Is Induced Abortion Health Care?

This is Issue 7 of the On Women’s Health Series. 

Executive Summary

• Although induced abortion is often referenced as health care, a critical examination shows that there is little objective evidence that this statement is true.
• Electively ending human life is the antithesis of the definition of health care as “maintenance or restoration of the health of the body or mind.”
• The disease being treated by elective abortion has never been defined, a critical first step in determining if a medical intervention is “evidence-based,” nor have any high-quality studies been identified in the Cochrane review database comparing the intervention of abortion to childbirth.
• Abortion fails to fulfill the principles of medical ethics toward the unborn child: beneficence, non-maleficence, autonomy, and justice.
• Thorough informed consent is almost never obtained from a woman seeking abortion, as complication rates are unknown, and alternatives are often not discussed.
• Abortion fulfills none of the seven criteria the American Medical Association has established for identifying health care for which physicians should advocate.
• Abortion is not health care; rather it is the intentional ending of an unborn child’s life that uses medical procedures to kill rather than heal, often harming his or her mother in the process.

Claims of medical organizations

The statement is commonly made by medical organizations that induced abortion is health care. Induced abortion is defined as an action taken to terminate a pregnancy with the intent that the unborn child die and that a live birth does not result,^[1] as contrasted with treatment of an intrauterine demise (spontaneous abortion) when an embryonic or fetal loss has already occurred. Although the medical interventions to resolve the pregnancy are often the same, the differences in intent in performing the intervention are dramatically and morally different. Hereafter, induced abortion will be shortened to “abortion.”

In its 2020 Committee Opinion, “Increasing Access to Abortion,” for example, the American College of Obstetricians and Gynecologists (ACOG) states that “[s]afe, legal abortion is a necessary component of comprehensive health care,” calling “for advocacy to oppose and overturn restrictions [on abortion] [and] to improve access.” ACOG goes on to refer to abortion as “mainstream medical care.”^[2] Similarly, ACOG’s 2022 “Abortion Policy” statement asserts that the organization is “committed to protecting and increasing access to abortion” and that it “strongly opposes any effort that impedes access to abortion care.”^[3]

ACOG feels so strongly about abortion as necessary health care that it opposes the conscience rights of its members to decline to refer for a life-ending procedure to which they are morally opposed. ACOG’s Committee Opinion on “The Limits of Conscientious Refusal in Reproductive Medicine” (2007, Reaffirmed 2019) states that “conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients … Physicians […] have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request.”^[4] In fact, the interim chief executive of ACOG stated in a 2023 Washington Post article, “Abortion is safe. It improves and saves lives, and it must be available without restrictions, without limitations and without barriers — just as any other critical part of health care.”^[5]

Other medical organizations have made similar statements demonstrating their commitment to abortion as health care. The American Medical Association (AMA) declares that “[t]he Dobbs decision represents ‘an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services’.”^[6] Even the American Academy of Pediatrics (AAP) affirms that “the rights of adolescents under 18 years of age to confidential care when considering legal medical and surgical abortion therapies should be protected,” going as far as opposing laws that mandate parental involvement in the decision of a minor to obtain an abortion.^[7]

Abortion and the definition of “health care”

While the fact that widely respected medical organizations support induced abortion as essential health care may appear to constitute a good reason for thinking that abortion is meeting the compelling medical needs of women, this assumption should be critically examined – especially in light of the ideological commitment to unlimited abortion these organizations have demonstrated.

Health care is defined as “the field concerned with the maintenance or restoration of the health of the body or mind.”^[8] Induced abortion cannot be considered health care under this definition either for the unborn child who is killed or for the pregnant mother. It should first be noted that there is no scientific controversy over the fact that induced abortion ends a human life (though euphemisms such as “termination of pregnancy” are frequently used to obscure this fact). Ninety-six percent of biologists surveyed affirm that human life begins at fertilization.^[9] It necessarily follows, then, that abortion involves the intentional killing of this human life, and thus is clearly not health care for the unborn child.

What about for the mother? Obstetrics is the medical field concerned with the care and delivery of pregnant women. The preservation and maintenance of pregnancy, along with prenatal care and delivery of babies, are forms of health care based on this definition. Disrupting the normal physiological process of pregnancy and ending an unborn human’s life, at least in cases of elective abortions (i.e., the vast majority), is thus the antithesis of health care for pregnant women. Moreover, abortion comes with a variety of significant health risks, both physical and mental, for women, as discussed below.^[10]

Is abortion “evidence-based health care”?

(Portions of the following text appear in the author’s paper, “Is Induced Abortion Evidence-Based Medical Practice?”^[11])

Many medical organizations and publications promote induced abortion as “evidence-based health care.”^[12] Unlike many of the euphemisms surrounding the discussion of abortion, however, the term evidence-based has a specific and testable meaning. To assert that an intervention is evidence-based indicates that the treatment has been proven by rigorous research to be both efficacious and effective or conversely, ineffective and possibly dangerous.

There is a structured and disciplined method by which a medical treatment or intervention is evaluated. The mnemonic “PICO” represents the four elements necessary to determine treatment effectiveness, by assessing each intervention and the quality of research upon which the therapeutic effectiveness has been decided. The patient (P) must have an illness, injury or disease which is the explicitly defined target of the intervention (I). This target illness is typically documented by a formal diagnosis and an extensive medical history. This documentation of the patients’ disease or condition enables the health care provider to evaluate the therapeutic intervention or treatment in terms of its proven effectiveness as measured by specifically defined and measurable outcomes (O) and in comparison (C) with other treatments available for the target illness.^[13]

The relative strength of the body of research used to assess these interventions is evaluated and assigned in a hierarchy of levels of evidence. The very best evidence, the gold standard, comes from randomized controlled trials (RCTs), where carefully selected patients are matched by important characteristics, then randomly assigned to experimental and control groups. The experimental group receives the treatment, and the control group receives some alternative treatment or no treatment at all, and the outcome differences between groups are tested for statistical significance. Often, multiple RCTs are combined to create a larger database (systematic review or meta-analysis), strengthening the conclusions even more. At the very bottom of the level of evidence hierarchy are expert opinions, surveys, and case studies since those designs are regarded to be the most susceptible to bias.^[14]

When a rigorous process is applied across the range of all treatments, the gulf between existing clinical practice and evidence-based treatment is formidable and persistent. Now we come to the essential question: What is the scientific evidence for the therapeutic effectiveness of an induced abortion? In other words, how valid is the claim that abortion is evidence-based medicine?

What is the patient’s illness, injury, or disease (P)? Pregnancy is a normal physiological function of a healthy woman. Although complications may arise, the diagnosis of a pregnancy is not, a priori, a diagnosis of pathology. What is the problem being addressed by ending a healthy pregnancy? From the states that report reasons for abortion, only 0.3% of reported abortions list risk to the mother’s life or a major bodily function as the reason, 2.2% for other physical health concerns, and 1.2% for an abnormality in the baby. Almost 96% of U.S. abortions are estimated to be performed for non-medical, preferential reasons such as financial and social indications, or for unspecified reasons.^[15] In almost all abortions, there is no medical disease being treated.

Despite the widespread narrative that “abortion is between a woman and her doctor,” abortionists have privately acknowledged that there is no medical decision to be made, nor does a doctor give advice for most abortions. Dr. Alan Guttmacher, under whose leadership Planned Parenthood began performing abortions, once stated, “[I]f a woman says she wants to be aborted … then we simply act as a rubber stamp and do it.”^[16] Similarly, Dr. Robert Hall, an obstetrician who prior to Roe v. Wade advocated for liberal abortion legislation, said, “[T]here are virtually no medical indications for abortion … I would place the doctor in the role of a technician, simply wielding the curette.”^[17]

Medical abortion advocates usually ignore the overwhelming number of preferential abortions and focus their attention on the tiny fraction that they argue are “medically necessary,” such as when a cardiac dysfunction, hypertensive crisis, aggressive cancer, or dangerous infection requires ending a pregnancy for treatment. Yet, even then, the action that is needed is separation of the mother and fetus, and delivery can usually be accomplished by labor induction even if the unborn child is unfortunately too young to survive. It cannot be argued that the direct and intentional killing of the fetus is required in this heartbreaking situation. Independent of method, however, all state laws allow an abortion (or separation, as the case may be) to be performed in the exceedingly rare circumstance that it is needed to prevent a pregnant woman’s death.^[18]

So, with these definitions in mind, what does a search for the systematic reviews addressing induced abortion in the Cochrane Library show? The identified reviews typically provide no therapeutic rationale for abortions; that is, no defined illness, condition or disease is addressed by the intervention. Instead, the major body of abortion research has been focused on how the procedure is performed and which method is safest for the mother^[19] or most effective in ending the unborn human’s life.^[20] Others compare outcomes between physician and non-physician abortionists  without addressing the condition being treated.^[21] Only a single systematic review addressed a medically defined reason for the abortion: when a child has received a prenatal diagnosis with the anticipation that he “would not survive or would have a permanent handicap.” However, they also included in their cohort unborn children who had already died (intrauterine fetal demise). These researchers did not compare abortion to continuing pregnancy until the child’s natural death, omitting the question of whether intervention was indicated. Instead, they merely contrasted different methods of abortion or removing an already dead child to determine which was most efficacious.^[22]

Thus, the assertion that induced abortion is evidence-based medical practice is unsupported and unverified by the body of existing knowledge.^[23]

Does abortion meet the standards of medical ethics?

It is widely acknowledged that the main principles of medical ethics are beneficence, nonmaleficence, autonomy, and justice. The principle of beneficence is “the obligation of [the] physician to act for the benefit of the patient.” Nonmaleficence is “the obligation of a physician not to harm the patient.” Autonomy considers “all persons [to] have intrinsic and unconditional worth, and therefore, should have the power to make rational decisions and moral choices, and each should be allowed to exercise his or her capacity for self-determination,” although autonomy is not absolute. An example of when autonomy must be limited would be “if the autonomous action of a patient causes harm to another person(s).” Justice is generally interpreted as “fair, equitable, and appropriate treatment of persons.”^[24] How do these principles apply to induced abortion? It is immediately obvious that ending the life of the fetal patient is not beneficent, is maleficent, is an abuse of the woman’s autonomy directed against her unborn child, and is an act of injustice toward the unborn child. Thus, abortion violates all four principles of medical ethics for the fetal patient.

Most obstetricians have a commitment to the life and health of both of their patients, mother and unborn child (a “two-patient paradigm”). In the eyes of ACOG, however, this should be replaced by a commitment to the woman’s desires only (a “one-patient paradigm”). This commitment to the maternal patient alone was demonstrated when ACOG wrote, while simultaneously endorsing abortion-on-demand, its Committee Opinion on “Ethical Decision Making in Obstetrics and Gynecology” (2007, Reaffirmed 2019), stating, “The principle of beneficence, which literally means doing or producing good, expresses the obligation to promote the well-being of others. It requires a physician to act in a way that is likely to benefit the patient. Nonmaleficence is the obligation not to harm or cause injury.”^[25] Clearly, abortion does not promote the well-being of the unborn child, does not benefit the unborn child, and positively causes harm and injury (death) to the unborn child. Given ACOG’s aforementioned endorsement of abortion-on-demand as health care, it logically follows that they have no true or consistent commitment to a two-patient paradigm. ACOG’s statements regarding abortion as health care are therefore unsupported and should be disregarded as untrustworthy.

In addition to ending the embryonic or fetal life, induced abortion has also been shown to harm an obstetrician’s other patient, the pregnant woman.^[26] Immediate physical complications have been documented following both drug-induced and surgical abortions.^[27] These physical risks increase as gestational age increases and the unborn baby continues developing, leading to a 76-fold increased risk of maternal death when an abortion is performed in the second half of pregnancy compared to earlier.^[28] Complications caused by abortion can also occur in subsequent pregnancies. Damage from surgical abortion can lead to cervical insufficiency and preterm birth^[29] as well as abnormal placental attachment leading to catastrophic hemorrhage at delivery.^[30] Additionally, mental health complications have been reported in many women following abortion, sometimes leading to “deaths of despair”: suicide, substance and alcohol abuse and overdose, accidents from high-risk taking behavior, even homicide by an intimate partner.^[31] There is also evidence showing that many women obtain unwanted abortions even though they would prefer to give birth to their child, either due to partner coercion or life circumstances that cause them to feel they have no other choice.^[32] In sum, induced abortion always kills the unborn patient, and carries many risks of harm to the other patient, the mother, with little evidence that any purported benefits objectively outweigh such potential harms. Abortion is thus deeply problematic from the standpoint of medical ethics for both patients.

Is true “informed consent” obtained for abortion?

The American Medical Association’s Principles of Medical Ethics makes the following recommendations regarding informed consent:

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent … physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

(i) the diagnosis (when known);

(ii) the nature and purpose of recommended interventions;

(iii) the burdens, risks, and expected benefits of all options, including forgoing treatment.

(c) Document the informed consent conversation and the patient’s … decision in the medical record in some manner.”^[33]

The often overwhelming decision of whether to obtain an abortion or give birth to a child has significant implications for a pregnant woman’s physical, psychological, and emotional health, relationships, and family. A woman facing such a life-altering, stressful, and emotional decision necessarily requires verbal, written, and visual information illustrating the reality of the unborn child’s life and stage of development, as well as the risks, benefits, and alternatives to the available options. The options include abortion, continuing the pregnancy, and parenting or making a plan for adoption. Time to consider the potential short and long-term consequences of each option is crucial. These reasonable and ethical provisions of informed consent help to ensure that a woman’s decision is thoroughly informed, unhurriedly considered, and free of coercive influence.^[34] It is not uncommon for a patient to present for counseling with a particular goal in mind, but then prefer a different route as she receives detailed, accurate, unbiased counseling. Additionally, a widely accepted ethical principle ensures that the level of detail, information, and time spent on obtaining informed consent should be proportional to what is at stake in that specific medical decision.^[35] In the case of abortion, a procedure that ends a human life, informed consent requires even more information from the medical practitioner and deliberation by the patient than other comparable procedures.

The Supreme Court of the United States (SCOTUS) acknowledged in Gonzales v. Carhart, “Whether to have an abortion requires a difficult and painful moral decision.”^[36] Additionally, in Washington v. Glucksberg, SCOTUS affirmed that the government undoubtedly “has an interest in protecting the integrity and ethics of the medical profession.”^[37] Both medical ethics and our legal system thus require thorough informed consent for a woman considering an abortion, but is this standard being applied in our country today?

Abortion advocates historically have strongly resisted any legislative limitations on abortion, complaining that abortion providers are singled out for different, more stringent requirements than comparable healthcare providers are forced to endure (so-called “TRAP” or “Targeted Regulation of Abortion Providers” laws).^[38] However, many of these limitations have the intent of strengthening the informed consent process, such as mandatory waiting periods, parental consent, provision of information regarding embryonic and fetal developmental, and preprocedural ultrasound. Each of these actions improves the available information that a woman relies upon to make this critical decision. Additionally, similar provisions are uncontroversial as part of standard informed consent counseling regarding less politically charged medical procedures.

It is standard medical practice to allow a waiting period to pass between a patient’s initial consultation and the performance of a medical procedure, except in the case of medical emergency. The convenience of the patient or the medical provider should not be a factor overriding traditional informed consent provision. In fact, the U.S. Department of Health and Human Services’ mandatory Medicaid consent form for elective sterilization requires that counseling and signing the consent form occur no less than 30 days or more than 180 days from the date of the procedure, demonstrating the care the government takes in preventing a rushed decision for a procedure with irreversible consequences – in this case, the inability to achieve future pregnancies.^[39] How much more care should be given to ensuring that a woman considering ending the life of her unborn child, a decision she may regret for a lifetime, has adequate time to reflect and assess? Post-abortion regret and mental health struggles are common, as evidenced by the proliferation of counseling programs in churches and pregnancy help centers for suffering women.^{[40], [41]}

Consent forms for procedures of similar complexity to early abortion, such as colonoscopy, are readily available through an internet search so that patients may educate themselves prior to or after their medical consultation.^[42] By contrast, it may be difficult to discover a similar consent form for abortion, as early responses to an internet search often yield vigorous discussion by abortion advocates about the onerous nature of informed consent requirements.^[43] Abortion advocates are often aggrieved by requirements for parental consent when minors seek abortion, even though minors (as well as adults) are at risk for post-abortion mental health complications such as suicide,^[44] and parental consent is standard procedure for any other medical intervention in this age group.^[45] One medical liability insurance provider observed, “As a rule, minors are considered incompetent decision makers and cannot make health care decisions or give informed consent on their own behalf. Consent, therefore, falls to the parent or legal guardian in most situations.”^[46]

A 2005 governmental task force in South Dakota held a series of investigative hearings and concluded that the state’s Planned Parenthood in Sioux Falls failed to provide adequate informed consent to the women obtaining abortion in that state. Specifically, the task force found that this Planned Parenthood (1) did not “disclose the essential nature of the procedure –that it terminates the life of the woman’s existing child,” (2) when they did discuss the procedure, “provided misleading information in misleading terms,” (3) gave “misleading information about the psychological and physical risks to the mother,” (4) assumed women had “made their decisions before they reach the facility,” (5) placed “the burden upon the mothers to discover material facts on their own,” (6) had abortion doctors whose only contact with the mother “consisted of a prerecorded audio tape, and the first face-to-face meeting of the doctor and patient [was] after she [had] signed the consent forms, paid for the surgery, and [was] on the procedure table.” They also found that (7) “[t]he pregnant mothers [were] often pressured into having an abortion by outside forces”, (8) “[t]he contact and procedures by the facility personnel prior to the abortion [were] inherently coercive and force[d] a quick decision,” and (9) “[t]he fatal and irrevocable nature of the decision [was] not made known to the mother and adequate time for reflection [was] not provided.”^[47] While these represent earlier actions of a Planned Parenthood in one state, the allegations are concerning, and care should be taken to ensure that such blatant deviations from the standards of medical informed consent do not occur today. Planned Parenthood’s 2022-2023 annual report documents that, in 2021-2022, abortions made up 97.1% of their pregnancy resolution services, while prenatal services, miscarriage care, and adoption referrals accounted for only 1.6%, 0.9%, and 0.4%, respectively,^[48] showing that conflicted women are likely not thoroughly counseled regarding abortion alternatives but are directed toward one option.

As the U.S. Food and Drug Administration (FDA) has progressively removed safeguards governing the use of the abortion drugs mifepristone and misoprostol, one must examine the ways in which these actions contribute to the impossibility of a woman obtaining adequate informed consent. Removal of the in-person prescribing requirements allows prescribing without in-person counseling (when prescribed via telemedicine) or even verification that the person requesting the drugs is a woman seeking abortion (when prescribed via online ordering). This allows access to abortion drugs by sex traffickers, incestuous abusers, and coercive boyfriends, circumventing the entire process of informed consent for women who are tricked or coerced into unwanted abortions.^[49]

The FDA’s removal of the requirement for mandatory complication reporting for prescribers further ensures that there is no database in the U.S. able to accurately document the frequency and rates of complications after drug-induced abortion.^[50] One large high quality records-linkage study from Finland found that hemorrhage (15.6%), infection (1.7%), retained pregnancy tissue (6.7%), surgery (5.9%), and emergency room visits (5-6%) occur commonly following early abortion drug use at less than nine weeks’ gestation. Less frequently, women may experience hospital admission, transfusion, intravenous antibiotics, ruptured ectopic pregnancy, ICU admission, and death.^[51] How can women receive accurate informed consent counseling regarding the frequency of complications following drug-induced abortion if no effort is being made to accurately and thoroughly gather such data in the U.S.?

Ultrasound technology is very safe, yet abortion advocates vocally oppose requirements for its use prior to abortion in order to facilitate access to medically unsupervised drug-induced abortions. There are many important medical reasons to perform an ultrasound prior to an abortion. Ultrasounds are often necessary, for example, to determine the correct gestational age of a pregnancy and the development of the unborn child. Underestimating gestational age by failing to perform an ultrasound will increase the likelihood of drug-induced abortion failures.

Movement of the embryonic heart can be detected as early as 23 days after fertilization through doppler technology, and this information should be relayed to the patient as part of the process of informed consent.^[52] Additionally, determination of fetal life should be documented prior to abortion. Approximately 15% of recognized pregnancies result in early miscarriages.^[53] An ultrasound may find the lack of a fetal heartbeat and thus spare a woman an abortion procedure. Selling an abortion, when in fact the pregnancy has already ended, will cause many women to undergo an unnecessary procedure, as well as carry the guilt of believing she has had a procedure that ended the life of her child. Maternal anatomic abnormalities, such as uterine fibroids, septum, or unusual orientation and abnormal placentation also may not be detected without ultrasound and could complicate the abortion procedure, potentially placing the woman’s life in danger.^[54]

Furthermore, lack of ultrasound will increase the likelihood that a potentially deadly ectopic pregnancy will remain undiagnosed prior to consuming abortion drugs, which are ineffective in resolving an abnormally implanted pregnancy. The pregnancy may continue to grow, rupturing the fallopian tube and leading to catastrophic bleeding. Because the consequences of a missed diagnosis of ectopic pregnancy are so serious, it is clearly the standard of care to rule out this life-threatening condition with ultrasound prior to providing abortion drugs.

And of course, failure to offer an ultrasound (or other literature on fetal development) will not provide complete informed consent counseling about the nature of the act of abortion that ends the life of a complex young human being. Observation of ultrasound will illustrate the development of the fetus to his mother, including the presence of movement and heartbeat. Failure to inform a woman of this development does not mean she will remain ignorant of these facts forever. When she later sees the development of another pregnancy on ultrasound, online, or through some other means, she will realize that her aborted pregnancy was not just a “blob of tissue” as she may have assumed, but a recognizable, living human being. The guilt and mental anguish of the belated recognition of this reality cannot be quantified.

Demonstration of embryonic or fetal development is a critical part of informed consent. Although many women in crisis consider abortion, they are often not confident in their decision and may be open to other options for ameliorating the crisis. Care Net, a national affiliation organization for over 1,000 pregnancy help centers (PHCs) that offer women in crisis pregnancies material and emotional support, found that eight in ten abortion-minded and abortion-vulnerable women who visited their centers, where ultrasound is a standard counseling procedure, decided to continue the pregnancy.^[55] Similarly, the National Institute of Family and Life Advocates (NIFLA), another national organization supporting PHCs, reported that 78% of abortion-minded mothers who visited affiliated PHCs chose life after they saw their unborn child by ultrasound in 2013.^[56] A more recent analysis estimated that over the five years from 2016-2020, more than 828,000 lives have been saved due to women at-risk for abortion choosing to carry to term after visiting a pregnancy help center, and that a higher percentage of abortion-minded women chose life when they viewed their ultrasounds at the pregnancy center.^[57]

Even abortion advocacy researchers have found evidence that ultrasound changes the mind of some women in abortion centers. Among women with high decisional certainty, viewing an ultrasound did not affect the decision, but among women with medium to low decisional certainty, viewing resulted in 7.4% deciding to continue the pregnancy.^[58] Similarly, a change in Wisconsin law to mandate ultrasound viewing resulted in an increase from 8.7% to 11.2% decisions to continue the pregnancy pre-law vs. post-law.^[59] In another study, a chart review of 44 women seeking abortion demonstrated that only 14 proceeded to abortion after viewing ultrasound.^[60] It should be emphasized that each woman who changes her mind after viewing an ultrasound has saved the life of her child, an outcome that has profound significance.

We can safely conclude, then, that pregnant women considering abortion often do not receive the standard of care for informed consent counseling. Abortion appears to be preferentially promoted to these women to the exclusion of other options. The risks are often downplayed, the unborn child essentially ignored, and accurate complication rates are impossible to determine due to lack of mandatory data federal collection in the U.S. Abortion advocates vigorously oppose any efforts to improve this data collection or offer alternatives other than abortion to a woman, demonstrating that abortionists operate outside the standards of any other medical procedure, especially that of informed consent.

What kind of health care should we advocate for?

(This section draws on previously published material co-authored by this present paper’s author in “Abortion Is Not Health Care.”)^[61]

Despite failing to meet the criteria to be considered evidence-based medicine, demonstrating comparative benefit neither for the mother nor the unborn child, there may be some physicians who still feel that abortion should be medically available. According to the American Medical Association, both individually and professionally, physicians should advocate for health care that:

“(a) Is transparent.

(b) Strives to include input from all stakeholders, including the public, throughout the   process.

(c) Protects the most vulnerable patients and populations, with special attention to historically disadvantaged groups.

(d) Considers best available scientific data about the efficacy and safety of health care services.

(e) Seeks to improve health outcomes to the greatest extent possible, in keeping with principles of wise stewardship.

(f) Monitors for variations in care that cannot be explained on medical grounds to ensure that the defined threshold of basic care does not have a discriminatory impact.

(g) Provides for ongoing review and adjustment in consideration of innovation in medical science and practice to ensure continued, broad public support for the defined threshold of basic care.”^[62]

These seven criteria are objective means one can use to evaluate whether abortion fits the definition of health care for which physicians should advocate. Let’s see if abortion meets these criteria.

Is induced abortion provision transparent?

Planned Parenthood, the largest abortion business in the U.S., attempts to reassure women by stating, “In-clinic abortion is very common, and it’s one of the safest medical procedures you can get,”^[63] and, “Medication abortion is very safe. In fact, it’s safer than many other medicines like penicillin, Tylenol, and Viagra.”^[64] Yet, they fail to acknowledge that abortion data collection in the U.S. is well known to be incomplete, and so the evidence for these statements is bound to be weak at best.

Abortion reporting in the United States – incidence, complications, and deaths – is entirely voluntary at the national level, even though other metrics of public health are tracked and required to be reported to the Centers for Disease Control and Prevention (CDC). Six states (CA, MD, NJ, MI, NH, and ND) do not report any abortion data from their health departments to the CDC.^[65] Notably, three of these are some of the highest abortion volume states, as reported by non-government sources.^[66] States have variable reporting requirements, but none have the ability to accurately track data related to abortion drugs because they may now be ordered online and distributed by mail.

Most U.S. abortions are paid for out-of-pocket^[67] and women are often hesitant to report a history of abortion, causing many preceding abortions to remain unknown when a complication occurs.^[68] Some biased abortion industry researchers report the number of abortions they have sold but have been criticized for limiting their reporting of complications to only those that are severe (such as intra-abdominal surgery, transfusion, hospitalization, or death); often considering hemorrhage not requiring transfusion, infection not requiring intravenous antibiotics, and surgical aspiration of retained pregnancy tissue unworthy of noting.^[69] Additionally, some ignore, or do not give sufficient evidential weight to, the large number of women lost to follow-up (as many as half),^[70] for whom abortion outcomes are unknown.

The paucity of U.S. data may be contrasted with other countries whose data is so complete, voluminous, and accurate that studies drawing from this data are considered the gold standard. These countries often have single-payer healthcare systems that cover elective abortions so that an abortion can be accurately linked to subsequent complications and deaths. When this data is consulted, complications have been found to be at least five to 10 times higher than pro-abortion researchers report,^[71] demonstrating a lack of transparency in counseling women about potential risks from abortion.

Does the abortion industry consider input from all stakeholders?

When the U.S. Supreme Court, in Roe v. Wade, ruled that the Constitution protected the right to abortion, it overturned nearly every state’s laws regulating or limiting induced abortion. For almost 50 years the people’s elected representatives were not permitted to legislate substantially on this highly controversial procedure. Moreover, as documented earlier, the leadership of ACOG avidly supports abortion on demand, even though they have never surveyed their members about whether they support ACOG’s abortion advocacy. Additionally, despite research showing that as many as one quarter of abortions are unwanted or coerced and nearly two-thirds are inconsistent with a woman’s values or preferences,^[72] the voices of unfortunate women who obtain abortions when they would prefer to give birth are seldom heard. Finally, some babies do survive an attempted abortion, and in fact, a recent study examining nearly 14,000 second trimester abortions found that 11.2% resulted in live birth – suggesting that the “risk of live birth following abortion may be underestimated.”^[73] Melissa Ohden, founder of the Abortion Survivors Network, who survived a saline abortion, asked the U.S. Congress,

Is there space for stories like mine, women who are alive today after surviving failed abortion procedures; for stories like my biological mother’s, women who have been coerced or forced into an abortion? Do we ever create space for the stories of women who regret their abortions? The most important stories, though, are likely the ones that you’ll never hear. The stories of the little girls who will never live outside of the womb. In all of the discussion about women’s rights, some lose sight of the fact that without the right to life, there are no other rights. This is the greatest human rights issue we are facing as a country.^[74]

Driven by ideology, the abortion industry has ignored input from key stakeholders: American voters, elected officials, obstetricians who do not perform abortions, women pressured into unwanted abortions, and from the abortion victims who managed to survive, as well as those who don’t survive.

Does induced abortion protect vulnerable populations?

Induced abortion does not protect the most vulnerable patients, children in the womb, but instead facilitates their destruction. Additionally, evidence shows that abortion advocates and policies target historically disadvantaged groups, such as people with physical and intellectual disabilities, Black populations, and women.

The ready availability of prenatal diagnostic testing has led to many discriminatory abortions. For example, 67% of children diagnosed antenatally with trisomy 21 (Down syndrome) are aborted, along with 60% of those diagnosed with trisomy 13 or trisomy 18.^[75] Abortion also disproportionately impacts the Black community. Although Black Americans comprise only 14% of the population, 41.5% of abortions end the lives of Black children.^[76] Finally, abortion is often promoted to vulnerable women in crisis. They are led to believe that ending the lives of their unborn children is the only or preferred solution to their complex social, financial, and relationship problems.

Do abortion advocates consider the best available scientific data?

As discussed earlier, the many limitations of U.S. abortion complication data collection often go unmentioned by abortion advocates. Additionally, they oppose requirements for pre-abortion ultrasound, even when this testing would improve abortion’s safety (for example, by ruling out an ectopic pregnancy). The steadily decreasing age of fetal viability – when the child may survive birth – is also frequently ignored, and late and dangerous abortions continue to be promoted.^[77] Moreover, many abortion advocates continue to rely on outdated and conceptually problematic science suggesting that fetal pain is only possible at 24-30 weeks of gestation and beyond, ^{[78], [79]} when more recent, well-evidenced, and conceptually rigorous research points to the reality of fetal pain by 15 weeks, and possibly as early at 12 weeks gestation.^[80] This makes their support  for dilation and evacuation “dismemberment” abortion procedures (typically performed between 14-24 weeks) all the more anti-scientific, and troubling.

Clearly, failure to consider the best available scientific data does not benefit pregnant women and impugns the motives of those who falsely make the assertion that abortion is health care.

Does abortion advocacy seek to improve health outcomes?

Black women in the U.S. have consistently been shown to have the worst maternal outcomes, with a rate of maternal mortality almost three times that of white women.^[81] Common narratives attribute this dramatic difference to systemic racism and recommend increased access to abortion as part of the solution.^[82] Yet, according to 2021 CDC data collected by Pew Research, the abortion rate in Black women is also 4.5 times greater than that of white women,^[83] and Black women have a large plurality of U.S. abortions, calling into question the notion that abortion in itself has a substantial impact on protecting these women from maternal mortality.

Obesity, hypertension, and diabetes are risk factors for pregnancy complications that occur more frequently in Black women compared to white women.^[84] While genetics may play a part in this, poverty is also associated with these conditions, and many Black women raise their children as single mothers living in poverty. Black women more commonly have later abortions (13%) than white women (9%). The risk of death from abortion increases by 38% every week after eight weeks gestation.^[85] Thus, deaths directly related to physical complications of later abortions are increased in Black women.

In addition to the immediate physical risks of abortion, there are long-term complications that increase a woman’s risk of death in a subsequent pregnancy. Forcibly opening a cervix, which is designed to remain closed until natural childbirth, may result in cervical trauma and cervical incompetence in future pregnancies, often leading to preterm birth. Black women are documented to have higher preterm birth rates, leading to much suffering for their children from the complications of prematurity.^[86] Obstetric interventions for the management of preterm birth can lead to mortality from infections or medication.^[87] There is much evidence that promotion of abortion in the Black population has led to worse outcomes for these unfortunate women.

Do abortion advocates ensure that the defined threshold of baseline care does not have a discriminatory impact?

The high maternal mortality rate in Black women could be partially explained by inequities in access to prenatal care. Black women may not have the same level of access to prenatal care as white women. In Philadelphia, a case study found that when 13 of the area’s 19 obstetrics units closed from 1997 to 2012, the remaining hospitals could not handle the numbers. Pregnant Black women were getting their prenatal care in their own neighborhoods but were required to deliver elsewhere, and ultimately the maternal deaths among Black women increased.^[88] Philadelphia only had six obstetrics units, but the city has at least seven abortion businesses. In Washington, D.C. between 2014-2018, 90% of pregnancy-related deaths involved Black women, even though only about 50% of births were to Black women during this period. This, despite the fact that the District has some of the most permissive abortion laws in the country. Notably, the District’s overwhelmingly majority Black neighborhoods, Wards 7 and 8, are served by one hospital, United Medical Center, which closed its obstetrics unit in 2017.^[89] The District has promised to open Cedar Hill Regional Medical Center GW Health in Ward 8, which will have an obstetrical care and Level II neonatal intensive care unit, but it is not slated to open until early 2025, eight years after the closure of the obstetrics unit at United Medical Center.^[90] During this same period, the District City Council passed the Strengthening Reproductive Health Protections Amendment Act, which did not strengthen reproductive health care. Instead, it removed all remaining protections from abortion provision—including baseline health and facility safety requirements for sanitary conditions, administration of medicine, and reporting of suspected abuse of children or human trafficking.^[91]

Because of the high instances of abortion among the Black population, Black women need access to better maternal health care, not worse. Instead of focusing on opening new abortion facilities, which hurt women physically and emotionally, states should provide prenatal services, especially for Black women who do not have access to adequate health care to raise their children. Instead of opening more abortion businesses and passing more legislation that allows those businesses to commit unsanitary abortions without fear of any consequences, cities should work to open more obstetrical units and promote actual health care for women.

Does abortion provision provide for ongoing review and adjustment?

Since Roe was decided in 1973, abortion practices have not changed to make abortion safer for women. Consider, for example, the increased promotion of the abortion drugs mifepristone and misoprostol, which now cause 63% of abortions in the U.S.,^[92] even though they have been documented to result in complications four times as frequently as surgical abortions.^[93] The FDA has progressively removed critical restrictions and regulations governing the provision of these drugs, despite little evidence supporting the safety of these changes. Such changes have included use of mifepristone at higher (and therefore more dangerous) gestational ages, permitting non-physician prescribers, and removing any requirement for pre-abortion, in-person testing by ultrasound, physical exam, or labs. The removal of the in-person testing requirement is problematic not only because it eliminates the possibility of detecting potentially dangerous conditions of the patient, such as ectopic pregnancy, but also because it robs women of the opportunity for adequate informed consent and prevents physicians from detecting if the woman is participating in the abortion willingly or is instead being coerced by an abusive or violent man. Removal of these important safeguards has led to increasingly dangerous, medically unsupervised and self-managed abortions.^[94]

Moreover, examining the medical care provided to women who desire to continue their pregnancies versus that provided to women who are seeking abortion shows two dramatically different standards of care.

Quality medical care is supervised in a number of ways. For example, doctors who admit patients to the hospital must obtain hospital admitting privileges. A committee of peers will review the physician’s application and investigate whether they may have lost privileges at another hospital, lost their license in another state, or lost board certification for poor quality care. Data from Florida shows, however, that nearly half of abortionists in the state do not have hospital admitting privileges,^[95] and 2022 data from KFF shows that a large majority of states do not require abortionists to have hospital admitting privileges, nor do they require that abortion centers have transfer agreements with hospitals in the event of complications.^[96]

Similarly, although state medical boards are tasked with supervising the medical care of the physicians licensed in the state, it is rarely reported that an abortionist has been sanctioned. As an example, the infamous and dangerous abortionist Dr. Kermit Gosnell was reported to the Pennsylvania Board of Medicine for gross incompetence nearly a decade before he finally lost his license after being convicted of manslaughter.^[97] Similarly, Dr. Cesare Santangelo has settled a wrongful death lawsuit as well as multiple board complaints, but continues his late-term abortion practice without restrictions in inner city D.C..^{[98], [99]} Most medical specialties offer a board certification which reassures the public that the physician has completed examinations to verify proficiency, but there is no requirement that abortionists obtain certification. Only recently has an accredited fellowship offered additional training and instruction on highly complex and potentially dangerous later abortion procedures.^[100]

For all of these reasons and more, a woman cannot be guaranteed that an abortionist will perform her abortion in a way that is safe for her and abides by regulations common in other areas of medicine, leaving her at higher risk of injury from an incompetent provider than a woman who sought routine prenatal care would be.

Conclusion

Abundant data indicates that elective induced abortion fails to fulfill the criteria to be considered health care and is certainly not the type of medical intervention for which any health care professionals should advocate. Rather, abortion is the intentional ending of an unborn child’s life that uses medical drugs and procedures to kill rather than heal, often harming his or her mother in the process.

Ingrid Skop, M.D., F.A.C.O.G., is Vice President and Director of Medical Affairs for the Charlotte Lozier Institute.

[1] “Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales.” Royal College of Obstetricians and Gynaecologists, p. 29, May 2010, https://www.rcog.org.uk/media/21lfvl0e/terminationpregnancyreport18may2010.pdf, stating, “When undertaking a termination of pregnancy, the intention is that the fetus should not survive and that the process of abortion should achieve this.” Also, ACOG’s definition acknowledges the intention more subtly: “Induced Abortion: An intervention to end a pregnancy so that it does not result in a live birth.” [Emphasis added.] See “Glossary” in Abortion Care. ACOG. Last reviewed May 2024, https://www.acog.org/womens-health/faqs/induced-abortion.

[2] “ACOG Committee Opinion 815: Increasing Access to Abortion,” ACOG. Available at https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-access-to-abortion.

[3] “ACOG Abortion Policy,” ACOG. Available at https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/abortion-policy.

[4] “ACOG Committee Opinion 385: The Limits of Conscientious Refusal,” ACOG. Available at https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/11/the-limits-of-conscientious-refusal-in-reproductive-medicine.

[5] Christopher M. Zahn and Jenni Villavicencio, “In the Abortion Debate, Honesty Matters,” The Washington Post, August 30, 2023, sec. Opinion, https://www.washingtonpost.com/opinions/2023/08/30/abortion-debate-honesty-matters/.

[6] “Advocacy in Action: Protecting Reproductive Health,” American Medical Association, May 31, 2024, https://www.ama-assn.org/delivering-care/public-health/advocacy-action-protecting-reproductive-health.

[7] American Academy of Pediatrics; Committee on Adolescence. The Adolescent’s Right to Confidential Care When Considering Abortion. Pediatrics. 2022 Sep 1;150(3):e2022058780. doi: 10.1542/peds.2022-058780.

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[10] Of course, pregnancy also comes with a variety of health risks for women. However, (1) contrary to popular belief, many of these risks are greater for abortion than childbirth (see “Fact Check: Abortion is 14 Times Safer than Childbirth”), and (2) in the case of pregnancy, the risks are those which attend what is otherwise a natural physiological process, whereas in the case of abortion, the risks are those which attend the violent interruption of a natural physiological process.

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[17] Ibid.

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