Dr. Tom Dean

Abortion is among the most, if not the most, emotional, painful and divisive issue our society has struggled with. The two sides are dug in with little to no prospect of compromise. Abortion opponents believe abortion is murder. Abortion rights supporters reject that and believe that decisions in early pregnancy are entirely the prerogative of the individuals directly involved. The discussion has basically devolved into one of hard-nosed power politics. In a society already divided, this promotes further division and, all too often, violent clashes.

Before going further, let me make my perspective clear. Very simply, I believe that decisions about childbearing are intimate, personal decisions that should be made only by the woman, her family and her closest advisers – without the interference of government. In my view, that is actually the conservative position. At the very same time, I believe that every abortion is a tragedy.

Reducing abortion is a noble goal. The task is, however, far more complex and challenging than most people realize.

First of all, abortion bans do not work. They may actually make the situation worse. The Dobbs decision that overturned Roe v. Wade allowed states to put in place a wide range of abortion restrictions, including completely banning the procedure. In spite of this, the number of abortions has actually increased. The numbers had steadily declined for several decades and hit a low point in 2017, about five years before Dobbs. Since 2017, in spite of Dobbs, the numbers have been increasing, and in 2023 the numbers were higher than before Dobbs.

Most experts believe the abortion numbers we have underestimate the actual rate, since many abortions go unreported. People borrow abortion meds from neighbors, buy abortion pills over-the-counter in Mexico, etc.

A very serious result of abortion bans is that risks for women with complications of pregnancy have increased. All too often, women hesitate to seek care in early pregnancy for fear of rejection or some other negative consequence.

Many anti-abortion laws call for punishment of physicians who assist in abortions. The problem is that if a woman presents to an emergency room with bleeding or other pregnancy related complications, there is no way for the physician to know if this is a routine miscarriage or a self-induced abortion gone bad. The accepted treatment in most such cases is to empty the uterus (a dilation and curettage or “D&C”), which is, of course, technically an abortion — an illegal procedure in some states. There are multiple reports of women with worrisome symptoms being sent home to wait for the process to “run its course” — an approach with potentially disastrous outcomes.

Most anti-abortion legislation supposedly contains provisions to protect the life of the mother. These provisions are poorly defined, leaving physicians in the nearly impossible position of knowing what needs to be done but not knowing whether they are legally allowed to proceed. Some physicians have chosen to leave states with abortion prohibitions and move to where they are allowed to deliver the care they know is appropriate.

For a variety of reasons, there has been a decline in the overall availability of women’s health services, especially in states where abortion has been banned. A consequence of this decline — somewhat indirect, but nonetheless profoundly important — is the very disturbing rise we have seen in U.S. maternal mortality.

Bottom line, I believe the arguments about legalizing or prohibiting abortion are seriously misguided. We should be focusing on the actual underlying problem: unwanted/unexpected pregnancy. It would seem that this is an area where both pro-life and pro-choice forces could find some level of agreement.

If we focus the energy and resources now being expended in battles over abortion toward preventing unwanted pregnancy, I believe we could have a major reduction in the demand for abortion. We could expect to see a real decline in both the physical and psychological trauma associated with unwanted pregnancy.

Unfortunately, we seem to be moving in the opposite direction. There has been a decline in overall women’s health services as well as education on pregnancy prevention. Legislation in Congress has proposed an actual cut in federal support for contraceptive assistance/family planning services.

We need to rethink this whole issue and find a better way.