despite campaigns to end the practice of abortion, abortifacient advertising was highly effective. Contemporary estimates of mid-19th century abortion rates suggest between 20% and 25% of all pregnancies in the United States during that era ended in abortion. This era saw a marked shift in those who were obtaining abortions. Before the start of the 19th century, most abortions were sought by unmarried women who had become pregnant out of wedlock. Out of 54 abortion cases published in American medical journals between 1839 and 1880, over half were sought by married women, and well over 60% of the married women already had at least one child. The sense that married women were now frequently obtaining abortions worried many conservative physicians, who were almost exclusively men. In the post-Civil War era, much of the blame was placed on the burgeoning women's rights movement.
Though the medical profession expressed hostility toward feminism, many feminists of the era were also opposed to abortion. In The Revolution, operated by Elizabeth Cady Stanton and Susan B. Anthony, an anonymous contributor signing "A" wrote in 1869 about the subject, arguing that instead of merely attempting to pass a law against abortion, the root cause must also be addressed. Simply passing an anti-abortion law would, the writer stated, "be only mowing off the top of the noxious weed, while the root remains. [...] No matter what the motive, love of ease, or a desire to save from suffering the unborn innocent, the woman is awfully guilty who commits the deed. It will burden her conscience in life, it will burden her soul in death; But oh! thrice guilty is he who drove her to the desperation which impelled her to the crime." To many feminists of this era, abortion was regarded as an undesirable necessity forced upon women by thoughtless men. Even the "free love" wing of the feminist movement refused to advocate for abortion and treated the practice as an example of the hideous extremes to which modern marriage was driving women. Marital rape and the seduction of unmarried women were societal ills which feminists believed caused the need to abort, as men did not respect women's right to abstinence.
However, physicians remained the loudest voice in the anti-abortion debate, and they carried their agenda to state legislatures around the country, advocating not only anti-abortion laws, but also laws against birth control. This movement presaged the modern debate over women's body rights. A campaign was launched against the movement and the use and availability of contraceptives.
Criminalization of abortion accelerated from the late 1860s, through the efforts of concerned legislators, doctors, and the American Medical Association. In 1873, Anthony Comstock created the New York Society for the Suppression of Vice, an institution dedicated to supervising the morality of the public. Later that year, Comstock successfully influenced the United States Congress to pass the Comstock Law, which made it illegal to deliver through the U.S. mail any "obscene, lewd, or lascivious" material. It also prohibited producing or publishing information pertaining to the procurement of abortion or the prevention of conception or venereal disease, even to medical students. The production, publication, importation, and distribution of such materials was suppressed under the Comstock Law as being obscene, and similar prohibitions were passed by 24 of the 37 states.
In 1900, abortion was a felony in every state. Some states included provisions allowing for abortion in limited circumstances, generally to protect the woman's life or to terminate pregnancies arising from rape or incest. Abortions continued to occur, however, and became increasingly available. The American Birth Control League was founded by Margaret Sanger in 1921; it would become Planned Parenthood Federation of America in 1942.
By the 1930s, licensed physicians performed an estimated 800,000 abortions a year.
Sherri Finkbine
One notable case dealt with a woman named Sherri Finkbine. Born in the area of Phoenix, Arizona, Sherri had 4 healthy children. However, during her pregnancy with her 5th child, she had found that the child might have severe deformities. Finkbine had been taking sleeping pills that contained a drug called Thalidomide which was also very popular in several countries. She had later learned that the drug was causing fetal deformities and she wanted to warn the general public. Finkbine strongly wanted an abortion, however the abortion laws of Arizona limited her decision. In Arizona, an abortion could only occur if the mother's life was in danger. She met with a reporter from The Arizona Republic and told her story. While Sherri Finkbine wanted to be kept anonymous, the reporter disregarded this idea. On August 18, 1962, Finkbine traveled to Sweden where she was able to obtain a legal abortion. It was also confirmed that the child would have been very much deformed. Sherri Finkbine's story marks a turning point for women as well as the history of abortion laws occurring in the United States. Sherri Finkbine, unlike many other women, was able to afford going overseas to have the abortion. However, many women seeking abortions may not be able to afford travel. In such cases, women may turn to illegal forms of abortion.
Pre-Roe precedents
In 1964, Gerri Santoro of Connecticut died trying to obtain an illegal abortion, and her photo became the symbol of an abortion-rights movement. Some women's rights activist groups developed their own skills to provide abortions to women who could not obtain them elsewhere. As an example, in Chicago, a group known as "Jane" operated a floating abortion clinic throughout much of the 1960s. Women seeking the procedure would call a designated number and be given instructions on how to find "Jane".
In 1965, the U.S. Supreme Court case Griswold v. Connecticut struck down one of the remaining contraception Comstock laws in Connecticut and Massachusetts. However, Griswold only applied to marital relationships. Eisenstadt v. Baird (1972) extended its holding to unmarried persons as well. Following the Griswold case, the American College of Obstetricians and Gynecologists (ACOG) issued a medical bulletin accepting a recommendation from six years earlier that clarified that "conception is the implantation of a fertilized ovum"; and consequently birth control methods that prevented implantation became classified as contraceptives, not abortifacients.
In 1967, Colorado became the first state to decriminalize abortion in cases of rape, incest, or in which pregnancy would lead to permanent physical disability of the woman. Similar laws were passed in California, Oregon, and North Carolina. In 1970, Hawaii became the first state to legalize abortions on the request of the woman, and New York repealed its 1830 law and allowed abortions up to the 24th week of pregnancy. Similar laws were soon passed in Alaska and Washington. In 1970, Washington held a referendum on legalizing early pregnancy abortions, becoming the first state to legalize abortion through a vote of the people. A law in Washington, D.C., which allowed abortion to protect the life or health of the woman, was challenged in the Supreme Court in 1971 in United States v. Vuitch. The court upheld the law, deeming that "health" meant "psychological and physical well-being", essentially allowing abortion in Washington, D. C. By the end of 1972, 13 states had a law similar to that of Colorado, while Mississippi allowed abortion in cases of rape or incest only and Alabama and Massachusetts allowed abortions only in cases where the woman's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to one where it was legal. The legal position prior to Roe v. Wade was that abortion was illegal in 30 states and legal under certain circumstances in 20 states.
In the late 1960s, a number of organizations were formed to mobilize opinion both against and for the legalization of abortion. In 1966, the National Conference of Catholic Bishops assigned Monsignor James T. McHugh to document efforts to reform abortion laws, and anti-abortion groups began forming in various states in 1967. In 1968, McHugh led an advisory group which became the National Right to Life Committee. The forerunner of the NARAL Pro-Choice America was formed in 1969 to oppose restrictions on abortion and expand access to abortion. Following Roe v. Wade, in late 1973, NARAL became the National Abortion Rights Action League.
Roe v. Wade
Prior to Roe v. Wade, 30 states prohibited abortion without exception, 16 states banned abortion except in certain special circumstances (e.g., rape, incest, health threat to mother), 3 states allowed residents to obtain abortions, and New York allowed abortions generally. Early that year, on January 22, 1973, the Supreme Court in Roe v. Wade invalidated all of these laws, and set guidelines for the availability of abortion. Roe established that the right of privacy of a woman to obtain an abortion "must be considered against important state interests in regulation". Roe established a "trimester" (i.e., 12 week) threshold of state interest in the life of the fetus corresponding to its increasing "viability" (likelihood of survival outside the uterus) over the course of a pregnancy, such that states were prohibited from banning abortion early in pregnancy but allowed to impose increasing restrictions or outright bans later in pregnancy.
In deciding Roe v. Wade, the Supreme Court ruled that a Texas statute forbidding abortion except when necessary to save the life of the mother was unconstitutional. The Court arrived at its decision by concluding that the issue of abortion and abortion rights falls under the right to privacy (in the sense of the right of a person not to be encroached by the state). In its opinion, it listed several landmark cases where the court had previously found a right to privacy implied by the Constitution. The Court did not recognize a right to abortion in all cases:
State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother.
The Court held that a right to privacy existed and included the right to have an abortion. The court found that a mother had a right to abortion until viability, a point to be determined by the abortion doctor. After viability a woman can obtain an abortion for health reasons, which the Court defined broadly to include psychological well-being.
A central issue in the Roe case (and in the wider abortion debate in general) is whether human life or personhood begins at conception, birth, or at some point in between. The Court declined to make an attempt at resolving this issue, noting: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer." Instead, it chose to point out that historically, under English and American common law and statutes, "the unborn have never been recognized ... as persons in the whole sense", and thus, the fetuses are not legally entitled to the protection afforded by the right to life specifically enumerated in the Fourteenth Amendment. So, rather than asserting that human life begins at any specific point, the court simply declared that the State has a "compelling interest" in protecting "potential life" at the point of viability.
Doe v. Bolton
Under Roe v. Wade, state governments may not prohibit late terminations of pregnancy when "necessary to preserve the life or health of the mother", even if it would cause the demise of a viable fetus. This rule was clarified by the 1973 judicial decision Doe v. Bolton, which specifies "that the medical judgment may be exercised in the light of all factors — physical, emotional, psychological, familial, and the woman's age — relevant to the well-being of the patient". It is by this provision for the mother's mental health that women in the US legally choose abortion after viability when screenings reveal abnormalities that do not cause a baby to die shortly after birth.
Later judicial decisions
In the 1992 case of Planned Parenthood v. Casey, the Court abandoned Roe's strict trimester framework but maintained its central holding that women have a right to choose to have an abortion before viability. Roe had held that statutes regulating abortion must be subject to "strict scrutiny" — the traditional Supreme Court test for impositions upon fundamental Constitutional rights. Casey instead adopted the lower, undue burden standard for evaluating state abortion restrictions, but re-emphasized the right to abortion as grounded in the general sense of liberty and privacy protected under the constitution: "Constitutional protection of the woman's decision to terminate her pregnancy derives from the Due Process Clause of the Fourteenth Amendment. It declares that no State shall 'deprive any person of life, liberty, or property, without due process of law.' The controlling word in the cases before us is 'liberty'."
The Supreme Court continues to grapple with cases on the subject. On April 18, 2007, it issued a ruling in the case of Gonzales v. Carhart, involving a federal law entitled the Partial-Birth Abortion Ban Act of 2003 which President George W. Bush had signed into law. The law banned intact dilation and extraction, which opponents of abortion rights referred to as "partial-birth abortion", and stipulated that anyone breaking the law would get a prison sentence up to 2.5 years. The United States Supreme Court upheld the 2003 ban by a narrow majority of 5-4, marking the first time the Court has allowed a ban on any type of abortion since 1973. The opinion, which came from justice Anthony Kennedy, was joined by Justices Antonin Scalia, Clarence Thomas, and the two recent appointees, Samuel Alito and Chief Justice John Roberts.
In the case of Whole Woman's Health v. Hellerstedt, the Supreme Court in a 5-3 decision on June 27, 2016 swept away forms of state restrictions on the way abortion clinics can function. The Texas legislature enacted in 2013 restrictions on the delivery of abortions services that created an undue burden for women seeking an abortion by requiring abortion doctors to have difficult-to-obtain "admitting privileges" at a local hospital and by requiring clinics to have costly hospital-grade facilities. The Court struck down these two provisions "facially" from the law at issue—that is, the very words of the provisions were invalid, no matter how they might be applied in any practical situation. According to the Supreme Court, the task of judging whether a law puts an unconstitutional burden on a woman's right to abortion belongs with the courts, and not the legislatures.
The Supreme Court ruled similarly in June Medical Services, LLC v. Russo on June 29, 2020, in a 5–4 decision that a Louisiana state law, modeled after the Texas law at the center of Whole Woman's Health, was unconstitutional. Like Texas' law, the Louisiana law required certain measures for abortion clinics that, if having gone into effect, would have closed five of the six clinics in the state. The case in Louisiana was put on hold pending the result of Whole Woman's Health, and was retried based on the Supreme Court's decision. While the District Court ruled the law unconstitutional, the Fifth Circuit found that unlike the Texas law, the burden of the Louisiana law passed the tests outlined in Whole Woman's Health, and thus the law was constitutional. The Supreme Court issued an order to suspend enforcement of the law pending further review, and agreed to hear the case in full in October 2019. It was the first abortion-related case to be heard by President Donald Trump's appointees to the Court, Neil Gorsuch and Brett Kavanaugh. The Supreme Court found the Louisiana law unconstitutional for the same reasons as the Texas one, reversing the Fifth Circuit. The judgement was supported by Chief Justice John Roberts who had dissented on Whole Woman's Health but joined in judgement as to upheld the court's respect for the past judgement in that case.
Current legal status
Federal legislation
Since 1995, led by congressional Republicans, the U.S. House of Representatives and U.S. Senate have moved several times to pass measures banning the procedure of intact dilation and extraction, commonly known as partial birth abortion. Such measures passed twice by wide margins, but President Bill Clinton vetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Congressional supporters of the bill argue that a health exception would render the bill unenforceable, since the Doe v. Bolton decision defined "health" in vague terms, justifying any motive for obtaining an abortion. Congress was unsuccessful with subsequent attempts to override the vetoes.
The Born-Alive Infants Protection Act of 2002 ("BAIPA") was enacted August 5, 2002 by an Act of Congress and signed into law by George W. Bush. It asserts the human rights of infants born after a failed attempt to induce abortion. A "born-alive infant" is specified as a "person, human being, child, individual". "Born alive" is defined as the complete expulsion of an infant at any stage of development that has a heartbeat, pulsation of the umbilical cord, breath, or voluntary muscle movement, no matter if the umbilical cord has been cut or if the expulsion of the infant was natural, induced labor, cesarean section, or induced abortion.
On October 2, 2003, with a vote of 281-142, the House approved the Partial-Birth Abortion Ban Act to ban partial-birth abortion, with an exemption in cases of fatal threats to the woman. Through this legislation, a doctor could face up to two years in prison and civil lawsuits for performing such a procedure. A woman undergoing the procedure could not be prosecuted under the measure. On October 21, 2003, the United States Senate passed the bill by a vote of 64-34, with a number of Democrats joining in support. The bill was signed by President George W. Bush on November 5, 2003, but a federal judge blocked its enforcement in several states just a few hours after it became public law. The Supreme Court upheld the nationwide ban on the procedure in the case Gonzales v. Carhart on April 18, 2007, signaling a substantial change in the Court's approach to abortion law. The 5-4 ruling said the Partial Birth Abortion Ban Act does not conflict with previous decisions regarding abortion.
The current judicial interpretation of the U.S. Constitution regarding abortion, following the Supreme Court of the United States's 1973 landmark decision in Roe v. Wade, and subsequent companion decisions, is that abortion is legal but may be restricted by the states to varying degrees. States have passed laws to restrict late-term abortions, require parental notification for minors, and mandate the disclosure of abortion risk information to patients prior to the procedure.
The official report of the U.S. Senate Judiciary Committee, issued in 1983 after extensive hearings on the Human Life Amendment (proposed by Senators Orrin Hatch and Thomas Eagleton), stated that
Thus, the [Judiciary] Committee observes that no significant legal barriers of any kind whatsoever exist today in the United States for a mother to obtain an abortion for any reason during any stage of her pregnancy.
One aspect of the legal abortion regime now in place has been determining when the fetus is "viable" outside the womb as a measure of when the "life" of the fetus is its own (and therefore subject to being protected by the state). In the majority opinion delivered by the court in Roe v. Wade, viability was defined as "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks". When the court ruled in 1973, the then-current medical technology suggested that viability could occur as early as 24 weeks. Advances over the past three decades allow survival of some babies born at 22 weeks.
As of 2006[update], the youngest child to survive a premature birth in the United States was a girl born at Kapiolani Medical Center in Honolulu, Hawaii at 21 weeks and 3 days gestation. Because of the split between federal and state law, legal access to abortion continues to vary by state. Geographic availability varies dramatically, with 87 percent of U.S. counties having no abortion provider. Moreover, due to the Hyde Amendment, many state health programs do not cover abortions; currently 17 states (including California, Illinois and New York) offer or require such coverage.
The legality of abortion is frequently a major issue in nomination battles for the U.S. Supreme Court. Nominees typically remain silent on the issue during their hearings, as the issue may come before them as judges.
The Unborn Victims of Violence Act, commonly known as "Laci and Conner's Law" was passed by Congress and signed into law by President Bush on April 1, 2004, allowing two charges to be filed against someone who kills a pregnant mother (one for the mother and one for the fetus). It specifically bans charges against the mother and/or doctor relating to abortion procedures. Nevertheless, it has generated much controversy among pro-abortion rights advocates who view it as a potential step in the direction of banning abortion.
The Pain-Capable Unborn Child Protection Act is a United States Congress bill to ban late-term abortions nationwide after 20 weeks post-fertilization on the basis that the fetus is capable of feeling pain during an abortion at and after that point of pregnancy. The bill was first introduced in Congress in 2013. It successfully passed the House of Representatives in 2013, 2015, and 2017, but has yet to pass the Senate. Opponents of the bill reject the claims made by the bill's supporters regarding fetal development, and argue that such a restriction would endanger women's health.
State-by-state legal status
Abortion is legal in all U.S. states, and every state has at least one abortion clinic. Abortion is a controversial political issue, and regular attempts to restrict it occur in most states. Two such cases, originating in Texas and Louisiana, led to the Supreme Court cases of Whole Woman's Health v. Hellerstedt (2016) and June Medical Services, LLC v. Russo (2020) in which several Texas and Louisiana restrictions were struck down.
The issue of minors and abortion is regulated at the state level, and 37 states require some parental involvement, either in the form of parental consent or in the form of parental notification. In certain situations, the parental restrictions can be overridden by a court. Mandatory waiting periods, mandatory ultrasounds and scripted counseling are common abortion regulations. Abortion laws are generally stricter in a conservative Southern states than they are in other parts of the country.
In 2019, New York passed the Reproductive Health Act (RHA), which repealed a pre-Roe provision that banned third-trimester abortions except in cases where the continuation of the pregnancy endangered a pregnant woman's life.
Abortion in the Northern Mariana Islands, a United States Commonwealth territory, is illegal.
Alabama House Republicans passed a law on April 30, 2019 that will criminalize abortion if it goes into effect. Dubbed the "Human Life Protection Act", it offers only two exceptions: serious health risk to the mother or a lethal fetal anomaly. It will also make the procedure a Class A felony. Twenty-five male Alabama senators voted to pass the law on May 13. The next day, Alabama governor Kay Ivey signed the bill into law, primarily as a symbolic gesture in hopes of challenging Roe v. Wade in the Supreme Court.
Since Alabama introduced the first modern anti-abortion legislation in April 2019, five other states have also adopted abortion laws including Mississippi, Kentucky, Ohio, Georgia and most recently Louisiana on May 30, 2019.
In May 2019, the US Supreme Court upheld an Indiana state law that requires fetuses which were aborted be buried or cremated. In a December 2019 case, the court declined to review a lower court decision which upheld a Kentucky law requiring doctors to perform ultrasounds and show fetal images to patients before abortions.
On June 29, 2020, previous Supreme Court rulings banning abortion restrictions appeared to be upheld when the U.S Supreme Court struck down the Louisiana anti-abortion law Following the ruling, the legality of laws restricting abortion in states such as Ohio was then called into question. It was also noted that Supreme Court Chief Justice John Roberts, who agreed that the Louisiana anti-abortion law was unconstitutional, had previously voted uphold a similar law in Texas which was struck down by the U.S. Supreme Court in 2016.
Amid the COVID-19 pandemic, anti-abortion government officials in several American states enacted or attempted to enact restrictions on abortion, characterizing it as a non-essential procedure that can be suspended during the medical emergency. The orders have led to several legal challenges and criticism by human rights groups and several national medical organizations, including the American Medical Association. Legal challenges on behalf of abortion providers, many of which are represented by the American Civil Liberties Union and Planned Parenthood, have successfully stopped most of the orders on a temporary basis.
One challenge was made against the FDA's rule on the distribution of mifepristone (RU-486), one of the two-part drug regiment to induce abortions. Since 2000, it is only available through health providers under the FDA's ruling. Due to the COVID-19 pandemic, access to mifepristone was a concern, and the American College of Obstetricians and Gynecologists along with other groups sued to have the rule relaxed to allow women to be able to access mifepristone at home through mail-order or retail pharmacies. While the Fourth Circuit issued a preliminary injunction against the FDA's ruling that would have allowed wider distribution, the Supreme Court ordered in a 6-3 decision in January 2021 to put a stay on the injunction, maintaining the FDA's rule.
Qualifying requirements for abortion providers
Qualifying requirements for performing abortions vary from state to state, and are currently being changed in several states by lawmakers who anticipate the possibility that Roe v. Wade may soon be overturned. Currently, New York, Illinois, and Maine allow non-physician health professionals, such as physicians' assistants, nurse practitioners, and certified nurse midwives, acting within their scope of practice, to perform abortion procedures; their laws do not explicitly specify which types of abortions these non-physicians may do. California, Oregon, Montana, Vermont, and New Hampshire allow qualified non-physician health professionals to do first-trimester aspiration abortions and to prescribe drugs for medical abortions. Washington State, New Mexico, Alaska, Maryland, Massachusetts, Connecticut, and New Jersey allow qualified non-physicians to prescribe drugs for medical abortions only. In all other states, only licensed physicians may perform abortions. In 2016, the FDA issued new guidelines recommending that qualified non-physician health-care professionals be allowed to prescribe mifepristone in all states; however, these guidelines are not binding, and states are free to determine their own policies regarding mifepristone.
Statistics
Because reporting of abortions is not mandatory, statistics are of varying reliability. Both the Centers For Disease Control (CDC) and the Guttmacher Institute regularly compile these statistics.
Number of abortions
The annual number of legal induced abortions in the US doubled between 1973 and 1979, and peaked in 1990. There was a slow but steady decline throughout the 1990s. Overall, the number of annual abortions decreased by 6% between 2000 and 2009, with temporary spikes in 2002 and 2006.
By 2011, abortion rate in the nation dropped to its lowest point since the Supreme Court legalized the procedure. According to a study performed by Guttmacher Institute, long-acting contraceptive methods had a significant impact in reducing unwanted pregnancies. There were fewer than 17 abortions for every 1,000 women of child-bearing age. That was a 13%-decrease from 2008's numbers and slightly higher than the rate in 1973, when the Supreme Court's Roe v. Wade decision legalized abortion. The study indicated a long-term decline in the abortion rate.
In 2016, the CDC reported 623,471 abortions, a 2% decrease from 636,902 in 2015.
Medical abortions
A Guttmacher Institute survey of abortion providers estimated that early medical abortions accounted for 17% of all non-hospital abortions and slightly over one-quarter of abortions before 9 weeks gestation in the United States in 2008. Medical abortions voluntarily reported to the CDC by 34 reporting areas (excluding Alabama, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, Pennsylvania, Tennessee, Vermont, Wisconsin, and Wyoming) and published in its annual abortion surveillance reports have increased every year since the September 28, 2000 FDA approval of mifepristone (RU