NAF has worked since 1977 to ensure that women, health care professionals, and policymakers have access to factual information about abortion. NAF has created a series of carefully researched fact sheets that cover topics related to abortion and abortion care.

Printable version of this fact sheet (PDF file, 34K)

Surgical abortion is one of the safest types of medical procedures. Complications from having a first-trimester aspiration abortion are considerably less frequent and less serious than those associated with giving birth. Early medical abortion (using medications to end a pregnancy) has a similar safety profile.1

Illegal Abortion is Unsafe Abortion

Abortion has not always been so safe. Between the 1880s and 1973, abortion was illegal in all or most U.S. states, and many women died or had serious medical problems as a result. Women often made desperate and dangerous attempts to induce their own abortions or resorted to untrained practitioners who performed abortions with primitive instruments or in unsanitary conditions. Women streamed into emergency rooms with serious complications – perforations of the uterus, retained placentas, severe bleeding, cervical wounds, rampant infections, poisoning, shock, and gangrene.

Around the world, in countries where abortion is illegal, it remains a leading cause of maternal death. An estimated 68,000 women worldwide die each year from unsafe abortions.2

Many of the doctors who provide abortions in the United States today are committed to providing this service under medically safe conditions because they witnessed and still remember the tragic cases of women who appeared in hospitals after botched, illegal abortions.

Evaluating the Risk of Complications

Since the Supreme Court reestablished legal abortion in the U.S. in the 1973 Roe v. Wadedecision, women have benefited from significant advances in medical technology and greater access to high-quality services.3 Generally, the earlier the abortion, the less complicated and safer it is.

Serious complications arising from aspiration abortions provided before 13 weeks are quite unusual. About 88% of the women who obtain abortions are less than 13 weeks pregnant.4 Of these women, 97% report no complications; 2.5% have minor complications that can be handled at the medical office or abortion facility; and less than 0.5% have more serious complications that require some additional surgical procedure and/or hospitalization.5

Early medical abortions are limited to the first 9 weeks of pregnancy. Medical abortions have an excellent safety profile, with serious complications occurring in less than 0.5% of cases.6 Over the last five years, six women in North America have died as a result of toxic shock secondary to a rare bacterial infection of the uterus following medical abortion with mifepristone and misoprostol. This type of fatal infection has also been observed to occur following miscarriage, childbirth and surgical abortion, as well as other contexts unrelated to pregnancy. The Centers for Disease Control and Prevention’s (CDC) continuing investigations have found no causal link between the medications and these incidents of infection. Although the Food and Drug Administration (FDA) has issued an updated advisory for warning signs of infection following medical abortion, it has recommended that there be no changes in the current standards for provision of medical abortion.7,8

Complication rates are somewhat higher for surgical abortions provided between 13 and 24 weeks than for the first-trimester procedures. General anesthesia, which is sometimes used in surgical abortion procedures of any gestation, carries its own risks.

In addition to the length of the pregnancy, significant factors that can affect the possibility of complications include:

  • the kind of anesthesia used;
  • the woman’s overall health;
  • the abortion method used; and
  • the skill and training of the provider.

Types of Complications from Surgical Abortion

Although rare, possible complications from a surgical abortion procedure include:

  • blood clots accumulating in the uterus, requiring another suctioning procedure, (less than 0.2% of cases);9
  • infections, most of which are easily identified and treated if the woman carefully observes follow-up instructions, (0.1%-2.0% of North American cases);9
  • a tear in the cervix, which may be repaired with stitches (0.6%-1.2% of cases);10
  • perforation (a puncture or tear) of the wall of the uterus and/or other organs (less than 0.4% of cases).5,9
  • incomplete abortion, in which tissue from the pregnancy remains in the uterus, and requires a repeat suction procedure, (0.3%-2.0% of cases);9
  • excessive bleeding requiring a blood transfusion (0.02%-0.3% of cases).5,9 In comparison, a woman’s risk of death during pregnancy and childbirth is ten times greater.5

Possible complications of a medical abortion include:

  • failure of the medications to terminate the pregnancy (less than 2% of cases), requiring a suction procedure to complete the abortion;11
  • incomplete expulsion of the products of conception, requiring a suction procedure to complete the abortion (occurs in less than 6% of cases);12
  • excessive bleeding, requiring a suction procedure, and rarely, transfusion (less than 1% of cases);11
  • uterine infection, requiring the use of antibiotics (0.09%-0.6% of cases) ;11
  • death secondary to toxic shock following infection with Clostridium sordellii (has occurred in less than 0.001% of cases in the US and Canada).6

Signs of a Post-Abortion Complication

If a woman has any of the following symptoms after having either a surgical or medical abortion, she should immediately contact the facility that provided the abortion for follow-up care13:

  • severe or persistent pain;
  • chills or fever with an oral temperature of 100.4° or more;
  • bleeding that is twice the flow of her normal menstrual period or that soaks through more than one sanitary pad per hour for two hours in a row;
  • malodorous discharge or drainage from her vagina; or
  • continuing symptoms of pregnancy.

In addition, if a woman who is having a medical abortion notices the onset of severe abdominal pain, malaise or “feeling sick,” even in the absence of fever, more than 24 hours after the administration of the second medication, she must immediately contact the facility that provided the abortion.7

Health care providers and clinics that offer abortion services should provide a 24-hour number to call in the event of complications or reactions that the patient is concerned about.

Preventing Complications

There are some things women can do to lower their risks of complications. One way to reduce risk of complications is to have the abortion procedure early. Generally, the earlier the abortion, the safer it is.

Asking questions is also important. Just as with any medical procedure, the more relaxed a person is and the more she understands what to expect, the better and safer her experience usually will be.

In addition, any woman choosing abortion should:

  • find a good clinic or a qualified, licensed practitioner. For referrals, call NAF’s toll-free Hotline at 1-800-772-9100 or find a provider online;
  • inform the practitioner of any health problems, current medications or street drugs being used, allergies to medications or anesthetics, and other health information;
  • follow post-operative instructions; and
  • return for a follow-up examination.

Anti-Abortion Propaganda

Anti-abortion activists claim that having an abortion increases the risk of developing breast cancer and endangers future childbearing. They claim that women who have abortions without complications are more likely to have difficulty conceiving or carrying a pregnancy, develop ectopic pregnancies, which are pregnancies outside of the uterus (commonly in one of the fallopian tubes), deliver stillborn

babies, or become sterile. However, these claims have been refuted by a significant body of medical research. In February 2003, a panel of experts convened by the National Cancer Institute to evaluate the scientific data concluded that studies have clearly established that “induced abortion is not associated with an increase in breast cancer risk.”15 Furthermore, comprehensive reviews of the data have concluded that a vacuum aspiration procedure in the first trimester poses virtually no risk to future reproductive health.16 (See Abortion Myths: Abortion and Breast Cancer.)

Women’s Feelings after Abortion

Women have abortions for a variety of reasons, but in general they choose abortion because a pregnancy at that time is in some way wrong for them. Such situations can cause a great deal of distress, and although abortion may be the best available option, the circumstances that led to the problem pregnancy may continue to be upsetting.

Some women may find it helpful to talk about their feelings with a family member, friend, or counselor. Feelings of loss or of disappointment, resulting, for example, from a lack of support from the spouse or partner, should not be confused with regret about the abortion. Women who experience guilt or sadness after an abortion usually report that their feelings are manageable.

The American Psychological Association has concluded that there is no scientifically valid support or evidence for the so-called “post-abortion syndrome” of psychological trauma or deep depression. The most frequent response women report after having ended a problem pregnancy is relief, and the majority of women are satisfied that they made the right decision for themselves. (See Abortion Myths: Post-Abortion Syndrome.)

References

  1. Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomised trial. World Health Organization Task Force on Post-ovulatory Methods of Fertility Regulation. BJOG 2000; 107:524-30.
  2. The World Health Report 2005 – Make every mother and child count. Geneva, Switzerland: World Health Organization, 2005.
  3. AMA Council Report. Induced Termination of Pregnancy Before and After Roe v. Wade.Journal of the American Medical Association, 1992, 268: 3231.
  4. Elam-Evans LD, Strauss LT, Herndon J, Parker WY, Whitehead S, Berg CJ. Abortion Surveillance-United States, 1999. Morbidity and Mortality Weekly Report 2002; 51 (SS09): 1-28.
  5. Tietze C, Henshaw SK. Induced abortion: A worldwide review, 1986. Third edition. New York: Guttmacher Institute, 1996.
  6. Grimes DA. Risk of mifepristone abortion in context. Contraception 2005; 71:161.
  7. FDA, Center for Drug Evaluation and Research, Mifepristone Information.http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsand Providers/ucm111323.htm
  8. Centers for Disease Control and Prevention. Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol – United States and Canada, 2001-2005. MMWR Morb Mortal Wkly Rep 2005; 54:724.
  9. Henshaw SK. Unintended pregnancy and abortion: A public health perspective. In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG. A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999, pp. 11-22.
  10. Haskell WM, Easterling TR, Lichtenberg ES. Surgical abortion after the first trimester. In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG. A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999, pp. 123-138.
  11. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists 2005; Number 67: Medical Management of Abortion. Obstet Gynecol 2005; 106(4):871-882.
  12. Allen RH, Westhoff C, DeNonno L, Fielding AL, Schaff EA. Curettage after mifepristone-induced abortion: Frequency, timing and indications. Obstet Gynecol 2001; 98(1):101-106.
  13. Lichtenberg ES, Grimes DA, Paul M. Abortion complications: Prevention and management. In Paul M, Lichtenberg ES, Borgatta L. Grimes DA, Stubblefield PG. A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999, pp. 197-216.
  14. Hern WM. Abortion Practice. Philadelphia: J.B. Lippincott Company, 1990.
  15. Summary Report: Early Reproductive Events and Breast Cancer Workshop, National Cancer Institute, www.nci.nih.gov/cancerinfo/ere-workshop-report
  16. Rowland Hogue CJ, Boardman LA, Stotland NL, Peipert JF. Answering questions about long-term outcomes. In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG. A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999, pp. 217-228.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writers: Susan Dudley, PhD, and Beth Kruse, MS, CNM, ARNP
Copyright© 2006, National Abortion Federation
Revised December 2006.

Printable version of this fact sheet (PDF file, 26K)

Definition

A medical abortion is one that is brought about by taking medications that will end a pregnancy. The alternative is surgical abortion, which ends a pregnancy by emptying the uterus (or womb) with special instruments. Either of two medications, mifepristone or methotrexate, can be used for medical abortion. Each of these medications is taken together with another medication, misoprostol, to induce an abortion.

When Is Medical Abortion Used?

Before any abortion can be done, a medical professional must confirm that a woman is indeed pregnant and determine how long she has been pregnant. The length of a pregnancy is usually measured by the number of days that have passed since the first day of the woman’s last menstrual period (abbreviated as LMP). Medical abortions can be provided as early as a pregnancy can be confirmed. In fact, the shorter the time that a woman has been pregnant, the better the medications will work. Because they do not work as well later in the first trimester of pregnancy, medical abortion is not usually an option after nine weeks (or 63 days) LMP. After that, surgical abortion is the safest and best option.

How the Medications Work

Mifepristone. Mifepristone (the abortion pill or RU-486) is a medication that was developed and tested specifically as an abortion-inducing agent. It was first licensed in France and China in 1988. Since then it has been used safely by millions of women worldwide. It was approved for use in the U.S. in September, 2000.

Mifepristone is taken in the form of a pill. It works by blocking the hormone progesterone, which is necessary to sustain pregnancy. Without this hormone, the lining of the uterus breaks down, the cervix (opening of the uterus or womb) softens, and bleeding begins.

Methotrexate. Methotrexate has been used in the U.S. since 1953, when it was approved by the FDA to treat certain types of cancer. Since that time, medical researchers have discovered other important uses for the drug. One of these uses is to end unintended pregnancies. Although the FDA did not consider methotrexate for this specific purpose, clinicians may prescribe methotrexate for early abortion.

Methotrexate is usually given to a pregnant woman in the form of an injection, or shot, although it also can be taken orally. It stops the ongoing implantation process that occurs during the first several weeks after conception.

Misoprostol. Within a few days after taking either mifepristone or methotrexate, a second drug, misoprostol, is taken. Misoprostol tablets (which may be placed either into the vagina, between cheek and gum, or swallowed) cause the uterus to contract and empty. This ends the pregnancy.

Mifepristone and methotrexate work in different ways, and so they will have slightly different effects on a woman’s body. A clinician can help a woman decide whether medically induced abortion is the right option for her, and which of the two drugs she should use.

How Long Do Medical Abortions Take?

It can take anywhere from about a day to 3-4 weeks from the time a woman takes the first medication until the medical abortion is completed. The length of time depends in part on which medications are taken and when the misoprostol is used. Complete abortion generally occurs sooner with mifepristone compared to methotrexate. The majority of women who take mifepristone will abort within four hours of using misoprostol. About 95% will have a complete abortion within a week. With methotrexate, 80-85% of women will abort within 2 weeks of taking the first medication. Some will take longer and may use additional doses of misoprostol.

During and After a Medical Abortion

Some women will have vaginal bleeding after the first drug. This bleeding may be light, or it may be like a heavy period. After taking the misoprostol, cramping and bleeding usually begin within a few hours, although it may take longer. The cramping and bleeding may be more than with a normal menstrual period. Written and verbal guidelines are given to all women to help them know what to expect, and when to call the clinic for further evaluation.

Most women in the United States use the misoprostol and expel the embryo at home. A woman considering medical abortion will need to be prepared for this. The clinic staff will provide guidance and answer questions about what to expect and how to manage the side effects at home.

The most common side effects of medical abortion are caused by misoprostol. In addition to cramps and bleeding, early side effects may include: headache, nausea, vomiting, diarrhea, fever, chills, or fatigue. If a woman experiences flu-like symptoms or abdominal pain more than 24 hours after using misoprostol, she is advised to call the clinic.

Most women have cramps for several hours, and many pass blood clots as they are aborting. Some women may see the grayish gestational sac. However, the embryo will probably not be seen among the blood clots. At 49 days LMP, the size of the embryo will be about one-fifth of an inch. In an earlier pregnancy, it might be much smaller than that. Cramps and bleeding usually begin to ease after the embryonic tissue has been passed, but bleeding may last for one to two weeks after medical abortion.

Some women report that their first regular menstrual period after a medical abortion is heavier, or longer, or in some other way different from normal for them. By the second period after the abortion, their cycles should be back to normal.

Possible Complications

About 95-98% of women will have a successful medical abortion. Complications are rare. However, a small percentage of women (approximately 0.5-2%) will need a suction aspiration (similar to a surgical abortion) because of heavy or prolonged bleeding. In about half of these cases, this heavy bleeding occurs 3-5 weeks after taking the medications. Rarely, in approximately 0.1-0.2% of cases, a blood transfusion might be required to treat very heavy bleeding. Some women also choose to have a suction aspiration because they would prefer not to wait for the medical abortion to be completed on its own.

In about 1% of cases or fewer, the medications do not work and the embryo continues to grow. In these cases, a suction procedure (surgical abortion) must be done to empty the uterus and complete the abortion. Deciding to continue the pregnancy to term is not an option after taking the first medication because the medications can cause birth defects in the pregnancy.
Seven deaths in North America have been reported in women following the use of mifepristone/misoprostol, out of more than 1.1 million cases. One death was the result of an ectopic pregnancy (a pre-existing condition not related to mifepristone/misoprostol use), and six deaths have been attributed to sepsis. No causal relationship has been established between the medications and these rare fatalities.

There do not appear to be any long-term complications associated with use of these drugs.

Follow-Up Care

Medical abortion requires a follow-up visit to the clinic or medical office. This return visit is very important to be sure that the abortion has been completed. In addition, a woman should contact her health care provider about any problems or concerns she has during the medical abortion.

Anti-Abortion Propaganda About Medical Abortion

Anti-abortion activists claim that medical abortion is unsafe for women, even though there is no evidence to support this claim. The real goal of those activists is to stop all types of legal abortion – a situation which would put the lives and health of women in danger. When abortion was illegal in the United States (from the late 1800s until 1973), more pregnant women died from complications from self-induced abortions or abortions performed by untrained practitioners than from any other cause. Today, abortion is one of the most common and safest medical procedures. Because earlier abortions are the safest, medical abortion is an important medical advance for women, and an option that many choose.

References

Allen RH, Westhoff C, DeNonno L, Fielding SL, Schaff SA. Curettage after mifepristone-induced abortion: frequency, timing, and indications. Obstet Gynecol 2001;98:101-106.

Fischer M, Bhatnagar J, Guarner J, et al. Fatal toxic shock syndrome associated with Clostridium sordelli after medical abortion. New Engl J Med 2005; 353:2352-2360.

Grimes DA. Medical abortion in early pregnancy: A review of the evidence. Obstet Gynecol1997;89:790-6.

Kahn JG, Becker BJ, MacIsaac L, et al. The efficacy of medical abortion: A meta-analysis.Contraception 2000; 61: 29-40.

Middleton T, Schaff E, Fielding S, et al. Randomized trial of mifepristone and buccal or vaginal misoprostol for abortion through 56 days of last menstrual period. Contraception 2005; 72: 328-332.

Paul M, Creinin MD (eds). Supplement on Early Medical Abortion. Am J Obstet Gyn 2000; 183: S1-S94.

Schaff EA, Eisinger SH, Stadalius LS, Franks P, Gore BZ, Poppema S. Low-dose mifepristone 200mg and vaginal misoprostol for abortion. Contraception 1999;59:1-6.

Schaff EA, Fielding SL, Eisenger SH, Stadalius LS, Fuller L. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception 2000;61:41-46.

Schaff EA, Fielding SL, Westhoff C. Randomized trial of oral versus vaginal misoprostol at one day after mifepristone for early medical abortion. Contraception 2001; 64: 81-85.

Wiebe E, Dunn S, Guilbert E, Jacot F, Lugtig L. Comparison of abortions induced by methotrexate or mifepristone followed by misoprostol. Obstet Gynecol 2002; 99: 813-9.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

For more information on medical abortion see Medical Abortion: History and Overview.

Writers: Susan Dudley, PhD, and Stephanie Mueller
Copyright ©2008, National Abortion Federation
Revised September 2008.

 

Printable version of this fact sheet (PDF file, 30K)

NAF issued Patient Information on Mifepristone on January 31, 2008

What is Mifepristone?

Mifepristone (formerly known as RU-486) is a medication that blocks the action of the hormone progesterone. Progesterone is needed to sustain a pregnancy. Mifepristone has been used, in combination with other medications called prostaglandins, for medical abortion since 1988 in France and China, and since the early 1990’s in the United Kingdom and Sweden. It has been licensed for use in 37 countries including the United States where it was approved in September 2000. Millions of women worldwide have safely used mifepristone regimens to end their pregnancies.

How mifepristone works to end pregnancy

Mifepristone blocks the action of progesterone, which is needed to sustain a pregnancy. This results in:

  • Changes in the uterine lining and detachment of the pregnancy
  • Softening and opening of the cervix
  • Increased uterine sensitivity to prostaglandin

In the U.S., mifepristone is used in combination with another medication, a synthetic prostaglandin called misoprostol. Misoprostol causes the uterus to contract, and helps the pregnancy tissue to expel.

How effective is the combination of mifepristone and misoprostol in terminating an early pregnancy?

Depending on the prescribing physician’s protocols, mifepristone and misoprostol can be used for early abortion up to 63 days after the start of the last menstrual period. Approximately 95-98% of women will have a complete abortion when using mifepristone/misoprostol. Success rates may depend on the treatment regimen and the duration of the pregnancy. The remaining women will need a suction procedure, either because of ongoing or excessive bleeding, an incomplete abortion (tissue remains in the uterus but there is no growing embryo), or an ongoing pregnancy (a viable growing pregnancy, which occurs in less than 1% of cases).

Treatment regimen with mifepristone/misoprostol

Clinical studies have shown that several variations in mifepristone/misoprostol treatment regimens are safe and effective. Generally, however, once a woman has decided to have a medical abortion, there are three steps in the process of a medical abortion:

Step One (at the medical office or clinic)

  • A medical history is taken and a clinical exam and lab tests are performed.
  • Counseling is completed and informed consent is obtained.
  • If eligible for medical abortion, the woman swallows the mifepristone pill(s).

Step Two (at the office/clinic or at home depending on the treatment regimen)

  • This step takes place within about 2 days of step one.
  • Unless abortion has occurred and has been confirmed by the clinician, the woman uses misoprostol. Misoprostol tablets may be swallowed, placed between cheek and gum, or inserted into the vagina, depending on the treatment regimen.

Step Three (at the office or clinic)

  • This step takes place within about 2 weeks of step two.
  • The clinician evaluates the woman to confirm a complete abortion. It is essential for women to return to the office/clinic to confirm that the abortion is complete.
  • If there is an ongoing pregnancy, a suction abortion should be provided.
  • If there is an incomplete abortion, the clinician will discuss possible treatment options with the woman. These may include waiting and re-evaluating for complete abortion in a number of days or performing a suction procedure.

Possible side effects of a mifepristone abortion

Side effects, such as pain, cramping and vaginal bleeding, result from the abortion process itself, and are therefore expected with a medical abortion. Other side effects may include nausea, vomiting, diarrhea, chills, or fever. Complications are rare, but may include infection, excessive vaginal bleeding requiring transfusion (occurs in approximately 1 in 500 cases), incomplete abortion or ongoing pregnancy which requires a suction abortion (see above). In exceedingly rare instances, as with miscarriage, suction abortion and childbirth, death may occur. Reports of death after medical abortion are very rare – less than 1 in 100,000 cases – a rate comparable to that for early surgical abortion and for miscarriage.1

What women can expect from a mifepristone abortion

  • Medical abortion with mifepristone/misoprostol requires at least two visits to a medical office or clinic.
  • Following established treatment regimens, approximately 95-98% of women using mifepristone/misoprostol will have a complete medical abortion.
  • Complete abortion generally occurs more quickly when misoprostol is used vaginally rather than orally.
  • In most cases, bleeding will begin within several hours of using vaginal misoprostol.
  • Approximately two-thirds of women will have a complete medical abortion within 4 hours of using oral misoprostol.
  • Approximately 90% of women will have a complete medical abortion within 24 hours of using oral misoprostol.
  • On average, women may expect to have bleeding and/or spotting for 9-16 days.
  • Women may pass clots, ranging in size.
  • Some women may see whitish pregnancy tissue.

If the medications fail to end the pregnancy, a suction abortion should be provided. For this reason, a woman who chooses medical abortion must be willing to have a suction abortion if needed.

References

  1. Grimes, DA. Risk of mifepristone abortion in context. Contraception. 2005;71:161.

For more information on Medical Abortion see Medical Abortion: History and Overview.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Updated February 2008

Printable version of this fact sheet (PDF file, 67K)

Procedure How it Works Advantages Disadvantages
Mifepristone Mifepristone, taken orally, blocks the action of progesterone, which causes the uterine lining to thin and the pregnancy to detach. It also causes the cervix to soften and dilate, and increases the production of prostaglandins, which cause uterine contractions. Misoprostol, a prostaglandin analogue taken either orally or inserted vaginally within a few days of mifepristone, induces uterine contractions and increases the effectiveness of mifepristone to approximately 95-98%. - Usually avoids the use of surgical instruments, thus avoiding the risk of injury to the cervix or uterus from instrumentation.- Anesthesia not required.- High success rate (95-98%).- Resembles a “natural miscarriage.”- May offer women more privacy.- Both drugs can be administered orally.- Can be used very early in pregnancy.- Procedure completed within 24 hours of the misoprostol administration in 90% of women.- Approved by the FDA for early abortion. - Requires at least 2 visits.- Effectiveness decreases with use after 7 weeks in regimens using oral misoprostol. Efficacy remains high up to 9 weeks with vaginal misoprostol.- Takes days or, rarely, weeks to complete.- Post-procedure bleeding may last longer than with surgical abortion.- Women may see blood clots and pregnancy tissue.
Methotrexate Methotrexate, given by injection, or occasionally orally, stops the ongoing process of implantation of an early pregnancy. Misoprostol, a prostaglandin analogue inserted vaginally several days after the methotrexate, causes uterine contractions and increases the effectiveness of methotrexate to approximately 95%. - Usually avoids the use of surgical instruments, thus avoiding the risk of injury to the cervix or uterus from instrumentation.- Anesthesia not required.- High success rate up to 7 weeks (95%).- Resembles a “natural miscarriage.”- May offer women more privacy.- Can be used very early in pregnancy.- Can be used to treat ectopic pregnancy.- Methotrexate and misoprostol are both FDA-approved for other uses. - Requires at least 2 visits.- Effectiveness decreases with use after 7 weeks.- May require several doses of misoprostol.- Takes several days or weeks to complete.- Post-procedure bleeding may last longer than with surgical abortion.- Women may see blood clots and pregnancy tissue.
Vacuum Aspiration Cervix is gradually opened with tapered rods. A cannula (straw-like tube), which is attached to a suction apparatus (either an electric machine or hand-held syringe), is inserted through the cervix into the uterus. The contents of the uterus are emptied by suction. Vacuum aspiration is approximately 99% effective. - Usually only requires one visit to the provider.- Procedure is usually completed within minutes.- Allows for sedation if desired.- High success rate (approximately 99%).- Can be used early in pregnancy. - Involves a surgical procedure.- May seem less private to some women than aborting at home.

 

Printable version of this fact sheet (PDF file, 31K)

Later Abortions

The earlier an abortion is provided the safer it is, because earlier abortions are less complicated. Therefore, it is important that women who decide to get abortions can do so without unnecessary delays. In fact, 88% of all abortions in the United States are obtained within the first 12-13 weeks after the last menstrual period (LMP). Sometimes, however, women have compelling reasons to obtain abortions in later weeks.

Undiagnosed Pregnancy

Some women do not recognize that they are pregnant until the pregnancy is well advanced. Examples might include:

  • women who menstruate irregularly or not at all due to illness, medication, or strenuous athletic activity;
  • women who believe their absent periods reflect the onset of menopause;
  • women with normally light periods, who mistake spotting that occurs in early pregnancy for menstruation;
  • women who believe they cannot become pregnant because they are nursing babies or undergoing medical treatment;
  • women whose pregnancies are initially – sometimes repeatedly – misdiagnosed by physicians or other practitioners.

Medical Complications

Like anyone else in the population, pregnant women are susceptible to cancer, heart disease, diabetes, severe depression, addictions, and other serious health problems. Surgery, X-rays, chemotherapy, or other treatment vital to a woman’s health or life may come to a halt once the pregnancy is discovered. A woman might choose abortion if a continued pregnancy would worsen her condition and/or threaten her life, or if she requires further treatments that may damage a developing fetus.

Severe Fetal Abnormalities

When a woman learns from the results of prenatal testing that a fetus has severe abnormalities, such as an undeveloped brain, a severe metabolic disorder, or no working kidney, she may wish to end the pregnancy rather than give birth to a child who will suffer and die in infancy or who will have severe disabilities. Unfortunately, the results of amniocentesis, one of the most important prenatal diagnostic tests, are generally not available until the 15th or 16th week of pregnancy, thus delaying the abortion decision.

Tragic Events

A pregnancy may have been planned and very much wanted – until tragedy strikes. For example, the diagnosis of some debilitating disease, a car accident, a job loss, or a natural disaster might lead a woman to decide this is the wrong time to have a baby and to choose abortion, even if the pregnancy has advanced past the first trimester.

Teens at Special Risk

Nearly one-third of all abortions after 12 weeks are obtained by teenagers. Teens face not only state regulatory hurdles, but also delays in recognizing that they are pregnant and taking decisive action. For example, they may:

  • understand little about how their bodies work and therefore may not recognize signs of pregnancy;
  • become pregnant before they have begun to menstruate or before their menstrual periods are regular, so they don’t have the signal of a missed period;
  • believe a variety of myths, such as “You can’t get pregnant the first time”;
  • keep rape or sexual abuse a secret, denying the possibility of pregnancy.

When such young women do realize they are pregnant, they may panic, fearing their parents will never forgive them or that their parents will force them out of the house. They may hide the pregnancy in secret shame, or spend weeks wishing and hoping it isn’t true, or that it will go away. Of course, when the pregnancy does not go away, the realities of the situation gradually become evident.

Another factor in teenagers’ delay is that few are experienced in using the health care system. They may not know where to go for a pregnancy test, or they may fear that they cannot speak in confidence to a school counselor or nurse for assistance or a referral.

Parental Notification or Consent

Even further delays are introduced by states that require abortion providers to notify or obtain consent from a minor’s parents before proceeding with an abortion. While most teens do tell a trusted adult, those faced with an abusive or absent parent are left with only two choices. They must either:

  • petition a state court and convince a judge that they are competent to make this decision or that an abortion is in their best interest; or
  • arrange an abortion in a state without such restrictions, raise extra money, and travel to the out-of-state facility.

Clearly either choice can tax the resources of a teenager, and can create delays that might easily push the abortion past the first trimester.

Lack of Money

In one study of women who were having an abortion at 16 or more weeks, a substantial percentage said the delay occurred because they needed time to raise money.1 Women who depend on the federal government to provide their health insurance coverage must pay for abortion services separately; they may receive Medicaid funding for other medical services, but the federal government and most states have prohibited the use of federal funds to pay for almost all abortions.

In addition, as the pregnancy advances, abortions have a higher risk of complications, require specialized skill from the physician, increased nursing care, and more medications. Therefore, they are more expensive. For a woman who has no savings, gathering enough money can take time and delay her abortion by weeks.

Physician Shortage

Most abortion providers are concentrated in large cities. Today, 88% of all counties in the U.S. have no abortion provider, and 97% of rural counties have none.

In several states, women in need of abortion care must travel hundreds of miles to reach the nearest provider. Women are often delayed many days or weeks as they arrange transportation, time off from work, and save additional money for travel and lodging costs.

Waiting Period Requirements

Some states require women to wait anywhere from 8 to 27 hours between their first appointment and when the abortion procedure can be provided. These laws can further delay the abortion. For example, a teenager may wait for a time when her absence from school will be less obvious. If a woman must schedule two separate appointments, she may face more delays as she arranges for time off work or school to make two long-distance trips.

Third Trimester Abortions

Despite the claims of some anti-abortion activists, women have access to abortion in the third trimester only in extreme circumstances. Fewer than 2% of abortions are provided at 21 weeks or after, and they are extremely rare after 26 weeks of pregnancy. Very few abortions are provided in the third trimester, and they are generally limited to cases of severe fetal abnormalities or situations when the life or health of the pregnant woman is seriously threatened.

References

  1. Forrest JD, Torres A. Why do women have abortions? Family Planning Perspectives, 1988, 20:169.

Statistical information in this fact sheet is based on research by the Guttmacher Institute and other members of the National Abortion Federation.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writers: Susan Dudley, PhD
Copyright© 1996, National Abortion Federation
Revised 2003.

Printable version of this fact sheet (PDF file, 29K)

Scientific Research

Breast cancer is a very important health concern for women. For all women, the risk of breast cancer increases with age. According to the National Cancer Institute, this risk rises from about 1 in 252 for a woman in her thirties, to about 1 in 27 for a woman in her sixties, to a lifetime risk of about 1 in 8.1 Discovering the causes of this disease is a high priority for research scientists around the world.

Since 1981 several dozen studies investigating whether abortion increases a woman’s risk of developing breast cancer have been published. The results of the studies often seem contradictory, which can be confusing and frightening for women who are considering having an abortion. Many of the older studies alleging a link between breast cancer and abortion were flawed, since some included only a small number of women, and most used a scientifically unreliable method dependent upon self-reported abortion data.2 Newer studies that rely on more accurate methods have consistently shown no association between abortion and an increased breast cancer risk.3

What the Experts Say

In February 2003, the National Cancer Institute, a branch of the National Institutes of Health, convened a workshop that evaluated studies on abortion and breast cancer and assessed whether an association between abortion and breast cancer exists. Over 100 of the world’s leading experts on pregnancy and breast cancer, including epidemiologists, clinicians and breast cancer advocates participated.4

These experts concluded that studies have clearly established that “induced abortion is not associated with an increase in breast cancer risk.”4 This conclusion was reviewed and unanimously approved by the NCI’s top scientific advisors and counselors.4

Types of Studies

In order to understand which studies give us the most accurate information, it is helpful to know more about how the studies are done. There are two basic ways to conduct research on this topic; one looks backward in time at the abortion experiences of women who have breast cancer, and the other looks forward in time at the development of breast cancer among women who have had abortions.

  • In case-control studies, scientists compare women who have breast cancer with similar women who do not. Both groups are asked whether they have had abortions in the past.
  • In cohort studies, scientists compare women who have had abortions and similar women who have not. Both groups are examined again as years pass to determine whether they develop breast cancer.

Case-Control Studies and Recall Bias

Of the two, case-control studies have a higher likelihood of inaccurate results because healthy women and women with cancer report information about their medical history differently. When healthy women are asked very personal questions about their sexual lives, especially about a topic as sensitive as abortion, there is a strong tendency not to report truthfully on abortions they have had. On the other hand, women being treated for breast cancer are strongly motivated to give their doctors very accurate information, and they are less likely to forget to report an abortion they have had. Comparing the two groups of women, those with breast cancer will appear to be more likely to have had abortions, even if this is not actually the case. Scientists call this difference in how women report their medical history “recall bias.”

A 1996 case-control study among Dutch women5 demonstrated how recall bias works. Scientists found that in areas of the country where abortion is socially accepted, women with breast cancer and women without breast cancer reported equal numbers of past abortions. But in regions where attitudes about abortion are less tolerant, healthy women reported fewer past abortions than women with breast cancer. Because it is not reasonable to assume that abortion leads to breast cancer in one place but not in another, the researchers concluded that attitudes about abortion led some of the healthy women to under-report their abortions if they lived in places where abortion was not socially accepted. Other case-control studies have found similarly conflicting results, with some suggesting that abortion and breast cancer may be linked, and others finding no connection at all.

Cohort Studies

Cohort studies are not affected by recall bias, because scientists monitor the women directly from the time of their abortions until the time of any breast cancer diagnosis, and they do not need to rely on potentially faulty memories of past events. Scientists consider the results of cohort studies to be much more accurate than case-control studies. Cohort studies, however, take many years to complete and they are very expensive, so fewer of them are done. Of all cohort studies which have been published to date, none have shown a link between abortion and breast cancer.

The research problems discussed above can be overcome when accurate and complete life-long medical records are kept. In some European countries, where the government maintains a complete health registry on each citizen, studies using these unbiased records can be very informative. In fact, the most convincing cohort study of abortion and breast cancer involved over 1.5 million women in Denmark.6 Using data from national registries, scientists found that abortion had no overall effect on the risk of breast cancer.

Some Additional Facts

  • A single study reporting a link between two events does not, by itself, prove that the first event caused the second. Both events might be caused by some unknown third factor.
  • Some anti-choice organizations have worked hard to stir up fears that abortion causes breast cancer even though there is a strong consensus in the scientific community that no such link exists. Anti-choice groups promote these scientifically unwarranted conclusions as if they were established facts in order to frighten women and discourage them from having an abortion. Anti-choice activists are opposed to legal abortion under almost any circumstances, regardless of its safety. Their real goal in this controversy is preventing women from exercising their legal right to choose abortion, not protecting women’s health.
  • If you are considering abortion, your health care provider can give you the most up to date information on new research on abortion and the risk of future breast cancer.

References

  1. National Cancer Institute, Lifetime Probability of Breast Cancer in American Women.
  2. National Cancer Institute, Cancer Facts, March 2003. See also section of this fact sheet entitled “Types of Studies.”
  3. National Cancer Institute, Cancer Facts, March 2003.
  4. See National Cancer Institute, Summary Report: Early Reproductive Events and Breast Cancer Workshop
  5. Rookus, M.A. & van Leeuwen, D.A. “Induced Abortion and Risk for Breast Cancer: Reporting (Recall) Bias in a Dutch Case-Control Study.” Journal of the National Cancer Institute, 1996, 88(23): 1759-1764.
  6. Melbye, M. et al. “Induced Abortion and the Risk of Breast Cancer.” The New England Journal of Medicine, 1997, 336(2): 81-85.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writers: Susan Dudley, PhD and Laureen Tews, MPH
Copyright© 2000, National Abortion Federation
Revised 2003

Printable version of this fact sheet (PDF file, 28K)

Many people are interested in learning about the possible effects of abortion on women’s emotional well-being, and several hundred studies have been conducted on this issue since the late 1970s. Unfortunately, much of the research on women’s psychological responses to abortion can be confusing. Nonetheless, mainstream medical opinions, like that of the American Psychological Association, agree there is no such thing as “post-abortion syndrome.”

A Summary of the Scientific Research

Since the early 1980s, groups opposed to abortion have attempted to document the existence of “post-abortion syndrome,” which they claim has traits similar to post-traumatic stress disorder (PTSD) demonstrated by some war veterans. In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data. They reported that the studies with the most scientifically rigorous research designs consistently found no trace of “post-abortion syndrome” and furthermore, that no such syndrome is scientifically or medically recognized.1

The panel concluded that “research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress.”2 While some women may experience sensations of regret, sadness or guilt after an abortion, the overwhelming responses are relief and happiness.3

In another study, researchers surveyed a national sample of 5,295 women, not all of whom had had abortions, and many of whom had abortions between 1979 and 1987, the time they were involved in the study. The researchers were able to learn about women’s emotional well-being both before and after they had abortions. They concluded at the end of the eight-year study that the most important predictor of emotional well-being in post-abortion women was their well-being before the abortion. Women who had high self-esteem before an abortion would be most likely to have high self-esteem after an abortion, regardless of how many years passed since the abortion.4

Psychological responses to abortion must also be considered in comparison to the psychological impact of alternatives for resolving an unwanted pregnancy (adoption or becoming a parent). While there has been little scientific research about the psychological consequences of adoption, researchers speculate that it is likely “that the psychological risks for adoption are higher for women than those for abortion because they reflect different types of stress. Stress associated with abortion is acute stress, typically ending with the procedure. With adoption, as with unwanted childbearing, however, the stress may be chronic for women who continue to worry about the fate of the child.”5

What the Experts Say

In a commentary in the Journal of the American Medical Association, Nada Stotland, M.D., former president of the Association of Women Psychiatrists, stated:

“Significant psychiatric sequelae after abortion are rare, as documented in numerous methodologically sound prospective studies in the United States and in European countries. Comprehensive reviews of this literature have recently been performed and confirm this conclusion. The incidence of diagnosed psychiatric illness and hospitalization is considerably lower following abortion than following childbirth…Significant psychiatric illness following abortion occurs most commonly in women who were psychiatrically ill before pregnancy, in those who decided to undergo abortion under external pressure, and in those who underwent abortion in aversive circumstances, for example, abandonment.”6

Henry P. David, PhD, an internationally known scholar in this area of research, reported the following at an international conference.

“Severe psychological reactions after abortion are infrequent…[T]he number of such cases is very small, and has been characterized by former U.S. Surgeon General C. Everett Koop as ‘minuscule from a public health perspective’…For the vast majority of women, an abortion will be followed by a mixture of emotions, with a predominance of positive feelings. This holds immediately after abortion and for some time afterward…[T]he positive picture reported up to eight years after abortion makes it unlikely that more negative responses will emerge later.”7

Russo and Dabul reported their conclusions of an eight-year study in Professional Psychology:

“Although an intensive examination of the data was conducted, controlling for numerous variables and including comparisons of Black women versus White women, Catholic women versus non-Catholic women, and women who had abortions versus other women, the findings are consistent: The experience of having an abortion plays a negligible, if any, independent role in women’s well-being over time, regardless of race or religion. The major predictor of a woman’s well-being after an abortion, regardless of race or religion, is level of well-being before becoming pregnant…Our findings are congruent with those of others, including the National Academy of Sciences (1975), and the conclusion is worth repeating. Despite a concerted effort to convince the public of the existence of a widespread and severe postabortion trauma, there is no scientific evidence for the existence of such trauma, even though abortion occurs in the highly stressful context of an unwanted pregnancy.”8 (emphasis added)

The Impact of Anti-Choice Activities

Russo and Dabul8 point out that when women in their study were interviewed from 1979 to 1987, anti-choice efforts to stigmatize abortion had not yet reached prominent levels. Today, anti-choice groups regularly harass clinic staff, intimidate patients at clinics, and use graphic language designed to punish women (e.g. “abortion is murder,” “women are baby-killers”). Additionally, the past few years have revealed a new anti-choice strategy of offering “counseling” services to women. Rather than exploring the roots of a woman’s psychological distress and providing unbiased therapy, anti-choice counselors tend to direct her anger towards the abortion provider by claiming that women are misinformed about the psychological trauma that abortion inflicts. Due to the political bias of these counselors and their misuse of psychological services, women can be left feeling angry and betrayed.

Russo and Dabul8 concluded that practitioners should acknowledge the detrimental effects of the social ostracism felt by abortion patients. Some post-abortion difficulties may result from a lack of social support because women are expected to bear the brunt of unplanned and unwanted childbearing. The researchers encouraged all practitioners to continue to provide accurate information since many women have been misled by anti-choice sources which may contribute to concerns if they choose abortion. Further, women who have concerns after an abortion should be encouraged to see a professional psychologist or join a support group supervised by a professional mental health provider, rather than one sponsored by any anti-choice organization.

References

  1. American Psychological Association. “APA research review finds no evidence of ‘post-abortion syndrome’ but research studies on psychological effects of abortion inconclusive.” Press release, January 18, 1989.
  2. Adler NE, et al. “Psychological responses after abortion.” Science, April 1990, 248: 41-44.
  3. Adler NE, et al. “Psychological factors in abortion: a review.” American Psychologist, 1992, 47(10): 1194-1204.
  4. Russo NF, Zierk KL. “Abortion, childbearing, and women’s well-being.” Professional Psychology: Research and Practice, 1992, 23(4): 269-280.
  5. Russo NF. “Psychological aspects of unwanted pregnancy and its resolution.” In J.D. Butler and D.F. Walbert (eds.), Abortion, Medicine, and the Law (4th Ed., pp. 593-626). New York: Facts on File, 1992.
  6. Stotland N. “The myth of the abortion trauma syndrome.” Journal of the American Medical Association, 1992, 268(15): 2078-2079.
  7. David HP. “Comment:post-abortion trauma.” Abortion Review Incorporating Abortion Research Notes, Spring, 1996, 59: 1-3.
  8. Russo NF, Dabul, AJ. “The relationship of abortion to well-being: Do race and religion make a difference?” Professional Psychology: Research and Practice, 1997, 28(1): 1-9.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writers: Rene Almeling and Laureen Tews, MPH
Research contribution by Sahar Rais
Copyright© 1999, National Abortion Federation

Printable version of this fact sheet (PDF file, 29K)

Unintended Pregnancy

Each year, almost half of all pregnancies among American women are unintended.1 About half of these unplanned pregnancies, 1.3 million each year, are ended by abortion.2

There are many myths and misconceptions about who gets abortions, and why. The fact is that the women who have abortions come from all racial, ethnic, socioeconomic, and religious backgrounds. If current rates continue, it is estimated that 35% of all women of reproductive age in America today will have had an abortion by the time they reach the age of 45.3

Measuring the Incidence of Abortion

The incidence of abortion can be tracked in two different ways. The first is simply to keep a tally of the total number of abortions obtained by women who fall into specified categories. Numbers tracked in this way are usually expressed as a percentage of all abortions provided in a year. Alternatively, the rate of abortion can be measured by calculating the total number of abortions obtained per 1,000 women who make up the total population in each category.

Age

Women between the ages of 15 and 19 account for about 19% of all abortions; women 20 to 24 account for another 33%; and about 25% of abortions are obtained by women who are 30 or older.4 Calculating abortion rates, older teenagers and young adults have the highest abortion rates, while women younger than 15 and older than 35 have the lowest.4

Length of Pregnancy

Most abortions (88%) are obtained in the first trimester of pregnancy. In fact, over half of all abortions are obtained within the first 8 weeks. Fewer than 2% occur at 21 weeks or later.5

Education, Residence, and Income

Of the women obtaining abortions in 2000:

  • 57% had some college education;
  • 88% were from metropolitan areas; and
  • 57% percent were low-income.4

Marital Status

Most women getting abortions (83%) are unmarried; 67% have never married, and 16% are separated, divorced, or widowed.4 Married women are significantly less likely than unmarried women to resolve unintended pregnancies through abortion.6

Religion

Women who obtain abortions represent every religious affiliation. 13% of abortion patients describe themselves as born-again or Evangelical Christians4; while 22% of U.S. women are Catholic,7 27% of abortion patients say they are Catholics.1

MYTH: Women are using abortion as a method of birth control.

In fact, half of all women getting abortions report that contraception was used during the month they became pregnant.1 Some of these couples had used the method improperly; some had forgotten or neglected to use it on the particular occasion they conceived; and some had used a contraceptive that failed. No contraceptive method prevents pregnancy 100% of the time.

If abortion were used as a primary method of birth control, a typical woman would have at least two or three pregnancies per year – 30 or more during her lifetime. In fact, most women who have abortions have had no previous abortions (52%) or only one previous abortion (26%).5Considering that most women are fertile for over 30 years, and that birth control is not perfect, the likelihood of having one or two unintended pregnancies is very high.

MYTH: Women have abortions for selfish or frivolous reasons.

The decision to have an abortion is rarely simple. Most women base their decision on several factors, the most common being lack of money and/or unreadiness to start or expand their families due to existing responsibilities. Many feel that the most responsible course of action is to wait until their situation is more suited to childrearing; 66% plan to have children when they are older, financially able to provide necessities for them, and/or in a supportive relationship with a partner so their children will have two parents.8 Others wanted to get pregnant but developed serious medical problems, learned that the fetus had severe abnormalities, or experienced some other personal crisis. About 13,000 women each year have abortions because they have become pregnant as a result of rape or incest.1

MYTH: Women are often forced into having abortions they do not really want.

Some women say that pressure from a husband, partner, or parent was one of several reasons they chose abortion, but only about 1% give that reason as the “most important” one in making their decision.9 Conversely, some women who do not want to continue their pregnancies are pressured to do so by family members, friends, or fear of social stigma. Pre-abortion options counseling is designed to determine whether a woman is fully comfortable with her abortion decision, and if she is not, she is encouraged to wait until she has had a chance to consider her options more fully.

MYTH: Many women come to regret their abortions later.

Research indicates that relief is the most common emotional response following abortion, and that psychological distress appears to be greatest before, rather than after, an abortion.

There are undoubtedly some women who, in hindsight, wish that they had made different choices, and the majority would prefer never to have become pregnant when the circumstances were not right for them. When a wanted pregnancy is ended (for medical reasons, for example) women may experience a sense of loss and grief. As with any major change or decision involving loss, a crisis later in life sometimes leads to a temporary resurfacing of sad feelings surrounding the abortion. Women at risk for poor post-abortion adjustment are those who do not get the support they need, or whose abortion decisions are actively opposed by people who are important to them.10 Learn more about post-abortion issues

References

  1. Guttmacher Institute. Facts in Brief – Induced Abortion. 2003. www.agi-usa.org/pubs/fb_induced_abortion.html
  2. Finer LB, Henshaw SK. Abortion incidence and services in the United States in 2000.Perspectives on Sexual and Reproductive Health 2003; 35: 6-15.
  3. Guttmacher Institute. State Facts About Abortion. 2003. www.agi-usa.org/pubs/sfaa.html
  4. Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000-2001. Perspectives on Sexual and Reproductive Health 2002; 34: 226-235.
  5. Elam-Evans LD, Strauss LT, Herndon J, Parker WY, Whitehead S, Berg CJ. Abortion surveillance-United States, 1999. Morbidity Mortality Weekly Report 2002; 51 (SS09): 1-28. www.cdc.gov/mmwr/preview/mmwrhtml/ss5109a1.htm
  6. Henshaw SK. Unintended pregnancy in the United States. Family Planning Perspectives1998; 30(1): 24-29 & 46.
  7. Personal communication, Archdiocese of Washington (based on statistics in the 2003 edition of The Kennedy Directory: The Official Catholic Directory).
  8. Henshaw SK, Kost K. Abortion patients in 1994-1995: Characteristics and contraceptive use. Family Planning Perspectives 1996; 28(4): 140-147 &158.
  9. Torres A, Forrest JD. Why do women have abortions? Family Planning Perspectives 1988; 20(4): 169-176.
  10. Psychological Responses Following Abortion. Reproductive Choice and Abortion: A Resource Packet. Washington, DC: American Pyschological Association, 1990.

Statistical information in this fact sheet is based on research by the Guttmacher Institute and other members of the National Abortion Federation.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writer: Susan Dudley, PhD
Copyright© 1996, National Abortion Federation
Revised 2003.

Printable version of this fact sheet (PDF file, 23K)

Before and After Roe v. Wade

When abortion was illegal in the U.S., desperate women often paid high fees to obtain abortions, even from unlicensed, untrained practitioners working in frightening, non-sterile conditions. Dangerous medical complications were likely to follow these illegal abortions, resulting in lengthy hospital stays, increased financial and health costs, and a serious drain on hospital maternity resources. Complications from black market abortions were a leading cause of maternal death when abortion was legally prohibited, exacting a huge price from American families.

In 1973, the Supreme Court’s Roe v. Wade decision re-established the right to legal abortion in every state. As a result, abortion is now medically safe and less expensive. Today, women who want abortions can select well-trained, compassionate medical personnel, who work in clean, well equipped offices, clinics, or hospitals. Now, almost 90% of abortions in the U.S. are provided during the first 12 weeks of pregnancy.1 The danger of serious complications is extremely small.

The Cost of Abortion

The exact cost of an abortion depends on many factors, such as how far along the pregnancy is, the kind of procedure and anesthetic that are used, and the kind of facility (clinic, physician’s office, or hospital).

In general, though, women getting an abortion between six and ten weeks’ gestation can expect to pay about $350 at an abortion clinic and $500 at a physician’s office. Providing abortions later in pregnancy is somewhat more complicated, and is usually more expensive. For example, at 16 weeks gestation, abortion clinics generally charge around $650 and physicians’ offices generally charge around $700. After the 20th week, the cost rises to above $1,000.2

Other costs might result if care is not available locally. These might include travel costs, costs for overnight stays, or lost wages in states requiring waiting periods between pre-abortion counseling and the abortion itself.

The Economics for Women and Their Families

Paying for abortion is not usually a problem for middle- and upper-income women, because the majority of private medical insurance plans and HMO organizations currently cover abortion services. However, the availability of abortion funding for low-income women is controlled by elected government officials. Since 1978, Congress has imposed a restriction on the use of federal money to cover abortion. This restriction, known as the Hyde Amendment, forbids federal funding of abortions except in cases of rape, incest, or when a woman’s life is endangered. The restrictions apply to Medicaid, the government program that pays for medical care for many low-income families, as well as other federally funded medical programs such as those for Native American women, military personnel and their dependents, and Peace Corps volunteers. Only 23 states use their own funds to cover abortion services beyond the Hyde Amendment’s restrictions.

The Economics for Abortion Providers

In very marked contrast to most other medical procedures, the cost of abortion has risen less than inflation. In fact, contrary to the distorted picture of the “abortion industry” as a tremendously profitable business designed to take advantage of women, in reality abortion providers have maintained lower than average fees for their services compared with physicians in other specialties. Correcting for inflation, legal abortions in 1991 cost only about half what they cost in the early 1970s.3

Physicians and other medical professionals who provide abortion services are people who understand that a woman’s right to choose whether she will continue a pregnancy is a critical part of her total health care. They are compassionate people who know that legal abortions are safe abortions.

The Costs of Denying Abortion Funding

When women are denied abortions that they seek because their insurance or Medicaid plans do not cover them, there are both real and hidden costs that they, their families, and other taxpayers must bear. There is also the social cost associated with forcing some women to bear children when they are not prepared to be mothers or when parents are unable to support their children.

For example, many of the women who are denied funding for abortion have one anyway, usually at great sacrifice to themselves and their families. They may take on extra work or borrow from their rent or grocery budgets. Sometimes, because it takes time to find the money, the woman has to obtain the abortion at a later stage of pregnancy, when the procedure is more expensive and more complicated.4

Some women without money to pay for an abortion attempt to induce one themselves. This usually fails, resulting in delays before seeking surgical abortion. Self-induced abortion attempts are often medically very dangerous, leading to serious complications or death.

Those who oppose public funding for abortion call it an unfair burden on taxpayers. In fact, funding restrictions on abortions cost taxpayers millions of dollars every year, due to the much higher cost of prenatal care and childbirth, and the secondary costs of unplanned births.Families also pay a high price whenever a woman must carry an unwanted pregnancy to term because she is unable to pay for abortion services.

Abortion and Health Care Reform

There are disagreements about whether abortion services should be covered in proposed health care reform plans. But as long as abortion funding is denied to low-income women, the effect is discriminatory and unfair. The Supreme Court has ruled that the right to choose abortion is guaranteed by the U.S. Constitution. If a government sponsored universal health care plan fails to cover abortion, all women will lose insurance funding for this procedure, and low-income women and young women will be especially penalized. The right to make private decisions about childbearing and reproductive health care should apply to all women, not just those who can afford it.

References

  1. Centers for Disease Control and Prevention. Surveillance Summaries, November 29, 2002.MMWR 2002:51 (No. SS-9).
  2. Henshaw S, Finer LB, The Accessibility of Abortion Services in the United States, 2001,Perspectives on Sexual and Reproductive Health, Volume 35, Number 1, January/February 2003.
  3. Grimes DA. Clinicians Who Provide Abortions: The Thinning Ranks, Obstetrics & Gynecology, 1992, 80: 719.
  4. Guttmacher Institute, Revisiting Public Funding of Abortion for Poor Women, Issues in Brief, 2000 Series, No. 5.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writer: Susan Dudley, PhD
Copyright ©1996, National Abortion Federation
Revised 2003.

 

Printable version of this fact sheet (PDF file, 33K)

Legal abortion is not widely accessible to women in the U.S.

The Supreme Court confirmed women’s right to choose abortion in 1973, and the courts have upheld that finding in subsequent cases. But access to abortion has been severely eroded. The most recent survey found that 87% of all U.S. counties have no identifiable abortion provider. In non-metropolitan areas, the figure rises to 97%. As a result, many women must travel long distances to reach the nearest abortion provider.

But distance is not the only barrier women face. Many other factors have contributed to the current crisis in abortion access, including a shortage of trained abortion providers; state laws that make getting an abortion more complicated than is medically necessary; continued threats of violence and harassment at abortion clinics; state and federal Medicaid restrictions; and fewer hospitals providing abortion services.

Shortage of Abortion Providers

In 1973 the Supreme Court struck down state laws that had criminalized abortion. Doctors working in hospital emergency rooms and ob-gyn units before that time knew first-hand about the medical devastation that women suffered as a result of self-induced abortions or black market abortions performed by unlicensed practitioners. Today, many of those doctors are retiring. The younger physicians replacing them have little direct experience with the consequences of illegal abortions and the public health benefits of ensuring that safe abortions remain available.

Even those young doctors who are committed to providing safe abortions to their patients may have trouble getting the training they need. A survey in 1998 revealed that first trimester abortion techniques are a routine part of training in only 46% of America’s ob-gyn residency programs. About 34% offer this training only as an elective, and 7% provide no opportunity at all for young doctors to learn to provide safe abortions.1

In 1996, the Accreditation Council for Graduate Medical Education, the agency responsible for accrediting medical residency programs, took steps to correct this problem. It now requires ob-gyn residency programs to include family planning and abortion training for their students. It is too soon to tell whether this will result in better preparation of ob-gyns in the future to provide safe abortion services, but it is clear that doctors who do not get this training are not in a position to provide the full range of care that their patients will need.

Restrictive Legislation

National polling consistently shows that the majority of Americans support a woman’s right to choose, but many legislators are committed to bringing an end to legal abortion and have passed laws that have drastically diminished access to abortion. These include:

  • Parental Consent or Notification Laws which are now enforced in over half the states can violate the privacy of young women by forcing them to involve their parents in their decisions, even when they have strong objections to doing so. As a result, some women to travel to other states that do not require parental involvement; others have resorted to illegal abortions rather than comply with a legal requirement that puts them in jeopardy.
  • Mandatory Waiting Periods require women to wait some period of time (up to 24 hours) between a state mandated counseling appointment and their abortion. Many of these laws require the counseling be done in person rather than on the phone. These laws imply that women come to abortion clinics without having seriously considered their options. As a result of these waiting periods, a woman’s abortion is often delayed much longer than 24 hours, particularly if she has to take time off from work, arrange for child care, travel a long way, and perhaps stay overnight in a distant city. These factors can significantly increase the cost as well.
  • Biased Counseling Laws require that clinic personnel lead their patients through detailed, state prescribed “scripts” that promote childbearing. Abortion providers have long been at the forefront of developing and delivering sound and effective options counseling to their patients. They consider these scripts “biased” because they contain information that is designed to frighten and dissuade women from having abortions. These coercive scripts are completely incompatible with the goal of true informed consent.

Clinic Violence and Disruption

Medical professionals who provide abortion services do so at a tremendous risk to their safety. Since 1993, three doctors who provided abortions have been murdered, and five others have been shot at by anti-abortion zealots in the U.S. and Canada. A clinic escort and three clinic employees have been murdered, and several other clinic staff have been shot. Violence against providers also includes bombings, arson, vandalism, burglary, illegal blockades, threats, and harassment.

Frivolous malpractice lawsuits against abortion providers are also generated by anti-abortion extremists who want to keep providers from offering abortion services. These lawsuits are rarely justified, but they are used unfairly to discredit the reputations of providers and frighten patients.

Funding for Abortion

The cost of a first trimester abortion has increased only slightly since 1973 (see Abortion Facts: Economics of Abortion), but many women still cannot afford the fee. The Hyde Amendment denies federal Medicaid funding for abortions except in specific, rare circumstances, and most states have similar laws restricting financial help to women who need abortions. More than 2/3 of women must initially pay for their abortions themselves – only 13% of abortions are paid for with a state’s public funds,2 and only 13% are covered by a woman’s private insurance at the time of her abortion.3 A small number of women may be reimbursed by insurance after their abortion.

The result is that too many women who need abortions must wait while they raise funds, postponing their abortions until later in their pregnancies, when the costs of these more complicated abortion procedures are higher. For the women who are struggling to make ends meet and who do not have insurance that covers abortion, the legal right to have an abortion does not guarantee that they will have access to it.

Declining Number of Hospitals Providing Abortion Services

Today, about 95% of women who need abortions have them in clinics or in private doctors’ offices where costs can be kept low without increasing health risks.

This pattern of abortion service delivery represents a significant shift away from hospital provided abortion care, which was far more common in the early years after the laws criminalizing abortion were struck down. “According to the American Hospital Association, there were 5,801 hospitals in the United States in 2001. However, a 2001-2002 study by the Guttmacher Institute identified only 603 hospitals that provided abortions in 2001.”2 This has serious implications for abortion access. Women in rural areas where there are no abortion clinics, and low-income women who depend on hospital emergency services for medical care, are left unserved when hospitals do not provide abortions. When hospitals do not offer abortions, young physicians they train have no opportunity to learn to provide safe abortions.

What is Being Done to Improve Abortion Access?

The National Abortion Federation’s Access Initiative Project was created specifically to address the escalating problem of limited access to abortion in the U.S.. The Access Initiative Project works with medical residency programs, educational institutions, health care associations, legal experts, public policy organizations, and interested individuals to ensure that qualified clinicians are able to get the training they need to provide safe abortions and that women can continue to have access to the quality health care they deserve.

References

  1. Almeling R, Tews L, and Dudley S. Abortion Training in U.S. Obstetrics and Gynecology Residency Programs, 1998. Family Planning Perspectives, 2000, 32(6):268-271 & 320.
  2. Guttmacher Institute. Facts in Brief: Induced Abortion. January, 2003.
  3. Henshaw SK, and Finer LB. The Accessibility of Abortion Services in the United States, 2001. Perspectives on Sexual and Reproductive Health, 2003, 35(1):16-24.

Statistical information in this fact sheet is based on research by The Guttmacher Institute and other members of the National Abortion Federation.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writers: Stephanie Mueller and Susan Dudley, PhD
Copyright© 1997, National Abortion Federation
Revised 2003.

 

Printable version of this fact sheet (PDF file, 35K)

What is a Crisis Pregnancy Center?

Crisis Pregnancy Centers (CPCs) exist to keep women from having abortions. In many instances, they misinform and intimidate women to achieve their goal. Women describe being harassed, bullied, and given blatantly false information. Many assert that their confidentiality has been violated, and that mistreatment by CPCs has threatened their health.

Today there are as many as 4,000 CPCs in the United States,1 compared to the 2,000 clinics that provide abortion care for women.2 CPCs also are prevalent throughout Canada, with more than 150 centers in the country.3

By and large, CPCs are not medical facilities, and most CPC volunteers who work directly with women are not medical professionals.4 Their main qualifications are a commitment to Christianity and anti-choice beliefs. Although CPCs historically have not employed medical staff, there is an emerging trend on the part of CPCs to gain validity by hiring part-time anti-choice medical professionals and purchasing ultrasound equipment.5

How Do CPCs mislead women?

CPCs have a long history of deception. For example, some CPCs intentionally choose their name to mislead women into believing that they offer a wide range of services, including family planning and abortion care. In a 1989 report, the Family Research Council showed that women faced with an unplanned pregnancy were most likely to look in the Yellow Pages under the words “Pregnancy,” “Medical,” “Women’s Centers” and “Clinics.”6 Accordingly, CPCs often are advertised under these categories, as well as “Abortion Alternatives,” and “Women’s Organizations.”7 CPCs also advertise through posters, signs, and billboards that contain messages like, “Free Pregnancy Test,” or “Pregnant? Scared? We Can Help! Call 1-800 #.”8 Women report, however, that when they call these numbers the CPC representatives evade questions about whether they provide abortions, and urge the women to make an appointment to meet with a ‘counselor’ to talk in person.9

CPCs’ deceptive tactics extend to their physical appearance as well. CPCs often design their facilities to look like actual health care facilities with a waiting room, a partitioned check-in desk, and an ultrasound machine.10 They typically locate themselves near clinics that offer abortions in a deliberate attempt to increase their legitimacy and lure potential patients away from receiving abortion care by capitalizing on patients’ confusion.11

Though CPCs portray themselves as medical clinics, advertising medical services including an “Ask the Doctor” section and urging women to come in for “options counseling,” they do not provide full options counseling and generally will not refer for abortion care or birth control.12 In fact, Care Net, the largest network of CPCs in the United States, specifically instructs its CPCs not to give out information about birth control.13 Most do not mention anywhere on their websites that the CPC will not provide or make referrals for abortions or birth control, but instead claim to provide a “nonjudgmental environment” where “each option” can be explored.14

How do CPCs target women?

CPCs often direct outreach towards young and low-income women. They offer free pregnancy tests, locate themselves in close proximity to colleges and universities, and advertise in school newspapers.15 Low-income women are particularly vulnerable because nationwide there is a shortage of clinics that offer full options counseling and abortion care.

The Family Research Council encourages CPCs to target individuals or groups a pregnant woman is most likely to consult, primarily mothers and other family members.16 CPCs are encouraged to target families and advise them of what to do if there is an unplanned pregnancy. Additionally, the Family Research Council found that 40 percent of women turn to their doctors and that intentional marketing to the medical community could significantly increase clientele.17

Do CPCs have religious affiliations?

Many CPCs are connected with religious organizations, but few disclose that fact in their advertising.18 Most CPCs do not initially disclose to women that they are driven by a religious agenda and that they oppose abortion and birth control. CPCs offer their “services” to women of all faiths, but their programs are often driven by extreme religious anti-abortion agendas. In some of their literature CPCs discuss religious messages about abortion and quote biblical passages that they claim show that God does not support abortion.19

What happens at a CPC?

CPCs have used tactics intended to delay and even harass or intimidate women from having abortions. For example, CPCs have been known to extend the waiting period for pregnancy test results to expose women to their anti-choice or religious propaganda. While women wait, CPCs often present them with videos and pictures depicting gruesome and graphic images of bloody and dismembered fetuses that have allegedly been aborted as a scare tactic in their effort to compel women not to have abortions.20

When the pregnancy results are revealed they may be presented in ways that are ambiguous21 or even false.22 Women also have received unwanted calls at their homes from CPCs urging them to not have an abortion following a visit, a clear violation of their privacy.23

What kinds of misinformation do CPCs give women?

Although many CPCs claim to provide options counseling both over the phone and in person,24 in reality they do not provide women with information about their full reproductive health options. For example, women are told that some birth control methods, especially emergency contraception (also known as the morning after pill), are actually abortifacients.25

CPCs mislead women about abortion procedures. Women are told that abortions are painful, life-threatening procedures that will leave them with long-term emotional, physical, and psychological damage.26 They are often told that having an abortion will put them at higher risk for developing breast cancer, post-traumatic stress disorder, infertility, and other serious medical conditions.27

Where can women turn for accurate information and referrals for services?

The National Abortion Federation’s toll-free Hotline (1-800-772-9100) offers women unbiased, factual information about pregnancy and abortion in English, Spanish and French. The Hotline also provides referrals to high-quality health care providers in the United States and Canada.

Has legal action been taken against CPCs?

Yes. CPCs have been sued using a number of different legal causes of action. For example, attorneys have successfully challenged CPCs’ use of public funds under the First Amendment’s Establishment Clause. Plaintiffs have also been successful in requiring CPCs to change some of their deceptive advertising tactics in states such as New York, California, Ohio, Missouri, and North Dakota.28

State Attorney Generals have also pursued legal action. In 2002, for example, the New York Attorney General reached a settlement with some CPCs requiring that they clearly disclose that they do not provide or make referrals for abortion or birth control; disclose verbally and in writing before providing a test and/or counseling about pregnancy that the center is not a licensed medical provider qualified to diagnose or accurately date pregnancy and inform the woman that only a licensed medical provider can confirm a pregnancy and provide medical advice about pregnancy; clarify in advertising and consumer contacts that the pregnancy tests it provides are self-administered; and tell people who call or visit the center that it is not a medical facility.29

What else can be done to stop CPCs?

Individuals can fight bills or initiatives that fund CPCs by providing testimony about their danger and/or unconstitutionality. Elected officials also can be educated through letters, emails, faxes, phone calls, and visits from their constituents and other concerned citizens. It is also important to convey support for affirmative bills that are based on medically accurate information and serve to keep abortion safe, legal, and accessible.

Women who have had first-hand experience with CPCs are encouraged to report and document their encounters. One way to share a story is to participate in the National Abortion Federation’s Patient Partnership. These stories of actual encounters help tell the truth about CPCs, and can be effective in educating the media and policy makers.

Residents can check their local Yellow Pages to see if CPCs in their area are involved with false or deceptive advertising, such as listing themselves under abortion services or abortion. In the event that that they are using such tactics, the Yellow Pages, the Better Business Bureau, and other local organizations supporting the CPCs should be contacted and a change in listing should be requested.

Individuals can also take part in public education campaigns about CPCs. This work could include submitting opinion pieces or letters to the editor, making informative posters, distributing brochures, coordinating discussion sessions, or hosting a forum on CPCs. If you are interested in finding out more about any of these activities, please contact NAF at 202-667-5881 or via email at [email protected].

References

  1. Ziba Kashef, The Fetal Position, Mother Jones, January/February 2003 (available athttp://www.motherjones.com/news/outfront/2003/02/ma_218_01.html).
  2. Lawrence B. Finer and Stanley K. Henshaw, Abortion Incidence and Services in the United States in 2000, The Alan Guttmacher Institute, Perspectives on Sexual and Reproductive Health, 2003, 35(1): 6-15.
  3. See LifeSite website (available at http://www.lifesite.net, list updated September 2005).
  4. See Care Net Administrative Manual job qualifications (requiring Christian beliefs, but not medical background) and sample organizational chart (all counselors are volunteers).
  5. Barbara Solow, Medicine or Ministry, Independent Online, June 18, 2003 (available athttp://indyweek.com/durham/2003-06-18/cover.html).
  6. Curtis J. Young, Turning Hearts Toward Life: Market Research for Crisis Pregnancy Centers, Family Research Council, 1998, p. 9.
  7. See, e.g., LegalCare: Advice and Education for Pregnancy Centers from Care Net, Your Key to Advertising in the Yellow Pages, November 1993.
  8. See, e.g., Care Net’s website (available at http://www.care-net.org).
  9. See Deb Berry, Choose Lies, Orlando Weekly, April 17, 2003.
  10. Solow, supra note 5.
  11. See Kaiser Daily Reproductive Health Report, Crisis Pregnancy Centers Moving to Expand Services, Seeking Government Funding, February 19, 2002; see also Alan Cooper, Abortion Battle: Prenatal Care or Pressure Tactics? The Washington Post, February 21, 2002, A01.
  12. See, e.g., Rockville Pregnancy Center website (available at http://www.rcpc.org); Care Net website (available at http://www.care-net.org); Expectant Mother Care website (available at http://www.expectantmothercare.org/pro_life_chapel.html – page unavailable 11/30/2009).
  13. See Care Net Training Manual.
  14. Maryland’s Rockville Pregnancy Center website (available at http://www.rcpc.org).
  15. See, e.g., Saint Ignatius of Antioch Catholic Church website; Karen Hauptman and Katie Kaplan, Crisis Pregnancy Center Misleads Teenagers, Black and White Online, December 21, 2001.
  16. Young, supra note 6 at 13.
  17. Id.
  18. Id at 4.
  19. Focus on the Family’s “What Does God Say About Abortion” can be found at Care Net facilities like the Rockville Pregnancy Center.
  20. See Women’s Health Action and Mobilization, Fake Clinics: A Public Health Hazard, Brooklyn Pro-Choice Network (available at http://www.echonyc.com/~bpcn/fakeclinic.html); Backwash.com (available at http://www.backwash.com/previewnewsarchive.php?newsid=565). Both pages unavailable 11/30/2009.
  21. Testimony of Mark Salo Before the Subcommittee on Regulations, Business Opportunities, and Energy of the House Committee on Small Business, 102nd Congress, September 20, 1991.
  22. Center for Reproductive Rights, Special Report: Crisis Pregnancy Centers Seek Public Funds and Legitimacy, Reproductive News, Volume XI No. 7/8, July/August 2002.
  23. Information from NAF CPC Patient Partnership Participants; see also Solow, supra note 8.
  24. See Care Net’s website (available at http://www.care-net.org/initiatives/ol.html – page unavailable 11/30/2009) promoting its OptionLine; see also Rockville Pregnancy Center’s website advertising compassionate, non-judgmental counseling about each option (available at http://www.rcpc.org).
  25. Heritage House’s The Morning After Pill: Get the Facts, which was given to one of NAF’s CPC Patient Partnership Participants at the Rockville Pregnancy Center; see also OptionLine website (available at http://www.optionline.org/); refuted by The Alan Guttmacher Institute’s Emergency Contraception stating that emergency contraception will prevent a pregnancy from occurring but will not abort an established pregnancy.
  26. See, e.g., Health and Safety Checklist, Rockville Pregnancy Center (available at http://www.rcpc.org/checklist.html).
  27. See, e.g., Westside Pregnancy Resource Center website (available at http://www.wpclinic.org/abortion/); OptionLine website; Berry, supra note 2.
  28. See NAF Report, Crisis Pregnancy Centers: An Affront to Choice (2006, PDF file, 211K).
  29. Vitoria Lin and Cynthia Dailard, Crisis Pregnancy Centers Seek to Increase Political Clout, Secure Government Subsidy, The Guttmacher Report on Public Policy, May 2002, Vol. 5, No. 2 (available at http://guttmacher.org/pubs/journals/gr050204.html).

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

prochoice.org

Writer: Kristin Harrison, Esq.
Copyright ©2006, National Abortion Federation

Printable version of this fact sheet (PDF file, 28K)

Fact: Each year, one million American teenagers become pregnant, and 78% of these pregnancies are unintended.

Four in every five Americans begin having intercourse before age 20. Many of the youngest women in this group (70% of those age 13 or under) report having had sex forced on them. By the time they turn 20, about 40% of American women have been pregnant at least once. Many of these young women have little understanding of their bodies and have begun having sexual intercourse before knowing about ways to prevent pregnancy.

Because teens in other developed countries receive more education about sexuality and have more access to contraception and family planning services, they have much lower rates of pregnancy and abortion. For example, in the Netherlands, where teenage sexual activity is about the same as in the U.S., pregnancy rates are only one-ninth those of the United States.

Fact: Of teenage women who become pregnant, about 35% choose to have an abortion rather than bear a child.

Teenagers with unplanned pregnancies face difficult choices. If a teen gives birth and keeps the baby, she will be much more likely than other young women to:

  • drop out of school;
  • receive inadequate prenatal care;
  • rely on public assistance to raise her child;
  • develop health problems; or
  • have her marriage end in divorce.

Children born to teenage mothers are more likely than children of older mothers to suffer significant disadvantages: medical, psychological, economic, and educational.

Many states have enacted, or are considering, laws that restrict teenagers’ access to abortion by requiring parental involvement in the abortion decision. Such laws include:

  • Parental notification laws that require medical personnel to notify a minor’s parent(s) of her intention to obtain an abortion;
  • Parental consent laws that require medical personnel to obtain written permission from the parent(s) before providing an abortion;
  • Almost all of the parental notification and consent laws have judicial bypass options that allow a teen who feels she cannot involve her parent(s) to get a judge’s permission to proceed with her abortion. Some states allow a physician to waive parental involvement, and some allow professional counseling instead of parental involvement.

Fact: Restrictive abortion laws may worsen family communication rather than promote it.

Abortion providers encourage teenagers to tell a parent or another important family member about their plans, and most teens do. Even without state laws, one or both parents of 61% of minors know about their daughters’ abortions. The younger the teen, the higher the likelihood that she has told her mother about the situation.

Those young women who do not or cannot tell their parents, however, often have important reasons such as a family history of alcoholism, emotional or physical abuse, or incest. To involve such parents could invite further abuse of the teenager and other family members.

Rather than tell their parents – for whatever reason – some teenagers resort to unsafe, illegal abortions or try to perform the abortion themselves. In doing so, they risk serious injury and death or, in some cases, criminal charges.

Fact: Restrictive laws endanger teens’ health by inhibiting them from seeking safe medical care early in pregnancy.

Doctors recommend that when a woman becomes pregnant – whether she plans to give birth or have an abortion – she seek medical care immediately. In the case of abortion, her risk is lowest if she seeks care in the early weeks of pregnancy.

By placing roadblocks in teenagers’ paths, restrictive laws have the effect of creating further delays among women who already have difficulty seeking prompt care. When teens know that health care providers are forced by law to tell their parents before providing services, they are less willing to get health care related to sexual activity.

Fact: Judicial bypass presents a formidable obstacle to those who need it most.

Going to court is usually intimidating to even the most sophisticated adults, who generally have an attorney to represent them. For a pregnant teen to use judicial bypass, she must not only find a judge, she must work her way through a confusing legal system and face intense, sometimes judgmental, and often traumatic questioning by strangers.

Indeed, the poorest, youngest, least experienced teenagers are least able to use judicial bypass, and thereby become the most likely to end up becoming teen parents or victims of black-market abortion.

Fact: Judicial bypass substitutes the judge’s values for the family’s.

According to judicial bypass laws, a judge should decide whether the young woman is mature enough to make the decision to have an abortion, or whether it is in her best interests not to involve her parents. They do not address how this young woman will be able to make parental decisions for a child of her own if she is legally barred from making them for herself.

Restrictive laws give judges the power to say no to a teen’s private decision to have an abortion. In response, she may feel forced to have a baby against her wishes; her parents may turn their backs on her or force her out of their home; or she might run away from home to face her pregnancy alone. Some teens may resort to a secret, unsafe, illegal, or self-induced abortion if her way to a confidential, legal abortion is blocked.

Any additional state laws restricting abortion (such as mandatory waiting periods between abortion counseling and abortion procedures) are doubly burdensome for teenage women who have fewer resources, less privacy, and less ability to meet all the requirements. All such restrictions to a woman’s access to safe and legal abortion rob her of her ability to take control of her life.

Fact: Laws restricting teen access to abortion are coercive.

Laws in 46 states and the District of Columbia allow mothers who are under 18 to place their children for adoption without involving their parents, but many of those same states require parental notification or consent before these young women can obtain abortions. This sets up a standard that clearly favors one resolution over another, restricts the reproductive choices of young women, and forces some to bear children that they do not want to bear.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Writer: Susan Dudley, PhD
Copyright ©1996, National Abortion Federation
Revised 2003

Printable version of this fact sheet (PDF file, 28K)

About Medicaid

Authorized in 1965, Medicaid is a joint federal-state program that provides the nation’s low-income population with basic health and long-term care coverage. Medicaid is the largest health care program in the United States, and covers more than 50 million people.1 Under Medicaid states receive federal matching funds to provide health care for low-income individuals.

Medicaid coverage is critical to the health care of millions of women. More than 16 million women receive their basic health and long-term coverage through Medicaid.2 In 2003, Medicaid covered one in ten women and one in five low-income women.3 In 2003, 11.5% of women of reproductive age were covered by Medicaid.4

Currently, all state Medicaid programs must cover pregnant women who meet the federal income requirements. Many states have elected to cover women with incomes that are higher than the federal requirements. However, this coverage is not without limits, and abortion services are among the provisions that are most stringently regulated.

Medicaid Spending

Medicaid is the largest form of aid to the states from the federal government, comprising 43% of all federal grants.5 As the national economy has worsened, state tax revenue has lessened and health care costs have continued to rise. This resulted in more people eligible for Medicaid.6 This has placed pressure on states to control Medicaid costs, typically the second-largest budget expenditure.7 The federal government is also looking at scaling back Medicaid funding, and the Bush administration has proposed to reduce Medicaid spending by $35 billion over the next ten years. These cuts will especially impact women.

The Hyde Amendment

After Roe v. Wade decriminalized abortion in 1973, Medicaid covered abortion care without restriction. In 1976, Representative Henry Hyde (R-IL) introduced an amendment that later passed to limit federal funding for abortion care. Effective in 1977, this provision, known as the Hyde Amendment, specifies what abortion services are covered under Medicaid.

Over the past two decades, Congress has debated the limited circumstances under which federal funding for abortion should be allowed. For a brief period of time, coverage included cases of rape, incest, life endangerment, and physical health damage to the woman. However, beginning in 1979, the physical health exception was excluded, and in 1981 rape and incest exceptions were also excluded.

In September 1993, Congress rewrote the provision to include Medicaid funding for abortions in cases where the pregnancy resulted from rape or incest. The present version of the Hyde Amendment requires coverage of abortion in cases of rape, incest, and life endangerment.

Challenges to Hyde

The first challenges to the Hyde Amendment came shortly after its implementation. The Supreme Court has held that the Hyde Amendment restrictions are constitutional8 and that states participating in Medicaid are only required to cover abortion services for which they receive federal funding rather than all medically necessary abortions.9 Challenges under state constitutions have been more successful. Several lawsuits have been brought in individual states arguing that state constitutions afford greater protection for privacy and equal protection than the federal Constitution.10

Implementation of the Hyde Amendment

The Hyde Amendment affects only federal spending. States are free to use their own funds to cover additional abortion services. For example, Hawaii, New York, and Washington have enacted laws funding abortions for health reasons. Other states, such as Maryland, cover abortions for women whose pregnancies are affected by fetal abnormalities or present serious health risks. These expansions are important steps toward ensuring equal access to health care for all women.

Prior to the 1993 expansion of the Hyde Amendment, thirty states chose not to use their own Medicaid funds to cover abortions for pregnancies resulting from rape or incest.11 Initially, a number of states expressed resistance to comply with the expanded Hyde Amendment, and presently thirteen states are under court orders to comply and cover rape and incest in addition to life endangerment.12 Every court that has considered the Hyde Amendment’s application to a state’s Medicaid program since 1993 has held that states continuing to participate in the Medicaid program must cover abortions resulting from rape or incest in order to be compliant with the Hyde Amendment, regardless of state laws that may be more restrictive.

State Funding for Abortion under Medicaid

Funding under Hyde Amendment Only: Alabama, Arkansas, Colorado, Delaware, District of Columbia, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Michigan, Missouri, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, and Wyoming.

Hyde Amendment and Additional Health Circumstances: Indiana (physical health), Iowa (fetal abnormality), Mississippi (fetal abnormality), Utah (physical health and fetal abnormality), Virginia (fetal abnormality), and Wisconsin (physical health).

All or Most Health Circumstances: Alaska, Arizona, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, Washington, and West Virginia.

Noncompliant with the Hyde Amendment: South Dakota (life endangerment only).

Impact of the Hyde Amendment

Unique barriers face low-income women accessing comprehensive reproductive health care. Barriers to abortion access such as the lack of providers, state laws delaying women from receiving timely care, and funding restrictions like the Hyde Amendment fall disproportionately on low-income women who have limited resources with which to overcome these obstacles. The Guttmacher Institute has found that 20-35% of Medicaid-eligible women who would choose abortion carry their pregnancies to term when public funds are not available.13 Additionally, lack of public funding results in women waiting while they raise funds, postponing their abortions until later in their pregnancies when the costs and health risks can be higher. For women who are struggling to make ends meet and who do not have insurance that covers abortion care, the legal right to have an abortion does not guarantee access.

The restrictions imposed by the Hyde Amendment unfairly jeopardize the health and well-being of low-income women and their families. Women who do not have the ability to pay for abortion services may resort to self-inducing an abortion or obtaining unsafe, illegal abortions from untrained practitioners. Also, the Hyde Amendment harms women’s health by denying coverage for abortion services in cases where women have serious physical or mental health concerns.

Conclusion

The Hyde Amendment marginalizes and stigmatizes abortion care rather than recognizing it as an essential component of women’s health, and denies low-income women basic reproductive health care. The Hyde Amendment is reauthorized each year under appropriations bills for the Department of Labor and the Department of Health and Human Services. The current restrictive version of the Hyde Amendment does not provide coverage for abortions in cases of fetal abnormalities, or health exceptions apart from life-threatening conditions. Removing funding restrictions for abortion care is an integral step in ensuring that abortion remains safe, legal, and accessible. American women have had the legal right to choose abortion for more than thirty years. To achieve reproductive equality for all women, restrictive barriers such as the Hyde Amendment must be removed.

References

  1. The Henry J. Kaiser Family Foundation, “The Medicaid Program at a Glance,” Key Facts (January 2005).
  2. The Henry J. Kaiser Foundation, “Medicaid’s Role for Women,” Issue Briefs: An Update on Women’s Health Policy (November 2004).
  3. Id.
  4. The Henry J. Kaiser Family Foundation and the Alan Guttmacher Institute, “Medicaid: A Critical Source of Support for Family Planning in the United States,” Issue Briefs: An Update on Women’s Health Policy (April 2005).
  5. The Henry J. Kaiser Family Foundation, “State Fiscal Conditions and Medicaid,” Medicaid Facts (November 2005).
  6. Id.
  7. Id.
  8. See Beal v. Doe, 432 U.S. 438 (1977) and Maher v. Roe, 423 U.S. 464 (1977)
  9. 448 U.S. 297 (1980).
  10. Advocates bringing lawsuits have ensured state Medicaid coverage for abortions in all or most circumstances in Alaska, Arizona, California, Connecticut, Illinois, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, Oregon, Vermont, and West Virginia. Courts in Florida, Idaho, Kentucky, Michigan, North Carolina, Pennsylvania, and Texas have upheld funding restrictions under their respective state constitutions. Center for Reproductive Rights, “Portrait of Injustice: Abortion Coverage Under the Medicaid Program”.
  11. Bruce Alpert, “Fight Brews as Clinton Backs Medicaid Abortions,” New Orleans Times-Picayune, December 30, 1993, at B1.
  12. The Guttmacher Institute, “State Funding of Abortion Under Medicaid,” State Policies in Brief (June 1, 2005).
  13. Heather Boonstra and Adam Sonfield, “Rights Without Access: Revisiting Public Funding of Abortion for Poor Women,” The Guttmacher Report on Public Policy vol.3(2) (April 2000).

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Copyright© 2006, National Abortion Federation

 

Printable version of this fact sheet (PDF file, 31K)

Abortion and Title X: What Health Care Providers Need to Know

What is Title X?

Title X (“title ten”) is a part of the United States Public Health Service Act. It is a federal program devoted solely to providing family planning services. It was first enacted in 1970 with broad bipartisan support. The program provides federal funds for project grants to public and private nonprofit organizations for the provision of family planning information and services. Community-based providers including Planned Parenthood affiliates, university health centers, independent clinics, hospitals, public and nonprofit agencies, and state and local health departments are eligible for Title X funds. The majority of Title X clients are low-income, uninsured, and do not qualify for Medicaid.

What types of services does Title X fund?

Title X funds may be used to pay for gynecological examinations and basic lab tests; and screening services for STDs, HIV, breast cancer, cervical cancer, high blood pressure, and anemia. Title X funds may also be used for contraceptive information and services, pregnancy testing, and community outreach. Since the inception of Title X, a statutory prohibition against the use of Title X funds for abortion has existed in Section 1008 of the law. It states that no Title X funds can be used “in programs where abortion is a method of family planning.”1

How are Title X funds distributed?

Title X is administered by the Department of Health and Human Services (HHS). Federal funds are given to approximately 80 regional grantees that distribute the funds locally to Title X projects and continue to monitor the projects. To receive funds Title X projects, their directors, and employees must agree to abide by federal guidelines and rules that outline and limit the approved uses of the funds. Clinics that receive Title X funds can, and do, use funds from other sources as well. These include a variety of other federal programs that may fund family planning, as well as state and local sources. In fact clinics receiving Title X funding obtain, on average, one-quarter of their revenues from the program.2

What do the federal guidelines require?

Title X projects must be open to all individuals regardless of race, religion, and income level. Title X services must be completely voluntary. The statute explicitly states that obtaining family planning services may not be made a condition for the receipt of other public benefits. Fees for services are based on the client’s income. Services must be confidential, and all clients, including teenagers, can access confidential services. However, to the extent possible, the project is required to encourage teens to talk to their parents about the confidential services they use. Title X requires that clients visiting clinics for contraceptive care be offered related preventive health services as well. As a result, the program regulations and official guidelines specify a wide range of services to be delivered to clients at Title X-supported clinics including blood pressure evaluation, breast examinations, pelvic examinations, Pap tests, and sexually transmitted disease (STD) and HIV testing, as indicated.

Can my Title X project give out information about abortion?

Yes. For example, if a client were to request counseling about abortion, a Title X project should give non-directive information such as factual, medically accurate brochures, fact sheets, web addresses, or other non-biased resources.

What if a client requests a referral for an abortion?

If requested, Title X facilities may provide abortion referrals. A referral consists of a name, address, telephone number, and other “relevant factual information,” such as what insurance is accepted. Affirmative actions such as obtaining consent for the abortion, arranging for transportation, negotiating a reduction in the fee, or arranging/scheduling the procedure are prohibited. If the referral is made for medical indications, these limitations on referrals do not apply.3 Title X project staff are always allowed under the regulations to give the phone number for the National Abortion Federation hotline (1-800-772-9100) to a woman asking for an abortion referral.

If a facility receiving Title X funding also provides abortion services, can they make a referral to their own facility?

If a facility receiving Title X funding is itself an abortion provider, it may make what is known as a “self-referral.” In 2000, when the final regulations were promulgated, fewer than five percent of Title X recipients were abortion providers. Nevertheless, some of these recipients may be the only abortion providers in their service area, making “self-referrals” a necessity. HHS will continue to monitor the issue of self-referrals for collusion, but has not seen it as a problem in the past.4

What about the “gag rule” on abortion information?

From 1970 to 1988, federal regulations allowed personnel at Title X projects to provide complete, uncensored information including non-directive abortion counseling. In 1988, HHS issued regulations revising their interpretation of Section 1008, the longstanding statutory prohibition against using Title X funds to “promote abortion.” These revised regulations implemented the “gag rule” which prohibited the discussion of abortion as a family planning option. Although never actually enforced nationwide, the “gag rule” also prohibited referrals to abortion providers and required a physical and financial separation of abortion-related activities from Title X activities. The “gag rule” was challenged by many Title X recipients, but was ultimately upheld by the United States Supreme Court.5 In 1993, President Clinton rescinded the rule and initiated a new rulemaking process that was finalized in 2000. These rules largely return to the pre-1988 interpretations of Section 1008.

Although a great deal of misinformation persists about Title X, the language of the federal law is absolutely clear; women who request options counseling must be given information about carrying a pregnancy to term, adoption, and abortion, and a referral to an abortion provider if requested.6

Has the Bush administration reinstated the “gag rule”?

The “gag rule” has not been reinstated. Currently, a policy known as the “global gag rule” is in effect. This restriction is tied to international family planning funds distributed by the United States. The “global gag rule” is similar to the previous Title X restrictions in that it prohibits recipients from advocating for abortion rights or providing abortion services. However, the “global gag rule” goes a step further by denying funds to organizations which use private funds to fund or advocate for abortion. So far, legal challenges have been unsuccessful.

If the Bush administration seeks to reinstate the domestic “gag rule,” HHS would first publish draft rules in the Federal Register, and then decide to revise or implement based on comments received. Congress could also pass legislation creating a “gag rule.”

What is the Weldon Amendment?

The Weldon Amendment is a provision attached to the current federal funding legislation for Title X. This provision would allow health care providers to continue to receive federal funding while refusing to give patients information regarding abortion and abortion care, even in cases of rape and incest. Providers could also ignore state laws requiring the dispersal of abortion information, and in some cases referrals under this Amendment. The Amendment would strip funding from states that “discriminate” against Title X recipients by “forcing” them to provide accurate medical information to patients. Because the Amendment is worded broadly and regulations have not been created, it may even allow Title X recipients to refuse to provide emergency contraception or referrals to survivors of rape.

Has the Weldon Amendment been challenged?

The National Family Planning and Reproductive Health Association (NFPRHA) filed a lawsuit to block the Weldon Amendment in December 2004. In September 2005 a federal court ruled against NFPRHA and in November 2006 a federal appeals court ruled that NFPRHA lacked standing to challenge the provision.

The state of California also filed a lawsuit suit to prevent enforcement of the Weldon Amendment because it would interfere with California’s state laws securing a woman’s constitutional right to an emergency abortion without impermissible government interference. That case is currently pending.

What can health care providers in Title X projects say about abortion?

The discussion of options for an unplanned pregnancy must be non-directive. Pregnant women must be given the opportunity to receive information on all options, including abortion. If the client requests information about abortion, Title X clinics may provide “as much factual, neutral information about any option, including abortion, as they consider warranted by the circumstances, but may not steer or direct clients toward selecting any option, including abortion, in providing options counseling.”7 If a client indicates that she does not want information and counseling on any particular option, that decision must be respected.

If my Title X facility becomes an abortion provider, what requirements exist?

Title X recipients must be able to demonstrate through financial records, protocols, procedures, and other means that Title X funding does not go toward the provision, promotion, or encouragement of abortion as a method of family planning. The requirement of physical separation, required by the “gag rule” and by pre-1988 interpretations, was dropped in the revised regulations.

However, it is clear that separate bookkeeping entries alone do not meet the separation requirements of Title X. Violations of Section 1008 are determined by analyzing whether the prohibited activity is a part of the project funded by Title X. For example, a common waiting room or filing system is allowed as long as costs are pro-rated. Common staff is permissible so long as salaries are allocated and all abortion-related activities are performed in a program which is entirely separate from the Title X project.8 Essentially, abortion-related activities must be easily distinguishable from Title X-funded activities.

It is important to keep in mind that Title X is administered regionally and that different regions and regulators might have different interpretations of the principles of separation.

Can my facility or organization still advocate against restrictions on abortion?

Yes. However, no Title X funds can go towards advocacy efforts such as lobbying, providing speakers to promote “the use of abortion as a method of family planning,” using legal action to make abortion available, or developing or disseminating materials that advocate for abortion in family planning contexts. However, HHS recognizes that this prohibition does not encompass neutral, factual information that grantees are permitted to provide in the counseling context. It is also permissible for Title X projects to be dues-paying members of abortion advocacy groups, so long as legitimate, Title X program-related reasons exist for the affiliation.

Where can I find additional information about Title X?

The Office of Population Affairs of the U.S. Department of Health and Human Services oversees Title X and has a web site at: www.hhs.gov/opa/. Additional information about Title X is available from several organizations including:

References

  1. 42 USCS § 300a-6.
  2. Alan Guttmacher Institute, Policies in Brief, “Title X: Three Decades of Accomplishment,” January 2001.
  3. 64 F.R. 41281 (“Provision of Abortion-Related Services in Family Planning Services Projects”).
  4. 65 F.R. 41270 at 41275. (“Standards of Compliance for Abortion-Related Services in Family Planning Services Projects”).
  5. Rust v. Sullivan, 500 U.S. 173 (1991).
  6. 42 C.F.R. 59.5(a)(5),
  7. 65 F.R. 41270 at 41273.
  8. 65 F.R. 41281.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

prochoice.org

Updated August 2007
Copyright 2007, National Abortion Federation

Printable version of this fact sheet (PDF file, 44K)

What is the Freedom of Access to Clinic Entrances Act?

The FACE Act makes it a federal crime to use force, the threat of force, or physical obstruction to prevent individuals from obtaining or providing reproductive health care services. FACE also authorizes reproductive health care providers, the state attorney general, and/or the federal government to bring civil lawsuits to get injunctions against these activities, or to get monetary damages.

Why was FACE passed?

During the 1980s and early1990s, clinic protests and blockades were on the rise. Violence against abortion providers was escalating across the country, culminating in the murder of Dr. Gunn in March of 1993 outside a Pensacola, FL clinic and the attempted murder of Dr. Tiller in August of 1993 outside his Wichita, KS clinic. These incidents created urgency in Congress to pass new federal legislation to address the violence committed against reproductive health care facilities and providers and the denial of access to women seeking their services.

When was FACE passed?

FACE was passed by the U.S. Congress and signed into law by former President Clinton in May of 1994.

What does FACE prohibit?

FACE makes it illegal to intentionally use force, the threat of force, or physical obstruction to injure, intimidate, interfere with, or attempt to injure, intimidate or interfere with individuals obtaining or providing reproductive health care services. FACE also punishes anyone who intentionally damages or destroys a facility that provides reproductive health services.1

Who does FACE protect?

  • A facility or anybody who works at a facility that provides reproductive health services.
  • Patients of facilities that provide reproductive health services.
  • People accompanying patients, such as a parent, partner, or clinic escort.

What is included in “reproductive health services”?

FACE covers more than just abortion services. “Reproductive health services” include medical, surgical, counseling, or referral services related to pregnancy or the termination of pregnancy provided in a hospital, clinic, physician’s office, or other facility that provides reproductive health services.

Who is a “reproductive health care provider”?

Anybody or any facility that provides reproductive health services. Trained professionals who work in credentialed facilities are covered by FACE, as are staff necessary to the safe functioning of a facility, such as security guards, maintenance staff, and patient escorts. People who work in anti-choice reproductive health facilities, such as crisis pregnancy centers, are also covered by FACE. Protesters such as sidewalk counselors who try to give information to women outside of reproductive health care facilities are not covered.2

What does the phrase “interfere with” mean?

Congress included specific definitions in the Act to clarify the meaning of the law. “Interfere with” means to restrict a person’s freedom of movement.

What does the term “intimidate” mean?

Placing a person in reasonable apprehension of bodily injury to him or herself or another.

What is considered a “physical obstruction”?

Rendering the entrance or exit of a facility that provides reproductive health services impassable, or making access into and out of such a facility unreasonably difficult or hazardous.

What is considered a “threat”?

For FACE purposes, a definition which has been adopted by the 9th Circuit Court of Appeals in Planned Parenthood v. ACLA is that a statement is a true threat if a reasonable person making the statement would foresee that it would be interpreted by the person to whom it is made as a serious expression to inflict harm or assault.3 In assessing whether a statement is an unlawful threat, the context in which the statement was made must be considered, including the reaction of the listener.

What are some examples of behavior FACE prohibits?

  • Any activity that blocks access to the entrance or obstructs the exit of a facility, including impairing cars from entering and leaving parking lots; impeding the progress of people trying to walk towards doors or through parking lots; or making getting in and out of the facility difficult or dangerous.
  • Trespassing, such as clinic invasions.
  • Acts of physical violence, such as shoving, directed towards clinic employees, escorts or patients.
  • Vandalizing a reproductive health care facility by gluing locks or pouring butyric acid.
  • Threats of violence. For example, in 1996 a woman was found guilty of a FACE violation for yelling through a bullhorn to a doctor, “Robert, remember Dr. Gunn. This could happen to you…” (referring to a doctor who was shot in 1993).4 In another case, a man was found to have threatened force under FACE when he parked a Ryder truck outside of a clinic shortly after the bombing of a federal building in Oklahoma City where a Ryder truck had carried the explosives.5
  • Stalking a clinic employee or a reproductive health provider.
  • Arson or threats of arson.
  • Bombings or bomb threats.

Does the prohibited behavior need to be repetitive to be in violation of FACE?

The Act does not require that the behavior occur more than once. If a singular event is heinous enough in the eyes of a U.S. Attorney, criminal prosecution is likely. However, if the prohibited act is not as severe, proof of repetition will assist in either a criminal or a civil case.

What behavior does FACE not prohibit?

FACE protects protesters’ First Amendment right to free speech. Clinic protesters remain free to conduct peaceful protest, including singing hymns, praying, carrying signs, walking picket lines and distributing anti-abortion materials outside of clinics.

Is shouting outside of a clinic a FACE violation?

FACE allows shouting outside of clinics, as long as no threats are made. However, noise levels many not exceed those set by state or local law.

Is the use of photography or videotaping outside a clinic prohibited under FACE?

Taking somebody’s picture, either still or moving, without their consent is not an act of force or a threat of force, therefore this is not a FACE violation. However, it may be actionable under state law.

Who can bring a criminal cause of action under FACE?

Only the federal government can file criminal charges under FACE.

What are the criminal penalties under FACE?

The criminal penalties vary according to the severity of the offense and the defendant’s prior record of FACE violations. The Act does not provide for minimum sentences; the following are illustrative of the maximum sentences:

  • Generally, a first-time offender cannot be sentenced to more than 1 year in prison and a $100,000 fine. For a second or subsequent violation after a prior FACE conviction, a defendant may be imprisoned for no more than 3 years and fined $250,000.
  • If the violation is a non-violent physical obstruction, a first time “blockader” faces no more than 6 months in prison and a $10,000. For subsequent violations, the maximum penalty in 18 months and a $25,000 fine.
  • The maximum sentence for offenses that result in bodily injury is 10 years imprisonment. In an offense that results in death the maximum penalty is life imprisonment.

Who can bring a civil cause of action under FACE?

The federal government, state governments, and/or any person or facility that has been the victim of a prohibited action under FACE can bring a civil lawsuit against a violator of FACE.

What are the civil penalties under FACE?

A private plaintiff can obtain temporary, preliminary, or permanent injunctive relief, compensatory and punitive damages, and fees for attorneys and expert witnesses. Rather than collecting compensatory damages, the plaintiff may choose to recover $5,000 for each proven violation.

The federal government or attorney general of your state may also bring a civil suit in federal court on behalf of third parties injured by FACE violations. The court may impose civil fines on the defendants according to the following, note these are all the maximum fines:

  • first offense, nonviolent physical obstruction: $10,000
  • other first offenses: $15,000
  • subsequent offenses for nonviolent physical obstruction: $15,000
  • other subsequent offenses: $25,000

Does FACE provide for areas that the protesters cannot enter?

No, FACE does not explicitly define areas that the protesters are prohibited from entering. However, the Act does provide for injunctive relief in the event of a FACE violation, which could limit the areas in which protest occurs. In other words, to obtain a protest-free buffer zone around a clinic entrance, either the facility or the state or federal government must file a civil lawsuit against individual protesters and/or their sponsoring organizations, and prove that their actions violate FACE.

Is FACE constitutional?

Yes, each of the eight federal appeals courts that have heard a FACE case held that FACE is constitutional.6 The U.S. Supreme Court has chosen not to review these cases, in essence affirming the Act’s constitutionality. FACE does not infringe the free speech and free assembly rights of anti-abortion protesters. Rather, the law covers unprotected conduct, such as threats, assault, trespass and vandalism.

Has the passage and enforcement of FACE assisted in the decrease of clinic violence?

Yes. In 1994, 52% of clinics reported experiencing severe violence (classified as blockades, invasions, bombings, arsons, chemical attacks, stalking, physical violence, gunfire, bomb threats, death threats, and murder). That number declined to 20% in 1999 and 2000.7 The general consensus is that the FACE Act is an important tool in responding to clinic violence and in deterring possible offenders.

What is the status of law enforcement response to clinic incidents?

Between the passage of FACE in 1994 and 2005, the Department of Justice (DOJ) has obtained the convictions of 71 individuals in 46 criminal prosecutions for violations of FACE.  Also, DOJ has brought 17 civil lawsuits under FACE, which have resulted in injunctive relief, damages, and/or penalties.8 Following the murder of Dr. Slepian in 1998, then U.S. Attorney General Janet Reno established the Department of Justice’s National Task Force on Violence against Health Care Providers to address violence against providers and patients of reproductive health care providers. The task force is responsible for coordinating criminal investigations of anti-abortion activities on a national level. They work with federal, state and local law enforcement agencies to address safety and security issues and to provide investigative support.

What are other legal devices that can be utilized by reproductive health care providers?

Although FACE is extremely useful, there are other tools available. Other federal statutes that may apply:

  • Threats (18 U.S.C. § 875 and § 876; 18 U.S.C. § 844). Criminalizes any threat to kidnap or injure a person that is sent through the mail or by interstate telephone lines. The threat need not be made directly to the intended victim. Although a telephone threat must be made between two states for it to be a federal crime, many states have parallel statewide provisions. Additionally, any threat by telephone or mail that involves the use of explosives to injure a person or destroy property is a federal crime, regardless of the originating point of the threat.
  • Telephone Harassment (18 U.S.C. § 223). Criminalizes any interstate telephone call that is made for the purpose of harassment. This includes calls where no conversation ensues.
  • Extortion (18 U.S.C. § 1951). Criminalizes threats of violence used to force someone to relinquish property. Thus, a threat to commit an act of violence against a physician or clinic if either continues to provide abortions is a crime. The statute probably does not protect recipients of health care services who are similarly threatened.

State statutes and local ordinances that may apply:

  • State FACE Acts. Some states have enacted their own versions of FACE. This allows states to press criminal charges under state law, and gives clinics more options for enforcement. State versions of FACE have been enacted in CaliforniaNew York and Washington.Connecticut, the District of ColumbiaKansasMaineMarylandMinnesota,NevadaNorth CarolinaOregon, and Wisconsin also have statutes that deal with harassment at health care facilities.
  • State Buffer Zone Laws. ColoradoMassachusetts, and Montana have passed buffer zone legislation. In Colorado, within 100 feet of any health care facility entrance, patients cannot be approached within 8 feet without consent for the purpose of leafleting, displaying a sign, or engaging in conversation. In Massachusetts, an 18-foot buffer zone exists around clinic entrances. Within the buffer zone, protesters must stay at least 6 feet away from clinic workers and patients. In Montana, a 36-foot buffer zone exists, within which protesters must remain 8 feet away from patients and clinic workers.
  • State criminal laws such as assault, trespass, and arson. Several states also have statutes protecting health care facilities.
  • Residential picketing laws or injunctions that prevent picketing focused on a particular residence. Such measures may prevent demonstrations not only in front of a targeted residence, but also in front of surrounding residences. They may also limit the number of picketers and the time and duration of the demonstrations to take account of the character of the neighborhood and the privacy of the “target.”
  • Loitering laws. These ordinances can be used if people are congregated in a public street for no apparent reason for an extended period of time.
  • Noise ordinances. The Supreme Court has approved of restrictions on noise (“singing, chanting, whistling, shouting, yelling, use of bullhorns, auto horns, sound amplification equipment…”) when the noise can be heard inside a clinic during clinic hours.
  • Municipal Ordinances. Pittsburgh, Pennsylvania has enacted a buffer zone ordinance containing two provisions: a 15-foot buffer zone around entrances to health care facilities, and an 8-foot personal bubble zone to prohibit protesters from approaching patients and health care workers.

References

  1. 18 U.S.C.A § 248(a).
  2. Raney v. Aware Woman Center for Choice, Inc., 224 F.3d 1266 (11th Cir. 2000).
  3. The Supreme Court denied an appeal in Planned Parenthood v. ACLA.
  4. U.S. v. Dinwiddie, 76 F.3d 913 (8th Cir. 1996).
  5. U.S. v. Hart, 212 F.3d 1067 (8th Cir. 2000).
  6. Norton v. Ashcroft, 298 F.3d 547 (6th Cir. 2002); U.S. v. Hart, 212 F.3d 1067 (8th Cir. 2000); U.S. v. Gregg, 226 F.3d 253 (3rd Cir. 2000); U.S. v. Wilson, 154 F.3d 658 (7th Cir.1998); U.S. v. Weslin, 156 F.3d 292 (2d Cir. 1998); Hoffman v. Hunt, 126 F.3d 575 (4th Cir. 1997); Cheffer v. Reno, 55 F.3d 1517 (11th Cir. 1996); Terry v. Reno, 101 F.3d 1412 (D.C. Cir. 1996). US v. Bird, 401 F.3d 633 (5th Cir. 2005).
  7. 2000 National Clinic Violence Report, Feminist Majority Foundation.
  8. National Task Force on Violence Against Health Care Providers, Department of Justice, Report on Federal Efforts to Prevent and Prosecute Clinic Violence 1998-2000.

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

Copyright© 2006, National Abortion Federation

Printable version of this fact sheet (PDF file, 31K)

What is a TRAP bill?

TRAP stands for Targeted Regulation of Abortion Providers. TRAP bills single out abortion providers for medically unnecessary, politically motivated state regulations. They can be divided into three general categories:

  • a measure that singles out abortion providers for medically unnecessary regulations, standards, personnel qualifications, building and/or structural requirements;
  • a politically motivated provision that needlessly addresses the licensing of abortion clinics and/or charges an exorbitant fee to register a clinic in the state; or
  • a measure that unnecessarily regulates where abortions may be provided or designates abortion clinics as ambulatory surgical centers, outpatient care centers, or hospitals without medical justification.

What is the purpose of a TRAP bill?

TRAP bills stigmatize and burden abortion providers and are calculated to chip away at abortion access under the guise of legitimate regulation. These measures are often introduced by abortion opponents who claim that abortion is an unsafe and unregulated procedure. By implying that abortion clinics are uniquely dangerous and in need of special regulation, such bills recklessly promote an unfounded fear that abortion is unsafe. Abortion is in fact one of the safest medical procedures provided in the United States.

Many TRAP bills grant broad authority to the state department of health to develop structural and staffing requirements for abortion clinics. Often, the resulting regulations are based on existing hospital guidelines including specific dimensions for procedure rooms and hallways, doorway widths, and complex ventilation systems. Some regulations mandate what types of medical professionals must be on staff, assign certain duties to various staff members or require patient evaluations that are not medically necessary. These types of regulations are not medically justified. Abortion has an outstanding safety record. Instead, these regulations create a large burden for small outpatient clinics. Clinics can be forced to extensively remodel and hire new staff or even close entirely, resulting in women having to travel great distances to obtain abortion care.

What are the real facts?

Abortion is very safe.

Abortion is one of the safest and most commonly provided medical procedures in the United States. Fewer than 0.3% of abortion patients experience a complication requiring hospitalization.1In the U.S., more than 90% of all abortions are provided in outpatient facilities such as doctors’ offices and clinics. Credit for the outstanding safety record of abortion care is attributed to the specialized quality care given and received in these facilities. Since the legalization of abortion in 1973, the provision of abortion services in the U.S. has become a public health model for the rest of the world. There is no evidence that abortions would be safer in another setting, or that abortions are performed inadequately in outpatient facilities.

Abortion is already regulated.

All health care facilities, including abortion providers, are required to comply with a variety of federal and state regulations. These include the federal Clinical Laboratory Improvement Amendments (CLIA), Health Insurance Portability and Accountability Act (HIPAA), and Occupational Safety and Health Administration (OSHA) requirements, as well as state and local regulations including building and fire codes. All medical professionals, including physicians and clinicians who work in abortion care, are required to maintain professional standards and licenses and complete continuing medical education courses.

NAF and other groups work to ensure safe, quality abortion care.

The National Abortion Federation, the professional association of abortion providers, has established evidence-based Clinical Policy Guidelines which help ensure the highest standards of quality care. These guidelines are available on the NAF website at http://prochoice.org.2 Other medical organizations, such as Planned Parenthood Federation of America and the American College of Obstetricians and Gynecologists, have also established professional guidelines for abortion clinics.

What is the impact of TRAP laws?

Enactment of this type of legislation discourages health care providers from offering abortion care and can make provision very burdensome and/or expensive for smaller providers. This exacerbates the provider shortage that already exists in the United States. In 2000, 87% of counties in the U.S. did not have a single abortion provider, and this number rose to 97% for non-metropolitan counties.3 In addition, mandated staffing requirements and qualifications that often appear in TRAP bills restrict clinicians’ autonomy by tying them to a particular hospital within a certain distance of the clinic, which unnecessarily limits the ability of providers to travel to serve underrepresented populations.

How prevalent are TRAP laws?

Currently, at least 34 states have some type of TRAP law. Each year, state legislatures across the country introduce new TRAP provisions or modify their existing regulations. In 2005, twenty-one states introduced TRAP bills, and four of these bills were enacted. As these restrictions continue to build on each other, it becomes more and more difficult for abortion providers to remain open and for women to safely access their full range of reproductive health care services. Activists must be vigilant to ensure that these targeted regulations do not force clinics to close and deny women access to safe and legal abortion services.

In 2005, twenty-one state legislatures considered TRAP bills:
Alabama, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Missouri, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Virginia, Vermont, Washington, and West Virginia.

Four states enacted TRAP bills in 2005:
Florida, Indiana, Missouri and Mississippi.

The Kansas Governor vetoed a TRAP bill in 2005, stating in her veto message: “Once again in 2005, the Legislature has chosen pure politics over good policy, has rejected uniform standards for all procedures, and has instead chosen to regulate only one procedure – abortion.”

References

  1. See The Guttmacher Institute, “Facts on Induced Abortion in the United States,” 2006 (available at http://www.guttmacher.org/pubs/fb_induced_abortion.html).
  2. Available at http://prochoice.org/resources/2014-clinical-policy-guidelines/.
  3. See The Guttmacher Institute, “Abortion Incidence and Services in the United States in 2000,” (available at http://www.guttmacher.org/pubs/journals/3500603.pdf).

For More Information

For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
Weekdays: 7:00 A.M.-11:00 P.M. Eastern time
Saturdays and Sundays: 9:00 A.M.-9:00 P.M.

For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
Weekdays: 9:00 A.M. – 8:00 P.M.
Saturdays: Noon – 5:00 P.M.

National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
202-667-5881

prochoice.org

Writer: Lisa M. Brown, Esq.
Copyright ©2007, National Abortion Federation