As we embark on what is likely to be a vicious political war over Supreme Court Justice Sandra Day O’Connor’s replacement, I think it important to take a quick a look at the issue that will be at the heart of much of the vitriol coming from both the right and the left: abortion. There is no question that President Bush is being pressured by his patrons in the religious right to appoint a justice who will vote to reverse Roe v. Wade, and so it is instructive to explore the likely, practical impact on American women should their right to choose be denied or narrowly restricted.
Writing in The Guttmacher Report on Public Policy in May of 2003 (“Envisioning Life Without Roe: Lessons Without Borders“), Susan A. Cohen did exactly that, compiling historical data on abortions and maternal mortality for the pre- and post-Roe United States, as well as that for a number of nations with either liberal or restrictive abortion laws. The conclusion is clear:
The American pre-Roe experience, just as that in the developing world today, demonstrates quite clearly that liberal abortion laws do not cause abortion, unintended pregnancy does. Indeed, some of the world’s lowest abortion rates may be found in countries with the most liberal abortion laws, where services are easily available and even subsidized; by contrast, high abortion rates (and, generally, high maternal mortality rates as well) may be observed in countries where the procedure is severely restricted.
As Cohen points out, illegal abortion was quite common in the US prior to the 1973 Roe decision, with as many as 800,000 procedures a year estimated to have taken place during the 1950s and 1960s. While affluent women could travel within the US or overseas to seek safe, legal abortions, poor women, mostly young and minority, often suffered severe health consequences. Even after the introduction of antibiotics in the 1940s dramatically reduced abortion-related maternal deaths, maternal mortality rates remained high compared to current levels.
Before and after comparisons like that in the US can be repeated country by country, but perhaps the most striking example is that of Romania, where abortion was legalized in 1957, outlawed in 1966, and legalized again after Ceaucescu’s fall in 1990.
When abortion was against the law in Romania, from
1966 to 1989, abortion-related deaths soared.
Romania’s abortion-related death rate soared after abortion was outlawed in 1966, and plummeted after it was relegalized in 1990. The lesson in Romania and elsewhere is that women will seek abortions whether they are legal or not; restricting access merely makes them less safe. According to the World Health Organization, unsafe abortions are responsible for about 13% of the half million annual deaths worldwide from pregnancy-related causes… in the most restrictive nations of Latin America, the rate is as high as 21%.
Indeed, not only do restrictive abortion laws uniformly increase maternal mortality rates in developed and developing countries alike, some of the nations with the most restrictive abortion laws also have some of the highest abortion rates.
|ABORTION LAWS, RATES AND MATERNAL MORTALITY|
|Country||Abortion rate per 1,000 women, 15-44||Maternal Deaths per 100,000 live births|
|Where abortion is Broadly Permitted|
|Where Abortion is Severely Restricted|
|Note: Most recent data available. Sources: Abortion data — AGI, Sharing Responsibility, Appendix Table 4, p. 54; Finer LB and Henshaw SK, Abortion incidence and services in the United States in 2000, Perspectives on Sexual and Reproductive Health, 2003, 35(1):6-15. Maternal mortality rates — United Nations Statistics Division (UNSD), The World’s Women 2000: Trends and Statistics, New York: UNSD, 2000/updated 2002.|
While the consequences of having an abortion depend on whether it is safe and legal, the cause is universal: unplanned pregnancies. 28% of the 210 million annual pregnancies worldwide are unplanned, and 22% end in abortion. Reducing unwanted pregnancies through wider and more effective use of contraception is the only effective means of reducing abortion rates… making our abortion laws more restrictive will only make abortion less safe.
In the three decades since Roe became law, Americans have forgotten their history and grown complacent about the very real human costs of illegal abortions, allowing the debate to increasingly focus on moral and religious beliefs rather than the public health issue that abortion really is. Abortion foes have successfully struck an emotional chord by illustrating their arguments with images of the undeniable horror of dead and mangled fetuses. Meanwhile, pro-Choice forces have tended to make a more intellectual appeal, arguing a vague and unwritten constitutional right to privacy.
But if Roe is overturned and Congress or the States narrowly restrict access to legal abortion, the public health calamity will be very real and very bloody. Thousands of young women will die of sepsis from botched, back-alley abortions. That is the undeniable conclusion from studying the impact of abortion laws at home and abroad. And that is the emotional, rhetorical appeal supporters of Roe must make if we are to educate our fellow Americans as to what is really at stake.
It is time to fight horror with horror.