For decades the National Academies have provided objective, expert advice to help the nation understand issues related to maternal and reproductive health, unintended pregnancy, prenatal care, racial and ethnic disparities in health care, and abortion.   

As the presidents of the National Academy of Sciences and National Academy of Medicine noted in a joint statement when the U.S. Supreme Court overturned Roe v. Wade, our work indicates that the ruling will make it more difficult for women* to access high-quality health care. This will likely negatively affect all women’s health and well-being, especially women of color, women with low incomes, and women in rural areas. Moreover, the decision will directly affect the well-being of families and society as a whole. The presidents called for the nation to “act urgently and redouble efforts to improve maternal and reproductive health and increase access to quality health care for all.”

To inform efforts that could mitigate negative impacts from the ruling and advance health and social equity, we have prepared this compilation that draws on our extensive body of independent, evidence-based work associated with abortion, women’s health, family well-being, and related societal impacts.

Among the notable conclusions of National Academies studies:

Conclusion: Access to a full range of reproductive health care, including contraception, is important for both women’s health and the economy as a whole.

Women have greater health care needs than men and require a broader array of health services, but not all clinicians are equipped or able to provide the full range of preventive services for women.

The U.S. health care system often provides reproductive health care services for women separately from other components of primary care. Because many preventive services for women are for reproductive health, such as contraception services and screening for cervical and breast cancer and sexually transmitted infections, many women may see obstetrician-gynecologists for those services and a general primary care clinician for other components of their routine health care. In one study, 58 percent of women in all stages of life from ages 18 to 64 saw an obstetrician-gynecologist in addition to a generalist physician. Thus, no single type of clinician can be identified as the sole primary care provider for women.

Benefits of reducing the rate of unintended pregnancies

Reducing the rate of unintended pregnancy greatly improves a women’s quality of life, health, and well-being.

Women who have unintended pregnancies may be at greater risk of:

• Depression

• Substance use disorders

• Physical abuse

Furthermore, reproductive health care and cardiovascular health care are provided in silos, despite what is known about their relationship to each other. Women who experience preeclampsia, gestational diabetes, preterm delivery, or have a baby with a low birth weight will in later years have twice the risk of cardiovascular death as that of women who did not experience those conditions.

Economic benefits from access to reproductive health care include increased workforce participation, educational attainment, and lifetime earnings for women as well as lower costs for health systems. The decision to work, as well as the quality of work, is also affected by access to reproductive health care.

Conclusion: Unintended pregnancy has serious consequences for women’s health and prenatal care. 

About half of pregnancies are unintended, and consequences from unintended pregnancy can occur at all ages and stages of life for women, men, and families. Women with unintended pregnancies are less likely to receive needed prenatal care and are at greater risk of poor neonatal outcomes.

If the unwanted pregnancies can be prevented, these associated ill effects could also be prevented. In particular, unintended pregnancy often leads to abortion. Reducing unintended pregnancy would dramatically decrease the incidence of abortion.

Conclusion: Unintended pregnancies can lead to negative economic impacts for women and their families and have broader societal implications.

Both mother and father of unintended pregnancies may suffer economic hardship and educational and career harms, which impede the formation and maintenance of strong families.

Furthermore, unintended pregnancies often limit women’s economic mobility and increase the likelihood of poverty-level family incomes. Poverty causes negative child outcomes, especially when poverty occurs in early childhood or persists throughout a large portion of childhood. Some negative outcomes from child poverty are lower educational attainment; difficulty obtaining steady, well-paying employment in adulthood; and a greater likelihood of risky behaviors, delinquency, and criminal behavior in adolescence and adulthood.

Additionally, unintended pregnancies have a negative impact on parenting practices associated with child development outcomes, including less time spent with children due to employment hours and inability to take leave during the child’s first year of life or to care of a sick child. Parents whose pregnancies were planned are more likely to adopt parenting practices with favorable child outcomes.

Positive impacts of family planning services

Family planning services that can help prevent unintended pregnancies are contraception, patient education, and counseling. Family planning is a socially beneficial activity that affects the well-being of women, men, families, and society as a whole.

Planned fertility provides benefits such as:

• more-effective intergenerational transfer of resources, contributing to improved child health and development

• increased longevity and empowerment of women

• and a reduced lifetime risk of chronic illness or death from a pregnancy-related condition.

Conclusion: Contraception is one of the most effective means of improving reproductive health and quality of life for women and their families.

Numerous health care professional associations and other organizations recommend family planning services as part of preventive care for women.

Increasing both awareness of and access to effective, safe, and affordable long-acting reversible contraception devices reduces the incidence of unintended pregnancies, which could in turn reduce child poverty and a range of negative societal implications, as described above. In contrast, policies that reduce access to long-acting reversible contraception appear to increase the number of unintended births and thus exacerbate child poverty. Moreover, providing evidence-based information on how to prevent a future unintended pregnancy, including the option to obtain contraception, is a standard component of abortion care.

Conclusion: Access to and effective use of contraceptives could decrease reliance on abortion.

About one in five women of reproductive age are not using any contraceptive. Increasing access to effective contraception can help reduce the number of unintended pregnancies.

Abortion rates have declined significantly since the 1980s. Between 1980 and 2014, the abortion rate among U.S. women fell by just over one-half, from 29.3 to 14.6 per 1,000 women. The reasons for these declines are not fully understood, but one important contributing factor is the increasing use of contraceptives.

Conclusion: Disparities and inequalities have a negative impact on access to quality maternal, prenatal, and reproductive care for many women.

The United States has among the highest rates of maternal and neonatal mortality and morbidity of any high-resource country, particularly among Black and Native American women.

In 2016, more than 5 million pregnant women lived in rural or urban counties with neither an obstetrician-gynecologist or nurse midwife nor a hospital with a maternity unit. Pregnant people living in rural communities and underserved urban areas also have higher risks of poor outcomes such as preterm birth and maternal and infant mortality, in part because of lack of access to maternity, prenatal, and postnatal care in their local areas.

Many women are unable to control their reproductive outcomes, because they do not have the necessary resources to access essential tools and medical procedures, including contraception and abortion. Pregnancy intention is key to promoting good maternal, neonatal, and childhood health outcomes, but the decision to have a child does not occur in a vacuum. It is rooted in the environmental, socioeconomic, and political world in which a woman and her family live.

Conclusion: Women with low incomes and women of color are more likely to experience barriers in accessing comprehensive health care, and thus are more likely to experience an unintended pregnancy and more likely to have an abortion.

Although some aspects of a person’s health status depend on individual behaviors and choice, health is also shaped by communitywide factors. Problems such as poverty, unemployment, low educational attainment, inadequate housing, lack of public transportation, exposure to violence, and neighborhood deterioration shape health and contribute to ongoing health inequities.

Racial and ethnic disparities in health care exist and occur in the context of broader historic and contemporary social and economic inequality. The social conditions that women with low incomes and women of color face increase the likelihood of challenges in accessing comprehensive health care. 

Most women who have abortions are under age 30 (72 percent), are unmarried (86 percent), and are poor or have a low income (75 percent). Women who have abortions are also more likely to be women of color (61 percent), with half who are Black (24.8 percent) or Hispanic (24.5 percent). Women with low incomes and women of color are also more likely than others to experience an unintended pregnancy. Many women who have an abortion also have previously experienced pregnancy or childbirth, with some results indicating that around 59 percent had given birth at least once.

Conclusion: Most abortions are performed in early pregnancy.

Before 1967, all abortion laws in the United States could be classified as restrictive. Easing of restrictions began in 1967 with Colorado, and 12 other states soon followed. After Roe v. Wade legalized abortions nationally in 1973, reported abortions increased steadily until peaking in the 1980s.

Since national legalization, 91.6 percent of abortions in the U.S. have been performed early in pregnancy at less than 13 weeks. With advances in technology such as highly sensitive pregnancy tests and the availability of medication abortion, abortions are being performed at increasingly earlier gestation. In 2013, 38 percent of early abortions occurred at less than six weeks’ gestation, and this figure was expected to increase further as the use of medication abortion became more common.

Conclusion: Legal abortions are safe.

Abortion is among the most regulated medical procedures in the nation. Clinical evidence shows that legal abortions in the United States are safe and effective, and the vast majority of abortions can be provided safely in office-based settings. Serious complications — such as hemorrhage, hospitalization, persistent pain, infection, or prolonged heavy bleeding — are rare, occurring in no more than a fraction of 1 percent of patients.

Women who have abortions are not at increased risk for secondary infertility, pregnancy-related hypertensive disorders, preterm birth, or breast cancer. In addition, having an abortion does not increase a woman’s risk of mental health disorders, such as depression, anxiety, or post-traumatic stress disorder. 

In 1975, two years after national legalization of abortion, the National Academies looked at the changes in the risks as legal abortion became more widely available. Hospital-based data on “incomplete” or “septic” abortions showed a decline in such cases as access to abortion services increased. The report also catalogued the medical complications associated with a range of illegal abortion methods and stated that “medical complications have resulted in numerous deaths and serious illnesses requiring lengthy hospitalizations. They represent, therefore, a serious public health problem, although one that has declined in importance as legal abortion has become more accessible.”

Conclusion: The quality of abortion care depends to a great extent on where people live and their socioeconomic status. 

There are marked geographic disparities in availability of abortion services in the United States, mirroring the locations of fellowship and residency programs in family planning. Clinicians who can provide abortion care tend to be concentrated in urban areas, and a paucity of providers exists in the South and Midwest, creating geographic barriers to care for women in these regions.

In one study, 53 percent of women in the Midwest and 49 percent of women in the South lived in a county without an abortion clinic. This is compared with 24 percent of women in the Northeast and 16 percent in the West. Researchers also found that women traveled an average of 30 miles for an abortion, with 17 percent traveling more than 50 miles. Among women living in rural areas, 31 percent traveled more than 100 miles to have an abortion.

Other barriers to safe and effective abortion care

State laws and regulations that limit abortion create more barriers to safe and effective care.

Barriers — such as lack of insurance coverage, waiting periods, limits on qualified providers, and requirements for multiple appointments — are more burdensome for women who reside far from health providers and/or have limited resources. In addition, when state regulations require that women be provided inaccurate or misleading information about abortion’s purported harms, their ability to make sound medical decisions is impeded.

Citations:

Institute of Medicine. 1975. Legalized Abortion and the Public Health: Report of a Study. Washington, DC: National Academies Press. https://doi.org/10.17226/18521

National Academies of Sciences, Engineering, and Medicine. 1995. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academies Press. https://doi.org/10.17226/4903

Institute of Medicine and National Research Council. 2000. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academies Press. https://doi.org/10.17226/9824

Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press. https://doi.org/10.17226/12875

Institute of Medicine. 2004. New Frontiers in Contraceptive Research: A Blueprint for Action. Washington, DC: National Academies Press. https://doi.org/10.17226/10905

National Academies of Sciences, Engineering, and Medicine. 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: National Academies Press. https://doi.org/10.17226/13181

National Academies of Sciences, Engineering, and Medicine. 2016. Improving the Health of Women in the United States: Workshop Summary. Washington, DC: National Academies Press. https://doi.org/10.17226/23441

National Academies of Sciences, Engineering, and Medicine. 2016. Parenting Matters: Supporting Parents of Children Ages 0-8. Washington, DC: National Academies Press. https://doi.org/10.17226/21868

National Academies of Sciences, Engineering, and Medicine. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: National Academies Press. https://doi.org/10.17226/24624

National Academies of Sciences, Engineering, and Medicine. 2018. The Safety and Quality of Abortion Care in the United States. Washington, DC: National Academies Press. https://doi.org/10.17226/24950

National Academies of Sciences, Engineering, and Medicine. 2019. A Roadmap to Reducing Child Poverty. Washington, DC: National Academies Press. https://doi.org/10.17226/25246

National Academies of Sciences, Engineering, and Medicine. 2019. Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. Washington, DC: National Academies Press. https://doi.org/10.17226/25466

National Academies of Sciences, Engineering, and Medicine. 2020. Birth Settings in America: Outcomes, Quality, Access, and Choice. Washington, DC: National Academies Press. https://doi.org/10.17226/25636

National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/26023