Everything You Need to Know About Abortion

Abortion rights are in question across the US. In May, a leaked majority draft opinion from the Supreme Court showed that justices are planning to reverse Roe v. Wade. Effectively ending a woman’s right to an abortion. It’s a heated topic on the Hill and at home. Here’s what you need to know. 

The Basics…

What’s an abortion?

It’s a procedure to end pregnancy. The word was first used in the 1500s, but abortion has been a thing since ancient times. In early America, abortions were legal until a mother felt “quickening” (a subjective term that describes the fetus moving, usually around 4 months). It wasn’t until the mid-1800s that some states started regulating it.

How common is it?

Accounts from the early 1900s indicate that abortions were “not an unusual feature” of married life. In 1973, the Supreme Court recognized a woman’s qualified right to have an abortion (see: Roe v Wade). The U.S. abortion rate today is actually lower than it was in 1973 — dropping about 20% between 2011 and 2017 (the latest data available). But they are still common: The Guttmacher Institute estimates that about one in four women in America will have an abortion by age 45. 

The Terminology…

• Fetal “heartbeat”...When you hear a thump-thump on an ultrasound, which the Texas anti-abortion bill puts as early as six weeks. But medical experts say the term “heartbeat” might not be a spot-on word for it: A heart will not actually be fully developed until weeks later. 

• Fetal-pain bans…Bans on abortions after a fetus can feel pain. This proposed bill puts that at 20 weeks, but many scientists disagree with that time frame.

• Fetal personhood…The idea that a fetus should get 14th Amendment rights separate from, and potentially at odds with, the pregnant person. It’s a concept that was rejected in Roe v Wade. 

• Fetal viability...aka the ability of a fetus to survive outside of the womb. The standard is about 24 to 28 weeks. 

• Late-term abortion…One performed after the 21st week of pregnancy, in the late second trimester. Thing to know: Only around one percent of abortions in America happen this late. 

• Partial-birth abortion…A non-medical term that can describe a late-term dilation and evacuation procedure (see D&E below).

• LMP...“Last menstrual period.” The day typically used to estimate how far along a pregnancy is.

• Spontaneous abortion...A medical term for a miscarriage. 

• TRAP laws…Stands for “Targeted Regulation of Abortion Providers,” aka laws that put strict and medically-unnecessary requirements on abortion clinics. In practice, the laws regulate things like having a minimum corridor width or having a partnership with a local (potentially uncooperative) hospital.

The Legal Side...

What’s Roe v. Wade?

It’s the landmark Supreme Court ruling from 1973. A Texas woman named Norma McCorvey (known as Jane Roe in later court documents) wanted an abortion. But Texas law only allowed abortion if the mother’s life was at risk. So, in 1970, McCorvey sued the Dallas County district attorney, Henry Wade. The case made it all the way to the Supreme Court, which ruled 7-2 that the constitutional right to privacy protects a woman’s right to an abortion. But the ruling still left room for states to regulate abortions.

Will Roe v. Wade be overturned? 

TBD, but it looks likely, according to the leaked draft opinion. On May 2, Politico published a leaked draft of a highly-anticipated Supreme Court ruling on Dobbs v. Jackson Women's Health. The case centers around a MI law passed in 2018, which bans most abortions after 15 weeks. Lower courts ruled against it, citing the precedent set with Roe v. Wade. But Mississippi pushed the court to overturn it, calling it “egregiously wrong.”

Since then, the case has made its way up to the US Supreme Court. And after opening arguments in December, the conservative-majority Supremes seemed ready to discard Roe v. Wade as the 'law of the land.'

Now, the leaked opinion shows this may happen — and soon. Justice Samuel Alito echoed Mississippi's court in the drafted opinion and wrote “Roe was egregiously wrong from the start” (sound familiar?) And Justice Clarence Thomas — plus all three of President Trump’s appointed justices — voted ‘yes’ to overturning Roe v. Wade, per the leaked doc.

But remember: The decision isn’t final until it’s published — which could happen sometime in June or July. It all comes amid a wave of anti-abortion legislation across the US. 

What would happen if Roe v. Wade is struck down?

A reversal of Roe v. Wade would immediately trigger abortion bans across more than 20 states. While several states take measures to protect abortion rights. But a lot remains uncertain right now, experts say that an end to Roe v. Wade would mean an end to many safe abortions — especially for marginalized communities and those living below the poverty line.

What states already have restrictive laws in place?

This year, more than 545 abortion restrictions have been intro’d in 42 states. And as of early May, at least 37 had already been enacted. Some of the most high-profile restrictions (other than Mississippi’s) include…

• Oklahoma: In April, Gov. Stitt signed off on a near-total ban on abortion. The law makes providing an abortion illegal unless it’s “to save the life of a pregnant woman in a medical emergency.” And it gives no exceptions for rape or incest. It's set to go into effect in August. Oklahoma’s legislature also approved a copy-cat Texas bill that would ban the procedure after six weeks. And incentivizes citizens to sue anyone who performs or helps someone get an abortion. But it's waiting for Stitt’s signature to become law.

• Texas: In Sep. 2021, Texas Gov. Greg Abbott (R) signed one of the country’s most restrictive anti-abortion bills into law. Bans abortions after a “fetal heartbeat” is detected — as early as six weeks. Doesn’t give exceptions for cases of rape or incest. And gives private citizens the power to enforce it. 

Psst...Want to learn more about the anti-abortion laws being passed across the US, click here.

The Physical and Mental Considerations...

How long does it take to know that you’re pregnant?

There’s a difference between being pregnant and knowing you’re pregnant. If you're not trying to have a baby, you'll likely miss a period before you pee on a stick. Best-case scenario, that’s about four weeks pregnant when you get a positive test result. For someone with an irregular period, it could take much more than six weeks before knowing what’s going on.

Are abortions safe?

Reports have shown that medical abortions today are safe, with only rare complications. And to clear this up: There’s no evidence that a patient is more likely to develop breast cancer afterward. 

Can you get pregnant after an abortion?

Yes. Abortions typically don’t impact fertility or the ability to have a healthy pregnancy in the future. So someone could feasibly get pregnant just a few weeks or months after an abortion. 

What does it cost?

Coverage depends on the insurance plan and where it’s done. Policies like the Hyde Amendment have limited federal funds for abortion. But California, New York, Maine, Illinois, Oregon, and Washington all include abortion coverage in ACA and Medicaid. Other states (see a map with access info here) only cover it if certain criteria is met (for example, if the pregnant person’s life is in danger). Out of pocket, an abortion could cost up to $3,000 or more, with $500 being about average. In many cases, cash for a legal abortion can come from an HSA or a FSA.

How does a surgical abortion work?

There are two common types, depending on how far along the pregnancy is.

• Vacuum aspiration abortions...The most common type, performed in the first trimester, up to about 13 weeks. The procedure itself might only take 15 minutes or less. 

• Dilation and evacuation abortions (D&E)...They’re typically used in the early second trimester of pregnancy, and can take around 30 minutes. 

What are abortion pills?

They end a pregnancy before the 9th or 10th week. (Whereas the morning-after pill works to stop or delay ovulation to prevent a pregnancy from happening at all.) There are usually two pills, and they can be taken at a clinic, doctor’s office, or at home. As of 2020, the abortion pill accounted for more than half of all abortions in the US, according to preliminary data from the Guttmacher Institute — a steep increase from 39% in 2017.

What happens after an abortion?

• Physically…Side effects can include bleeding, cramping, dizziness, sweating, and nausea. But after a day or two of rest, many patients can get back to most normal activities (but wait a bit on tampons and sex to avoid infection). Periods typically return in a cycle or two. 

• Mentally…Recovery varies. Studies show that not getting an abortion someone thinks they need could cause more anxiety than having the procedure. The American Psychological Association has more info on abortion and mental health here. 

theSkimm

Abortion is not just a topic up for debate. It's a discussion about who has the power to decide what happens after someone gets pregnant: the government or the pregnant person. And soon, we’ll get our answer.

Update on May 11 to include details around the Supreme Court’s leaked majority opinion draft and what would happen if Roe v Wade is overturned.

Updated on Feb. 24 to include new data about the abortion pill.