Abortion May Soon Be Illegal. But Who Will That Affect the Most?

Editor's note: This article is part of a series originally published in 2022, after the unprecedented leak of a draft decision by the Supreme Court of the United States that would overturn 1973's landmark Roe v. Wade ruling. At the time, the proposed removal of federal protection for abortion rights represented a seismic shift with far-reaching implications, many of which are now a reality for millions of American women. Giddy is committed to thorough and fact-based coverage of this issue and we present these original data-driven articles as a snapshot of America as it was preparing to navigate a changing landscape of abortion rights.

For months now, abortion has remained steadily at the forefront of news in the United States, as citizens ravenously watch and read the Supreme Court's internal debates about citizens' constitutional right to end a pregnancy.

We wouldn't be this invested if we didn't all know—or believe we know—who the issue impacts. But do we really? Who is the average abortion patient, if there even is such a person? How many people terminate a pregnancy every year and why do they decide to undergo the procedure in the first place?

When abortion was illegal

The landmark Roe. v. Wade case, decided on January 22, 1973, legalized abortion across much of the U.S.

"Although the word 'abortion' does not appear in the Constitution, the U.S. Supreme Court found in Roe that the right to terminate a pregnancy was part of a right to privacy in the 14th Amendment to the Constitution," said Genevieve Grabman, J.D., M.P.H., attorney for United Nations agencies in Washington, D.C., and author of "Challenging Pregnancy."

Although it's commonly thought Roe v. Wade made abortion legal in the U.S. for the first time, some states were actually ahead of the curve. Up to 1973, there was a patchwork of state laws regarding the termination of a pregnancy.

In 1967, Colorado decriminalized abortion in cases of rape, incest or where the mother's life was in danger, and California, North Carolina and Oregon passed similar laws soon after. Hawaii legalized abortion at the request of a woman in 1970, and in the same year, New York repealed an 1830 law resulting in abortions being legally performed up to the 24th week of pregnancy.

In 1971, Washington, D.C., formally allowed abortions to take place, and by the end of 1972, 13 states had similar laws to the one that Colorado had passed five years earlier.

At the time Roe v. Wade was under consideration by the Supreme Court, abortion was illegal in 30 states, legal under varying circumstances in 16 states and legal without restriction in four states.

"Prior to Roe v. Wade, women underwent unsafe medical alternatives often resulting in death, hemorrhage, infection, infertility and hysterectomies—all from botched abortions," said Kecia Gaither, M.D., who is board-certified in OB-GYN and maternal-fetal medicine, and the director of perinatal services and maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York City.

In 1976, the Centers for Disease Control and Prevention (CDC) reported the number of illegal abortions decreased from about 130,000 in 1972 (pre-Roe v. Wade) to 17,000 in 1974 (after the ruling).

The safety of abortion has improved over the years, too, though it isn't easy to pinpoint exact maternal mortality figures due to abortion, especially before 1973 since many were unreported. There have been claims that "thousands of women" died annually due to unsafe abortions before the Supreme Court ruled in Roe v. Wade, but the Washington Post debunked these claims in 2019.

On a global scale, unsafe abortions are a leading cause of maternal mortality in countries where abortions are prohibited, resulting in about 7 million women being hospitalized annually, according to the U.N. Population Fund.

The 1976 CDC report stated the number of deaths associated with illegal abortion from 1972 to 1974 decreased from 39 to five. The women who died from illegal abortion during this period were typically Black, in their second trimester and underwent self-induced abortions.

The 2019 Pregnancy Mortality Surveillance System identified that two women died due to complications from legal induced abortion.

Deaths from abortion have significantly decreased over the decades due to women having access to safe, legal abortion and contraception and subsequent improvements in women's health care.

Abortion statistics across America

Gaither said 95 percent of abortions across the U.S. are performed in clinics, with statistics indicating that abortion rates directly correlate with people's access to abortion. In Washington, D.C., which has several abortion providers, the number of abortions per 1,000 women ages 15 to 44 is 32.7.

In contrast, in the rural state of Wyoming, which has only one abortion provider and numerous legal restrictions on abortion, the rate is 1.3 per 1,000 women—about 2 percent of total pregnancies.

Gaither added that the majority of women who choose abortion are at or below the poverty line, and are often single mothers. The CDC abortion surveillance data states that more than 85 percent of women who had an abortion in 2019 were unmarried.

Based on reported statistics from 2019, most abortions occur in the first trimester—the first 12 weeks—with more than 79 percent of abortions taking place before nine weeks gestation and 92.7 percent at or before 13 weeks.

Surgical abortions—such as vacuum aspiration or dilation and extraction—account for 49 percent of abortions at or before 13 weeks and 7.2 percent beyond 13 weeks gestation. Abortion pills, approved by the Food and Drug Administration for up to 10 weeks gestation, account for 42.3 percent of abortions.

The CDC data indicated 58.2 percent of women had no previous abortions, 23.8 percent previously had one abortion, 10.5 percent previously had two abortions and 7.5 percent previously had three or more abortions.

The reasons for abortion

The Guttmacher Institute, a sexual and reproductive health research organization, reports 1 in 4 American women will have an abortion before age 45. According to the 2019 CDC statistics, women in their 20s accounted for more than half of all abortions.

Depending on the source, Black women constitute the highest abortion rate, 23.8 per 1,000, and white women the lowest abortion rate, 6.6 per 1,000, Gaither said.

However, there are no statistics outlining reasons for having an abortion. No two stories are the same. Although many people may paint a picture of who they believe the typical abortion patient is, there really is no such thing.

Gaither explained that someone may choose abortion for several reasons, including:

• Poor finances; the inability to financially support a child
• Little or no social support
• A poor relationship with the father of the baby; the relationship could have ended or been abusive or otherwise unhealthy
• Already has children and doesn't want more
• The pregnancy was the result of rape, abuse or incest
• Fetal congenital anomaly
• Failed birth control and no plans to raise a family; the pregnancy may jeopardize current life plans, such as school or career progression
• Maternal medical condition precludes pregnancy; for example, carrying a baby to term might adversely affect the mother's health
• Not capable of caring for a child
• Not having housing or having an unstable home life

Abortion is not uncommon in the United States. In 2019 alone, the CDC reported a total of 629,898 abortions, based on reports from 49 states. With more than half of states likely to alter their abortion laws if Roe v. Wade is overturned, hundreds of thousands of women could be affected each year.

There is a common misconception that women who have abortions are childless. But 2019 CDC data indicated 60 percent of women who had an abortion already had one or more children.

Gaither fears the ruling will likely impact underserved Black women most, as this demographic has the highest incidence of pregnancy terminations. As well as affecting the mother and child, there are also infrastructure problems to consider. Would facilities or financial support be available to care for unwanted children or children with special needs?

The average cost of medical abortion in the first trimester is around $560 before insurance, increasing to about $850 for a termination in the second trimester. This amount does not include the costs of anticipated travel if the state you live in does not offer safe and legal abortion. According to polling by Bankrate, 57 percent of Americans don't have enough available cash to cover an emergency costing $500 or more.

Abortion may not be the only right we lose

Grabman said other cases—such as a married couple's right to use contraception, the right of individuals to marry someone of the same sex and the right of parents to determine the education of their children—were also based on a constitutional right to privacy.

However, Grabman noted the term "privacy" is not found in the 14th Amendment. The actual text of the relevant clause in the Constitution requires the government to protect "life, liberty or property."

"For almost 50 years, strict constructionists have decried the Roe court's interpretation of the Constitution's text to include abortions or privacy at all," Grabman said.

The Supreme Court's draft decision on Dobbs v. Jackson Women's Health Organization was leaked May 2 by Politico. Grabman explained that the majority of the court argued that rights protected by the Constitution but not explicitly mentioned within the document must be strongly rooted in U.S. history and tradition.

Based on the leaked decision draft, it could be assumed the court will likely find there is no consistent American history of abortion rights, thus, there is no federal constitutional protection for abortion. A final court decision is expected in the coming weeks.

Without federal protections, individual states would have oversight to decide whether pregnant people can legally seek an abortion, Grabman said. Currently, half the states are poised to outlaw abortion entirely or restrict it to a very early stage of pregnancy. Several states have trigger bans set to go into effect. Some have pre-Roe bans on the books.

"The ability of Americans to access contraception, too, is at risk, as may be access to infertility treatments, sterilizations and medical procedures that would imperil the health of a developing fetus," Grabman said.

The full consequences of the awaited legal decision are yet to be seen. But statistics are clear. Most medical professionals agree that abortion is a common, safe procedure and most women cannot predict if, when or where they'll need one. Every situation is unique, and only the person having an abortion knows if abortion is the right, and only, decision for them.

Abortion is a medical procedure that is currently illegal or restricted in some portions of the United States. For more information about the legality of abortion in your area, please consult a local healthcare provider.