Origins and Outcomes: Systemic Barriers to Abortion Accessibility in the United States

What is Abortion Accessibility?

Modern American laws force many females into motherhood. Cornell University's reports on Dobbs v, Jackson Women's Health Organization, a 2022 case that went to the Supreme Court and resulted in the reversal of Roe v. Wade thus, overturning the federal right to abortion, leaving the legality of abortion up to states individually. Despite the subsequent restrictions, Kathryn E. Fay, an obstetrician-gynecologist, claims that 95% of obstetrician–gynecologists still support abortion, stating that they are willing to provide the provision of care, even if it conflicts with their personal beliefs. This ideology highlights the medical importance of abortion and is not uncommon among obstetrician-gynecologists, especially on an international scale. The Center for Reproductive Rights, a global organization fighting for reproductive rights, highlights the international availability of abortion. They explain that thirty-nine European countries have legalized abortion on request, meaning that professionals are not required to justify or certify a specific reason to perform an abortion, contrasting the limited accessibility in the United States.

Historical Medical Control

One of the arguments factored into the Dobbs decision was, "Until the latter part of the 20th century, there was no support in American law for a constitutional right to obtain an abortion." Charisse Marie Loder, a clinical professor specializing in gynecology, would counter this position, as the argument fails to explain that there was no demand for a constitutional right to obtain an abortion until the late 20th century because it was widely accessible up until the mid-18th century. European colonists used the phrase "restoring the menses," referring to balancing the body, and performed abortions under this ideology. Similarly, different Indigenous groups and enslaved Africans performed abortions through herbal recipes. By this point, abortions were only thought to be illegal after the mother began to feel the baby's movements.

It was only in 1857 that the American Medical Association, also known as the AMA, began the anti-abortion movement. They did so to gain control of reproductive health and restrict clientele from midwives and homeopaths, who previously dominated maternal care spaces. Additionally, female physicians were accused of performing illegal abortions to tarnish their reputations. To preserve their social standing, female physicians began to lead the anti-abortion movement in the 1890s. Early feminist ideologies were suppressed to conform to societal expectations.

As birth rates of white protestant families declined and immigrants entered the country, the leader of the AMA anti-abortion movement, Dr. Horatio R. Storer, began to convince white protestants they would be out-populated and lose their political power. He compared the children of immigrants to aliens, thus increasing the hostility towards immigrants and people of color and fueling the anti-abortion campaign. Overall, the demand for a constitutional right to obtain an abortion came in the late twentieth century because there was no need for one beforehand, as females had the service readily available to them. Although abortions did have a moral and legal cut-off, they were thought to be a standard part of female’s self-care routines until then. Furthermore, it is likely the demand for a constitutional right to abortion came significantly late because of the stigmatization the AMA curated around abortion. Female physicians had to actively contradict their support for abortion due to the accusations they faced from their male counterparts, making it difficult for other females to express their support. The AMA also encouraged racial and ethnic biases via their claims that abortion access would lead to the overpopulation of minorities, further connecting fear and bigotry with abortion. The AMA did not start the antiabortion movement out of concern for expecting mothers, their priorities were eliminating competition, thus improving their revenue and maliciously hurting minorities.

Norman A. Ginsberg, an obstetrics and gynecology specialist at Northwestern University, builds upon the evolution of abortion via her explanation of Roe V. Wade. The legal case had been filed by a woman under the pseudonym "Jane Roe," who wanted to terminate her pregnancy within Texas law. On January 22, 1973, the court sided with Roe, striking down the previous Texas abortion ban. After RVW was issued, a legal precedent was established, impacting the outcomes of 30 subsequent Supreme Court cases related to abortion. Furthermore, RVW rendered the almost nationwide abortion bans unconstitutional, making abortion more accessible throughout the United States.

Contemporary Legal and Cultural Dynamics

According to Pew Research Center, a widely trusted nonpartisan fact tank, 61% of American adults believe that abortion should be legal in all/almost all cases. The United States government ignores this support and continues to restrict access to abortions. In 2022, the aforementioned Dobbs v, Jackson Women's Health Organization went to the Supreme Court and resulted in the elimination of the federal right to abortion, overruling Roe v. Wade and leaving the legal specifics of abortion up to individual states.

Sumedha Gupta, an economist specializing in health policies in the Department of Economics at Indiana University, details the legal status of abortion in each state. 13 states have almost or entirely banned abortion. This includes Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming. Moreover, many of these states, such as Arkansas, disregard rape and incest as exceptions to their total bans. Through these bans, the state is imposing upon female’s autonomy, as they have for generations. The United States government similarly imposes its own private will, restricting female’s access to abortion, regardless of its equally crucial and common role in healthcare.

Health Consequences and Social Stigma

Judith A. Berg, a clinical professor with a Ph.D. in nursing, details the implications of restricted abortion access. Berg explains that restricting abortion access will not decrease the demand for abortion, leading female’s to seek unsafe abortions. In countries where abortion access is restricted, unsafe abortions performed with outdated methods are significantly more common. By restricting abortions, the United States is not decreasing the overall amount of abortions. Instead, they are decreasing the amount of safely performed abortions. Furthermore, as females age they need increased medical care, some of which will be lost due to the overruling of Roe. According to Berg's research, the United States is not only risking female’s health, but also limiting their access to medical care via abortion restrictions.

Just as childbearing people’s physical health is at risk due to abortion denial, so is their mental health. In a national study of four thousand abortion patients, almost two-thirds reported that others would frown upon them if they were aware they had an abortion, explains M. Antonia Biggs, a social psychologist with a Ph.D. in Psychology. These patients are battling abortion stigma, described as "a negative attribute ascribed to those who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood."

Biggs conducted a study in which she found that abortion stigma was strongly correlated with psychological stress in the years following those who had abortions and those who were denied abortions. It was specifically those who were denied an abortion, later miscarried, or had an abortion elsewhere that reported the highest level of perceived abortion stigma across the interviews. Because of this, these groups suffered the most psychological distress, proving Biggs's hypothesis that abortion denial is stigmatizing. Considering the increase in abortion denial due to Roe v. Wade and the psychological stress following that denial, the United States is risking the emotional well-being of its citizens as states continue to pass abortion bans.

Systemic Failures in Current Care

Biggs also suggests that those who successfully have a child avert abortion stigma, as they meet the cultural ideas of motherhood by having a child. Loes Meeussen, a researcher at the Center for Social and Cultural Psychology at the University of Leuven, supports Biggs claims regarding the strict cultural ideas of motherhood. Meeussen explains motherhood is often thought to be the central goal of a woman's life. Fulfilling these norms is central to one's belonging and leads to social acceptance, while deviating from these norms leads to punishments.

Many modern females want to live freely, deviating from gender roles such as motherhood. This is supported by Maura Kelly, a public sociologist focused on equity for childbearing people, who reports 7% of females were voluntarily child-free in 2002, a 5% increase from 1998, and recent data suggests this trend will continue. Furthermore, these participants decided against having children as it allows them to focus on their desires, such as work and their relationships.

Meeussen reports mothers are the primary caretakers of their children, putting their children's needs ahead of theirs. Unless given access to abortion, childbearing people will be forced to become mothers and also their children's primary caretaker, regardless of their desires. Many modern individuals feel similarly regarding motherhood, understanding they will live unhappily after giving birth, in desire of freedom. And as Biggs described, they will likely suffer psychologically due to being denied access to an abortion. The steps that have been made to undo this imposition, such as the constitutional right to abortion, have been overturned. This leaves many adult Americans who are in support of abortion, waiting for relief, and waiting for others to cease control of them.

International Perspective

In the bulk of European countries, abortion denial is nowhere near as concerning as it is in the United States. Thirty-nine European countries have made abortion accessible upon request, states the Center for Reproductive Rights, a global legal organization dedicated to reproductive justice. Abortion on request means that professionals cannot demand or certify the existence of a reason to justify providing an abortion. The majority of Europe, despite their varying socioeconomic standings, provides accessible abortions. Yet, the United States does not, continuing to pass anti-abortion laws. This risks citizen's health, as supported by Berg, and deprives its citizens of the basic autonomy that most of the European continent provides.

Final Thoughts

Due to the reversal of Roe v. Wade, abortion access has been restricted, contradicting the support Americans have for abortion accessibility. The reversal of Roe v. Wade lacks nuance, and risks the mental and physical well-being of American citizens, forcing them to bear children regardless of their wants. The United States is responsible for protecting its citizens, honoring their wants as a democracy, and providing them with rights other nations have access to. Therefore, the United States government does have a responsibility to provide accessible abortions.

Works Cited

Berg, J. A., & Woods, N. F. (2023). Overturning Roe v. Wade: Consequences for midlife women's health and well-being. Women's Midlife Health, 9(1). https://doi.org/10.1186/s40695-022-00085-8

Biggs, M. A., Upadhyay, U. D., McCulloch, C. E., & Foster, D. G. (2020). Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PLOS ONE, 15(1), e0226417. https://doi.org/10.1371/journal.pone.0226417

Center for Reproductive Rights. (2022, June). European abortion laws a comparative overview.

Fay, K. E., Karvelas, N. B., Karjane, N., Schubert-Facteau, S., & Scott, D. M. (2022). Abortion as essential health care and the critical role your practice can play in protecting abortion access. Obstetrics & Gynecology, Publish Ahead of Print. https://doi.org/10.1097/aog.0000000000004949

Ginsberg, N. A., & Shulman, L. P. (2021). Life without Roe v Wade. Contraception and Reproductive Medicine, 6(1). https://doi.org/10.1186/s40834-021-00149-6

Gupta, S., Kozhimannil, K. B., & Myers, C. (2023). Trends in abortion- and contraception-related internet searches after the US Supreme Court overturned constitutional abortion rights. JAMA Health Forum, 4(4), e230518. https://doi.org/10.1001/jamahealthforum.2023.0518

Hartig, H. (2022, June 13). About six-in-ten Americans say abortion should be legal in all or most cases. Pew Research Center. https://www.pewresearch.org/short-reads/2022/06/13/about-six-in-ten-americans-say-abortion-should-be-legal-in-all-or-most-cases-2/

Kelly, M. (2009). Women's voluntary childlessness: A radical rejection of motherhood? Women's Studies Quarterly, 37(3/4), 157–172. https://www.jstor.org/stable/27740584

Kolbert, P., & Scholl, C. (2023, July 7). Status of abortion laws, state by state. Ms. Magazine. https://msmagazine.com/2022/07/07/abortion-legal-state-laws/

Loder, C. M., Ferguson, S., & Okafor, I. (2022). The historical context of abortion in the United States. SAGE Open, 12(4). https://doi.org/10.1177/21582440221137904

Meeussen, L., & Van Laar, C. (2018). Feeling pressure to be a perfect mother relates to parental burnout and career ambitions. Frontiers in Psychology, 9, 2113. https://doi.org/10.3389/fpsyg.2018.02113

Newton, C. (2022, June 28). Dobbs v. Jackson Women's Health Organization (2022). Cornell Law School Legal Information Institute. https://www.law.cornell.edu/wex/dobbs_v._jackson_women%27s_health_organization_%282022%29

Reporter of Decisions. (2022, June 24). Syllabus 19-1392 Dobbs v. Jackson Women's Health Organization. Supreme Court of the United States.