Cardinal Way: Civility Rules encourages constructive dialogue on difficult issues. You can participate in the project by filling out this survey that asks your views: What’s the best way to make an argument in favor of abortion rights to someone who is opposed to abortion? What’s the best way to make an argument in favor of restricting abortion to someone who is against restrictions? Is there room for common ground on abortion? If so, where? Has your view on abortion changed over time? Do you think there is a point of view that someone could offer that would influence your view?
See the other article in this package: “On abortion, listening is the key to understanding.”
In 1967, I was 13 years old when my gray-haired mother became so ill with a tumor that she and her doctor presumed cancer. Much to her surprise, she was pregnant. For the remaining eight months I watched her energy drain and her personality change. When my sister was born and Mom returned to her energetic self, I realized an unplanned pregnancy could be debilitating. Several years later, a high school acquaintance suffered serious complications from an illegal abortion she secretly accessed. I had never heard of abortion but my grandmother told me it was common in some countries.
Living in the South, where discussions of sex education still range from awkward to taboo, I’m acutely aware of challenges some women face when they need sound sexual education and access to reliable, safe contraception. Accessible, reliable education and contraception prevent the need for most abortions. Others may be medically indicated because of rape, incest, intimate partner violence, fetal anomalies, illness during pregnancy, a medically fragile mother or exposure to certain medications.
Early in my career I came to understand that contraception use is a preventative health decision between a woman and her physician and abortion is a medical decision for certain women with a particular need defined in the context of a physician-patient relationship, based on the patient’s medical history and current circumstances.
Throughout my medical career, maternal and child healthcare has been a priority focus and a source of joy. I served as public health director for the Alleghany and Roanoke city health districts when Health Department clinicians were the primary providers of maternal health services for under-insured and uninsured women. We provided contraception services, prenatal care, post-natal care, home visiting for moms and babies and referrals for women seeking abortion.
Because of my commitment to public health, I support efforts to reduce the rate of unintended pregnancy and abortion. That same commitment has led me to oppose state-mandated abortion bans which undermine public health in complex and substantive ways.
The health impact to women is irrefutable. Legal abortions, performed by licensed medical professionals in regulated, sanitary medical facilities, are safer than illegal abortions performed under clandestine and often dangerous circumstances. There are approximately 26 million legal abortions and 20 million illegal abortions performed annually worldwide. The collective abortion rate among the countries that allow the procedure is roughly the same as for those that ban it. Yet the rates of death and severe complications are vastly higher in countries with restrictions.
Among the 20-odd countries that ban all abortions (including to save the woman’s life), three-quarters of them have abortion rates higher than the rate of legal abortion in the U.S. This seems counterintuitive. However, countries restricting the personal autonomy of women typically do so for contraception and health education as well as for abortion. Similar tendencies exist among the U.S. states.
Based upon maternal and child health data from the Centers for Disease Control and Prevention, abortion restrictions disproportionately affect people of color and those with low-incomes, accentuating health disparities such as low birth weight babies, maternal morbidity, and premature deliveries. A 2020 study from the American Journal of Preventive Medicine found that women living in states with progressive reproductive health policies were less likely to give birth to low-weight babies.
Data from the Turnaway Study (the first study to rigorously examine the effects of receiving versus being denied a wanted abortion on women and their children) found that women who were denied wanted abortions had higher levels of household poverty, debt, evictions and other economic hardships and instabilities. Women seeking but unable to obtain abortions endured higher levels of physical violence from the men who had fathered these children.
As a result of such data, the American Academy of Pediatrics opposes abortion restrictions based, in part, on the negative health impacts to children. The American Public Health Association asserts that access to contraception and safe abortion is integral to the health and well-being of individuals and to the broader public health. Restrictions on access to any evidence-based health service undermines public health.
Since the 2022 Supreme Court Dobbs decision that overturned Roe v. Wade, 14 states have banned abortion in one form or another. In the 12 months following that decision, the number of abortions in the U.S. actually increased slightly (0.2%) from the prior year. Certainly, some women in these states ended up giving birth who would have otherwise sought legal abortion. But many more women sought out-of-state abortions, even in cases where delays meant more complex and riskier medical procedures. Still others sought medication without the supervision of a trusted medical provider.
Simply banning abortion is an ineffective means of reducing the need for abortion.
Ironically, the states that now ban abortion have begun to experience disruptions in prenatal and maternity care. Idaho’s Bonner General Health four OB-GYNs left Idaho to practice where abortion is legal. All four reported that the state’s abortion ban contributed to their decisions to leave Idaho. Bonner County has become a “maternity desert.”
Maternity deserts may proliferate in states with abortion bans. A 2023 study reported by the American College of Obstetricians and Gynecologists found that, among third- and fourth-year medical students, 58% are “unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions.” Data collected by the Association of American Medical Colleges shows that states with abortion bans had a 10.5% drop in applications for OB-GYN residencies this year.
Some abortion opponents may feel that the negative public health consequences from abortion bans are justifiable to save even one human life. But there are better ways to reduce abortion. Opponents can encourage adoption. They can seek greater public funding of prenatal, maternity services, and subsidized daycare. These are practical, compassionate approaches.
Whether a person believes contraception, abortion or any other medical intervention is moral or immoral is a conclusion based on a personal moral code. That is a construct which physicians routinely navigate with patients.
For optimal pregnancy outcomes in Virginia, our state government should assure contraceptive and abortion decisions are treated like other medical decisions, made by a patient in consultation with a trusted physician.
If both sides of the abortion divide were to jointly pursue compassionate and effective means to limit abortions through age-appropriate sexuality education, contraceptive services, increased public funding for pre-conceptual care, prenatal care, maternity care and subsidized daycare, the aspirations of both could be achieved.
