Reproductive Rights

Here’s Why The Abortion Debate Is Even More Complex Than You Ever Thought

It didn’t start with Roe v. Wade.

For decades, abortion in the United States has been such a divisive topic that even speaking about it in certain settings (like at the dinner table with your parents, yikes) can set off explosive arguments. Furthermore, each state has its own laws and every political leader has a different opinion, making the legislative landscape almost impossible to navigate. But it doesn’t have to be that way: We’re here to help you understand the ongoing argument.

Elite Daily spoke to two experts on reproductive rights and health about what you need to know about the United States abortion debate — from its legal, medical, and scientific history, to the legislative battles, and everything in between. Mary Ziegler is a legal historian and professor of law at Florida State University who specializes in the legislative history of abortion in America. Dr. Mariam Savabi, M.D., MPH, is an obstetrician and gynecologist in Washington state, and a fellow with Physicians for Reproductive Health. Here are their takes on America’s heavyweight abortion debate.

The following interviews have been edited for length and clarity.

So, to start: How has abortion become such a divisive political topic?

MZ: Some people think of the Supreme Court’s 1973 decision to legalize access to abortion nationally, Roe v. Wade, as the starting point, but they don't know about the longer history. Before the 19th century, abortion before “quickening” — the first fetal movement a pregnant person feels, often around the 15th or 16th week of pregnancy — was a common practice in the United States.

Laws criminalizing abortion came into effect in the late 19th century. That began to change after the Great Depression: As you can imagine, there's usually an uptick in abortion when there's a big economic downturn. But because abortions were illegal, they were much more dangerous, and people ended up in the hospital with complications. Doctors and hospitals began forming therapeutic hospital abortion committees, which were basically committees to regulate and limit safe, legal abortions. At first, those committees decreased the abortion rate pretty dramatically, but over time, more abortions started getting approved. Doctors began saying, “The problem isn’t we’re approving too many abortions, the problem is the law — it’s stupid, and doesn't allow us to practice medicine as we see fit.” Almost as soon as there was a move to reform strict abortion laws, which really began in earnest in the ‘60s, an anti-abortion political movement popped up.

Ronald Reagan’s presidential campaign in the early 1980s was likely the most successful in making abortion a political issue. By emphasizing abortion, Reagan saw an opportunity to weaken the New Deal coalition, a diverse voting bloc of labor unions, blue-collar workers, minority groups, and more who supported the Democratic Party. These voters would typically vote Democratic, largely because doing so was in their best economic interests. But many people in the coalition were also Catholic, evangelical, or Protestant — and uncomfortable with abortion. Reagan figured abortion was such a polarizing topic, it was a great way to pick off the votes of socially conservative whites from the Democratic Party, shatter the New Deal Coalition, and strengthen the Republican Party.

At the same time, on the Democratic side, feminists within the party were beginning to gain more political influence, and were pushing the party toward embracing abortion rights. All of that came to a head in the early ‘80s, and for the first time, you’d be able to say, “The Republican Party is opposed to abortion rights, and the Democratic Party is in favor.”

Let’s backtrack. What exactly is abortion, as a medical procedure, and how does it work?

MS: There are several different ways to perform abortions. Medication abortion, as well as dilation and curettage (D&C), are typically performed during the first trimester of pregnancy. During a medication abortion, the patient takes two different pills, mifepristone and misoprostol, to pass the pregnancy from the uterus with some cramping. Dilation and curettage is a surgical procedure. [Editor’s Note: According to 2018 CDC data, around 92.2% of abortions are performed during the first trimester, less than 13 weeks into a pregnancy, with about 7% taking place between 14-20 weeks and only 1% past 21 weeks.]

Abortion is life-saving. Having access to abortion care is critical for people to exercise their reproductive autonomy. Pregnancy is dangerous, and much more likely to lead to mortality when compared to having a safe, early-trimester abortion. I'm an obstetrician, and I see complications all the time. Sometimes there's a complication with the pregnancy or the fetus itself, and the patient can't carry the pregnancy safely; sometimes the patient just had a baby and doesn’t have the resources to support another; and sometimes, it’s just not the right time.

SAUL LOEB/AFP/Getty Images

How does the legislative history of abortion affect the political landscape today?

MZ: After Roe v. Wade was decided in 1973, judges would apply what was called the “trimester framework” rule to decide whether or not an abortion restriction was constitutional. During the first trimester, weeks one through 12 of a pregnancy, state legislators couldn't regulate abortion much at all. In the second trimester, weeks 13-26, they could reasonably regulate — not outlaw — abortion procedures to protect patient health, but only after viability, when the fetus can survive outside the patient’s uterus. That’s usually around 24 weeks. After that, state legislators were free to regulate or outlaw abortions in the interest of protecting fetal life, except when needed to preserve the physical and/or mental health of the patient.

After Roe, there were many significant Supreme Court cases on abortion that people don’t typically discuss, like Maher v. Roe, and Harris v. McRae. These cases essentially established Roe v. Wade doesn’t mean you actually have the right to have an abortion — you just have the right to decide to have an abortion. So if the obstacle preventing you from getting an abortion isn’t the government — for example, if you can’t afford it — then it’s your own problem.

Perhaps the most important case is 1992’s Planned Parenthood v. Casey. That case got rid of the trimester framework and introduced the “undue burden” standard, which prevents state legislators from imposing restrictions for “the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.” This new standard made it a lot easier for states to restrict abortion. So now, when we ask ourselves, “Is the court going to overturn Roe?” what we really should be asking is, “Is the court going to overturn Casey?” because Casey has dramatically changed what the abortion landscape looks like in America. The rules we apply today to determine if a state’s abortion laws are unconstitutional are from Casey, not from Roe.

As of the end of 2020, 29 states were considered “hostile” to abortion, and the divide between “hostile” and “supportive” states has widened over the years. How do restrictive abortion laws affect real people?

MS: Abortion care is incredibly safe, particularly when it's done in the first trimester. So in many cases, hospital-grade facilities aren’t a necessity. But regulations like Targeted Restrictions on Abortion Providers (TRAP laws) require abortion clinics — many of which are small outpatient clinics — to qualify as hospital-grade facilities based off small rules, like requiring each door in the clinic to be a certain height and width. For many small clinics, that’s a major renovation. So these regulations are immediately cost- and space-prohibitive. Furthermore, some hospitals don’t even allow abortion care in their systems because they don’t want to be seen as controversial.

Between 2011 and 2017, TRAP laws were directly responsible for shutting down 50 clinics in the South, and 33 clinics in the Midwest. That means patients have to travel for care, which creates a delay in getting to services and additional travel costs many low-income patients may not be able to afford — especially if they already have children and have to pay for child care and a hotel. Some people may not be able to take time off work to travel, and risk losing their jobs altogether. So there have been multiple small regulations that may feel insignificant, but ultimately affect patient care in extremely compromising ways.

Abortion will always exist, whether it’s legal or not. Before Roe v. Wade, people would pursue abortion regardless of its legality — and because it was illegal, there was a higher risk of unsafe abortions. During that time, many hospitals would have a ward solely dedicated to treating people who had septic abortions, after they had tried to perform an abortion at home. Making abortion illegal won’t stop abortion altogether. It’ll just increase the number of unsafe abortions.

What are some of the most common arguments against abortion access?

MZ: Usually the arguments against abortion are about fetal personhood and the right to life. The arguments are generally that a fetus, on day one of pregnancy, is genetically unique, human, and inherently valuable, and abortion is essentially denigrating the value of that life.

Some abortion opponents will frame it as an issue of racism, saying, “If Black lives matter, why are we OK that Black people are having abortions at a higher rate?” And they’ll bring up the history of racism and eugenics to claim abortion is a racial justice issue. They’ll say, “If you're concerned about equality, you should actually be opposed to abortion, because abortion carries the idea some groups of human beings can be disposed of, and others cannot.” So those are some of the arguments in a nutshell.

MS: There’s a philosophical perspective about what medical care means. People want to ask, “When does life begin?” And that's a philosophical question. I will never be able to answer that. I'm a scientist and a medical provider. But before medical technology like ultrasounds, there was no definition of when “life” began. People use philosophy to suggest life begins at conception, when, biologically, there's nothing that could live at conception, you know?

What misconceptions are out there?

MS: There's a misconception that people of color use abortion as birth control or pursue abortion more than people who aren’t of color. There is a political agenda being pushed suggesting Black mothers are killing their babies through abortion, but that’s not true. Statistically, marginalized communities lack the necessary resources to not only access equitable reproductive care, but to access health care in general. So these communities are going to have less opportunities to practice reproductive justice, and may get pregnant at more frequent rates. But what we've seen is people from all backgrounds pursue abortion care.

There’s also misinformation. Some states legally require abortion providers to say abortion may increase your risk of breast cancer, which is not true. There's just some really terrible and egregious assumptions related to abortion care, and some state laws require those assumptions to be repeated by medical providers.

OK, we’ve talked about the science and history. But what does the future political landscape of abortion look like?

MZ: When it comes to the legal environment for abortion rights in the next few years, the outlook isn’t good. In May, the Supreme Court agreed to hear a case called Dobbs v. Jackson Women's Health Organization to determine the constitutionality of a restrictive Mississippi abortion law [Editor’s Note: The law would ban abortion at 15 weeks, well before viability]. It won’t be heard until October 2021 at the earliest, but the court may use that case to make some pretty significant changes to abortion rights. While Roe and the right to abortion probably won’t be overruled in 2022, I think the Dobbs v. Jackson case is likely to set the stage for doing so in the not-too-distant future.

MS: Seeing how restrictive a lot of these state laws are becoming, many health care professionals are very afraid more people are going to turn to unsafe home abortions again — especially in communities that already have limited access. We already know racial disparities and income inequalities exist in America, and people from BIPOC and low-income communities are politically exploited. Many politicians are using the abortion debate as a new arena to continue to oppress people with targeted identities. So as states continue to impose these restrictive abortion laws, they limit opportunities for people with targeted identities to access abortion care, simply because they don't have the resources to navigate these legal barriers.

There are many laws specifically designed to pick apart Roe v. Wade in small pieces that may not seem obvious to everyone — but they’re not put in place by accident. They’re very intentional, and if Roe is overturned, these already vulnerable communities would suffer the most.

Is there anything people, particularly teens and 20-somethings, can do to protect abortion access in their states?

MZ: I think voting, knowing where politicians stand on abortion, and voting in state and local elections are some of the best things you can do. People pay more attention when it comes to federal elections, but when it comes to abortion laws, state and local elections are even more critical. Because the elected officials who run state legislatures will often determine what reproductive laws look like in your state. So get just as involved in state elections as you would in federal elections, because they’re so important.

If you’re in a state where abortion is legal, what strategies can you use to help people who need abortion access in states where it’s been banned? Roe being overturned is a scary thought for a lot of people, but if the Supreme Court makes that decision, there’s going to be a huge progressive boost in state-wide grassroots organizing. So as depressing and scary as it may sound, young generations of Americans can see the potential overturn of Roe as an opportunity to come together, reframe the discussion, and capture the attention of people who wouldn’t normally care about the issue.

MS: I think everybody — everybody — should know what's going on with this issue, and just how important it is. Contact your local elected officials, advocate for your reproductive rights, and encourage other people to do the same. Participate in your state and local elections, and give space to people who need abortion access. There are so many volunteer opportunities available to people who want to help out. You can be a clinic escort to help people who need an abortion safely navigate through anti-abortion protesters at care facilities. You can even help with community outreach or event support. There are so many ways to get involved. You can also donate to your local private clinics, who are sometimes financially struggling with trying to comply under strict state regulations.

But one of the best things to do to help protect abortion access in your state is to simply speak up and educate people when you can, especially in settings where people have a homogenous thought process. Just asking questions like, “Why is the state trying to control people's bodies and reproductive rights? Shouldn’t people be able to have privacy? Shouldn't people be able to make the best decisions for themselves and their families?” can do so much to change people's hearts and minds. Just speaking up can be really powerful.

In Elite Daily's series .EDU (Elite Daily University), we ask experts to explain everything you need to know about hot-button issues. Read more here.