Four key facts that show legalized abortion saves and improves maternal lives.
Roe v. Wade had an impressive effect on maternal outcomes. Reversing it stands to be deadly.
If the Supreme Court of the United States overturns Roe v. Wade, abortion will become illegal in many states. The public health implications for women are massive.
Much on this has already been said. However, I spent the morning looking through data from the pre-Roe and post-Roe periods in the United States. What I found is unsurprising. Here are four key takeaways. After Roe was decided, maternal deaths decreased drastically; fewer abortions occurred over state lines; women of color had much better access to safe abortion; and a higher share of abortions occurred earlier in pregnancy than before.
Let’s take a deeper dive.
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Legalized abortion, and other social policies and legal changes that coincided with it, clearly saved many, many lives. While the number of yearly maternal deaths in the pre-Roe era were likely not remotely as dire as some have claimed, there were indeed hundreds of documented maternal deaths caused by abortion each year in the 1960s and early 1970s. On January 23, 1973, the Roe decision was announced, making abortion legal throughout the country. By 1976, the number of annual maternal deaths due to abortion had dropped to 16. That change was permanent—at least so far.
Some of this reflected trends already in progress. As many states had moved to legalize abortion in the years leading up to Roe, and access to contraception became more widespread, maternal deaths due to abortion had dropped in the 1960s and early 1970s. (Rates rose until the 1990s, and then fell this century.) From 1968 to 1972, deaths due to abortion dropped by 50%. Then, in January of 1973, Roe legalized abortion in all states overnight.
No surprise, a sudden marked decrease in maternal deaths was again recorded. In fact, in 1973, deaths due to abortion were halved again compared to 1972. All told, maternal deaths caused by abortion in the five years after Roe fell 80% compared to the five years before the decision.
While decreases in maternal deaths occurred in all regions of the country, the largest year-over-year change occurred in the South between 1972 and 1973, where maternal deaths caused by abortion dropped by 56%. Given abortion laws, this is not surprising.
Deaths resulting from abortion in the United States dropped dramatically after Roe was decided in January, 1973.
I’m not sure whether the legalization of abortion increased the total number of annual abortions that occurred in the United States, but it certainly substantially increased (by a factor of two) the ones that epidemiologists know about during the 1970s and 1980s. Despite this, there was an approximate 90% decrease in maternal deaths stemming from abortion—and that decrease is even greater the further back in time you go to use as the “baseline” for comparison. As has been said before, ending legal abortions does not stop them from occurring; it just stops them from occurring in safe medical settings.
What will happen, if history repeats itself, is that the end of Roe will mean the return of horrific desperate attempts to end pregnancies at home, or in “back alleys.” Ending Roe will also largely limit abortion to wealthy people—those who can travel. Prior to Roe, 44% of legal abortions occurred in a state other than the woman’s home state. By 1980, only 7% of legal abortions happened over state lines. We also know that legalized abortion made it less burdensome for non-White people to obtain safe abortion care. Prior to Roe, non-White people accounted for 23% of the documented legal abortions. That rose to the 30%–35% range by the 1980s, and to 44% by the end of the century.
Another interesting trend in the years after Roe was that abortions suddenly started happening earlier in pregnancy. (Regardless of how one feels about abortion overall, I think we can assume that even those with reservations about it would prefer that abortions occur earlier in pregnancy.) In 1972, 34% of legal abortions occurred early in pregnancy (i.e., before the 9th week). By 1980, the share of legal abortions that occurred early in pregnancy had risen to 52%, rising to 58% by 1999. Meanwhile, the share of legal abortions performed between 9 and 20 weeks dropped right after Roe was decided, and remained fairly stable for the rest of the century. (Abortions after 20 weeks accounted for around 1% of legal abortions both before and after Roe was decided.)
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All told, legal abortion in the United States has saved hundreds of women’s lives per year. If abortion is banned in many states, which seems likely, and trends replicate pre-1973 findings, fewer legal abortions will occur. But it isn’t at all obvious that fewer abortions overall will take place; they’ll just be harder to obtain, less safe, and more expensive, and will occur later in pregnancy and farther from home. That’s not progress.
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Acknowledgements: Dr. Esther Choo for comments and review.