The last article addressed the complex, but well-documented philosophical debates on the topic of abortion. The most prominent defences of abortion gained traction through the moral philosophical essays of Thomson and Warren (1971, 1973). It is a polarising issue – one that is made worse by disinformation, misunderstanding, emotion and fear.

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Reasons for having an abortion.

A common misconception among opponents of abortion is that abortion is used as a contraception – that it has become a convenient choice to avoid giving birth – on a level with other contraceptive health care options. The data does not support this belief. Biggs et al. (2013) concluded the reasons women seek abortion are complex and interrelated. They identified 11 broad themes, and each person seeking an abortion often pointed to a myriad of factors that contributed to the desire to seek an abortion, including their socioeconomic status, employment, age, health, parity and marital status, life trajectory and other children. Partner related reasons such as being abusive, non-supportive or partner not wanting a baby were cited by 31% of respondents. 74 % signalled a sense of emotional and financial responsibility to individuals other than themselves. Disparities were found among low-income women, citing access to healthcare, finances, and contraception. The health of the woman was also a factor (12%), including their own or their partners alcohol, drug, or tobacco use.

The American College of Obsterics and Gynecologists (ACOG) published a statement after Roe v. Wade was overturned. In it they briefly cite the extensive research, education literature and best practice guidelines available for abortion as part of gynaecological care, but also an expanded list of the reasons people chose to have an abortion from their medical perspective. They state that“(…) they include, but are not limited to, contraceptive failure, barriers to contraceptive use and access, rape, incest, intimate partner violence, foetal anomalies, illness during pregnancy, and exposure to teratogenic medications” In addition to: “Pregnancy complications, including placental abruption, bleeding from placenta previa, preeclampsia or eclampsia, and cardiac or renal conditions, may be so severe that abortion is the only measure to preserve a woman’s health or save her life.”

Healthcare outcomes

The world health organisation (WHO) describes abortion as a ‘common health intervention’. 97 % of abortions take place in third world countries, and 45 % are considered unsafe, I.e., carried out by untrained persons without access to appropriate equipment using invasive methods. Methods often include self-inflicted abdominal and bodily trauma, ingestion of dangerous chemicals, self-medication with a variety of drugs, and reliance on unqualified abortion providers

These facts lead themselves to the conclusion shared by, among others, the WHO and ACOG, that the consequence of banning legal and safe abortions lead to an increase in unsafe and illegal abortions – i.e., it does not reduce the number of abortions.

They identify unsafe abortions as a leading, but preventable cause of maternal death and morbidity – estimated between 5 and 13% - or up to 21 million women annually. In developed regions, this equates to 30 out of every 100 000 unsafe abortions. In developing regions this is 220 out of every 100 000 unsafe abortions. They further define a lack of access to safe abortions as a critical public health and human rights issue. Comprehensive abortion care is included in the list of essential health services published by the WHO.

The physical health risks associated with unsafe abortions include:

• incomplete abortion (failure to remove or expel all pregnancy tissue from the uterus);
• haemorrhage (heavy bleeding);
• infection;
• uterine perforation (caused when the uterus is pierced by a sharp object);
• damage to the genital tract and internal organs as a consequence of inserting dangerous objects into the vagina or anus.

Consequences

Even prior to the decision to overturn Roe v. Wade, a study found that despite having a constitutional right to safe and legal abortions, many states only complied with this ruling on paper. Ralph (2021) found 7 % of women in the US attempted a self-managed abortion at least once in their life, women of colour were more likely to report having attempted an abortion, citing finances, teenagers needing parental consent, travel distance and cost. The preferred methods mirror those cited by the WHO and include using inappropriate medication.

The consequences since the overturning are numerous, complicated, and severe. Forbes published a list of several specific events that arguably included the most severe events on a macro scale. One of the most controversial could arguably be the criminalisation of abortion procedures, putting healthcare providers at risk of losing their professional license, jobs, legal fines, and prison if they carry out abortions in their states. This has come straight after a 2-year pandemic period which put the healthcare system under extreme stress, where many healthcare providers died of exposure to the virus, and other left the profession.

This is accompanied by a rapid closure and relocations of abortion clinics; many people are losing their jobs and access to safe abortions is lost to millions of women. These women are travelling to neighbouring states, some even further, causing a significant overload for providers in states that do provide safe and legal abortions.

A more immediate and detrimental impact is the impossible position healthcare providers have been placed in with regards to medical emergencies. ACOG have created guidelines to help providers navigate the post Roe v. Wade landscape. ACOG stated: “it is impossible for a law to appropriately capture how or whether a "medical emergency" exception applies to a particular clinical situation”. The guidelines on when an abortion can be provided if the mothers health is at risk is vague, poorly written and has forced hospitals to change their policies without appropriate evidence-based practice to base their medical decisions on, resulting in mismanagement, increased mortality, and delay of care.

There is also an argument to be made about the polarisation of politics in America – many people are challenging these bans in court resulting in significant legal, financial and administrative challenges. People find themselves on one side or the other of this argument, there is little room for debates on bioethics, philosophy, rights, privacy, religion, spirituality. For instance, three Jewish women in Kentucky have filed a lawsuit arguing that their religious rights are being violated by state laws banning abortions. The lawsuit says that “Judaism has never defined life as beginning at conception, (…) millennia of commentary from Jewish scholars has reaffirmed Judaism’s commitment to reproductive rights.” This introduces another complex dimension to the decision to overturn Roe v. Wade – was the decision routed in medicine, ethics, philosophy, or white western Christian morality?

The conflict carries into the highest levels of politics as well. Administrative orders from President Biden’s administration that go against the overturning of Roe v. Wade include passing 2 executive orders on abortions rights, guidelines to abortion providers as well as allowing the department of veteran affairs to perform abortions regardless of state law. Whilst likely to provide relief and much needed security to millions of women, it also has the potential to cause further political divisions. Medications for a wide range of other conditions such as rheumatoid arthritis, lupus and even cancer are no longer available because they can be used to induce abortions, delaying vulnerable and dying patients potentially life staving care.

Several stories at the level of the individual have also been reported – most notably the case of a 10 year old child rape victim denied a lifesaving abortion. Initially dismissed as a hoax by some republicans and, perhaps surprising to some, by the wall street journal, a new source that traditionally scores higher than average in factual reporting (64%) but has been shown to have a moderate right bias in its reporting. The story drew widespread condemnation among abortion advocates and illustrated the real life and direct impact the abortion ban had on a young life already devastated by an unimaginably horrific event.

Conclusion

Based on the arguments and data presented in the article we conclude the statement that abortion is healthcare. Abortion should be legal, safe and freely available. It can be justified philosophically and has been extensively debated for decades. Evidence has conclusively shown that making abortions illegal and/or not having access to safe and legal abortion does not reduce the total number of abortions, but instead increases the number of unsafe and illegal abortions and, in turn, is a direct cause of death of millions of women annually. 

The decision-making process involved in having an abortion is complicated, multi-dimensional and evidence demonstrates it is not a decision taken lightly. It is supported by the vast majority of the population, by clinical literature, best practice medical guidelines and major international health care related governing bodies such as the WHO and ACOG,

Abortion is healthcare.