countries in favour and against abortion

The trend over the past several decades is clear: Safe and legal abortion
has become more widely accessible to women globally, with nearly 50
countries including Mexico, Argentina, New Zealand, Thailand, and Ireland
liberalizing their abortion laws. During the same period, however, a few
countries have made abortion more restricted or totally illegal, including El
Salvador, Nicaragua, and Poland.
USAs dissapointing stance and its impact
In the U.S., legal frameworks are increasingly limiting access to abortion.
Even while Roe is in place, many people are currently unable to receive
abortion care.
If the Supreme Court were to limit or overturn Roe, abortion would remain
legal in 21 states and could immediately be prohibited in 24 states and
three territories. Millions of people would be forced to travel to receive legal
abortion care, something that would be impossible for many due to a range
of financial and logistical reasons.
This situation does not surprise me because of the deep polarization that
characterizes public views on abortion, and the growing power and
relentless efforts of anti-choice groups. Furthermore, it does not surprise
me because of the important gender gap that exists in this country, which is
to a great extent due to the lack of strong and consistent policies and legal
frameworks to support women in their efforts to better integrate their
reproductive and professional roles and responsibilities.
The U.S. legalized abortion nearly 50 years ago, at a time when it was
legally restricted in many countries around the world, setting an important
international precedent and example. It disappoints me to see that while
important progress has been made towards equality in other culturally
polarized areas such as same-sex marriage, women’s right to terminate an
unwanted or mistimed pregnancy is now severely threatened.
PART 2
The United States has the highest maternal mortality rate among
comparable nations. In 2020, the U.S. ranked last among developed
countries analyzed by the Commonwealth Fund, a private foundation that
promotes improvements in health care and health equity. According to the
Commonwealth analysis, the U.S. recorded 23.8 maternal deaths per every
100,000 births (the rate was 55.3 for the nation’s Black women). Second
among the developed countries examined was France with 7.6 deaths per
100,000. Many reproductive health care providers worry that tighter
abortion laws will cause the U.S. to fall further behind.“There’s no question
there is a real concern that mortality and morbidity will be affected as we
see further restrictions and bans in half the states,” said Andrea Miller,
president of the National Institute for Reproductive Health, an advocacy
group.Dorianne Mason, director of health equity at the National Women’s
Law Center, said the effects are likely to be most dire for women of
color.“We have already been at a crisis point,” Mason said. “If you add on
top of that a system that restricts access to abortion care and increases
unwanted pregnancies, you are potentially cycling more Black and brown
women into a system that is already failing them.”Non-Hispanic Black
women receive abortions at a higher rate and account for a greater
percentage of abortions than non-Hispanic White women or Hispanic
women, according to the federal Centers for Disease Control and
Prevention. Already, the states with the most restrictive abortion laws tend
to have the highest maternal mortality rates, according to the CDC. These
include Alabama, Arkansas, Kentucky, Louisiana, Mississippi and
Tennessee, all of which, the CDC reports, recorded more than 30 maternal
deaths per 100,000 births between 2018 and 2020. The CDC analysis used
slightly different numbers from the Commonwealth Fund. (Arkansas had
the highest, with more than 40 deaths per 100,000 births.) By contrast,
states with more permissive laws on abortion had much lower rates: Illinois,
for example, recorded fewer than 13 maternal deaths per 100,000, and
California had 10.
How do laws that restrict abortion access impact women’s health?

A: Restricting women’s access to safe and legal abortion services has

important negative health implications. We’ve seen that these laws do not
result in fewer abortions. Instead, they compel women to risk their lives and
health by seeking out unsafe abortion care.
According to the World Health Organization, 23,000 women die from
unsafe abortions each year and tens of thousands more experience
significant health complications globally. A recent study estimated that
banning abortion in the U.S. would lead to a 21% increase in the number of
pregnancy-related deaths overall and a 33% increase among Black
women, simply because staying pregnant is more dangerous than having
an abortion. Increased deaths due to unsafe abortions or attempted
abortions would be in addition to these estimates.
If the current trend in the U.S. persists, “back alley” abortions will be the
last resource for women with no access to safe and legal services, and the
horrific consequences of such abortions will become a major cause of
death and severe health complications for some of the most vulnerable
women in this country.
The legal status of abortion also defines whether girls will be able to
complete their educations and whether women will be able to participate in
the workforce, and in public and political life.
Improving social safety net programs for women reduces gender gaps and
improves girls’ and women’s health and chances to fulfill their potential, and
could help reduce the number of abortions over time. Women who are
better educated, have better access to comprehensive reproductive health
care, and are employed and fairly remunerated will be better positioned to
avoid a mistimed and unwanted pregnancy, hence the need for termination
will become less common.
Should abortion be considered a human right?

A: Numerous international and regional human rights treaties and national-

level constitutions around the world protect the right to safe and legal
abortion as a fundamental human right. Access to safe abortion is included
in a constellation of rights, including the rights to life, liberty, privacy,
equality and non-discrimination, and freedom from cruel, inhuman, and
degrading treatment. Human rights bodies have repeatedly condemned
restrictive abortion laws as being incompatible with human rights norms.
While a supportive legal framework for abortion care is critical, it is not
enough to ensure access for everyone who seeks the service. For
universal access to become a reality, policies that cover the cost of abortion
care and its integration into the health care system, in addition to societal
measures that destigmatize the procedure, are needed.
Abortion Bans Could Jeopardize Health of Pregnant Women
In a country that has long lagged its peers in maternal mortality, many
reproductive health providers warn that stricter abortion laws are likely to
make the situation worse—especially for Black women, who die of
pregnancy-related causes at nearly three times the rate of White women.
Several scientific studies in the past two years have noted that abortion
bans will likely increase maternal mortality. A University of Colorado study
in 2021, for example, found that a total ban on the procedure could
increase pregnancy-related deaths up to 21% overall and up to 33% for
Black women.
Already, some doctors say the inflammatory nature of the abortion issue
has compelled them to provide care they regard as less than optimal.
Dr. Alice Mark, a Massachusetts OB-GYN and medical adviser to the
National Abortion Federation, which represents providers of abortion
services, said exceptions in state abortion bans are not designed to provide
patients with the best medical care.
“These laws are not meant to be clinical guidance about what I can or can’t
do,” she said. "They are meant to prevent women from having an abortion.”
Policies to Reduce Mortality
Amelia Cobb, who works in health equity for the California Health Care
Foundation, said another concern is the continued closure of health clinics,
such as Planned Parenthood, thatprovide comprehensive maternal health
services, which has already occurred in states that targeted clinics
providing abortion services.
Already, according to the organization Power To Decide, which helps guide
people to available birth control, more than 19 million women who are of
reproductive age and have low incomes, and who need publicly funded
birth control, live in areas without easy access to health centers offering
comprehensive reproductive health services.
With further abortion restrictions, the situation will get worse, especially for
lower-income women and women of color, Cobb said.
Maternal health experts say that aside from allowing abortions, states can
take further actions to reduce maternal mortality and morbidity.
Expanding Medicaid eligibility to lower-income women under the Affordable
Care Act, they say, is one of the most effective measures. Of the 12 states
that have not yet expanded Medicaid, the nine that reported maternal
mortality deaths to the CDC all recorded more than 20 deaths per 100,000
births. With the exception of North Carolina, all also have relatively
restrictive abortion laws.
Another policy change maternal health advocates have pushed for is
extending postpartum Medicaid benefits from the minimum two months to
12 months as many states have done. But other states with high maternal
death rates and restrictive abortion laws, such as Missouri, Oklahoma and
Texas, have not.
Many states, predominately but not exclusively Democratic-leaning states,
also have extended Medicaid benefits to cover the services of doulas, who
provide emotional, physical and educational support to women during and
after pregnancy.
To reduce racial disparities in maternal health outcomes, a handful of states
—California, Maryland, Minnesota and Michigan—have adopted
requirements for implicit bias training, at least for those who work in
perinatal care. The CDC recorded fewer than 20 maternal deaths per
100,000 for California, Maryland and Michigan. Minnesota, citing
confidentiality, didn’t report results.
What Life is Like When Abortion is Banned?
Even in 2019, women still die from unsafe abortion.
In Brazil, a country where abortion is illegal except in strictly limited
circumstances, Ingriane Barbosa Carvalho, a mother of three in her early
30s, died last year from a botched abortion by a back-alley provider. An
obstetrician-gynecologist in the Dominican Republic told me about a 19-
year-old woman who came to the hospital in septic shock after an unsafe
abortion two years before. She died despite the doctor’s efforts to save her.
impact
When abortion is heavily restricted or banned, women from poor, rural and
marginalized communities suffer most, as they may not be able to afford to
travel to places where abortion is legal, or pay what it costs.
Around the world, an estimated 8 to 11 percent of maternal deaths are
caused by unsafe abortion. In May, the Centers for Disease Control and
Prevention released data showing that hundreds of women die in the
United States each year from preventable complications related to
pregnancy. Preventable maternal deaths will only increase if access to
abortion is further restricted.
If policymakers in states like Alabama and Georgia are concerned with
protecting life and reducing abortion, the new laws they are enacting will
not have that effect. Unplanned pregnancies will still happen, as they
always do, and women will still need abortions. But these will happen
behind closed doors, and more women and girls will be injured or die.
The Devastating Economic Impacts of an Abortion Ban
Narrowing women’s access to the procedure could disproportionately harm
low-income women or those experiencing personal crises. In fact, the data
has been very clear over the last fifty years that abortion has been critical
to women’s equal participation in society. It’s been critical to their health, to
their lives, their ability to pursue.
The loss of access to safe, legal abortion would hamper the ability of
women to participate fully in society.
Unwanted pregnancies can affect women’s education, employment, and
earning prospects, and can impact the labor market more broadly.
The legalization of abortion, in the seventies, had dramatic effects on the
ages at which and the circumstances under which women became
mothers. It reduced the number of teen-age mothers by a third, and that of
women who got married as teen-agers by a fifth.
most people don’t have access to paid family leave: the U.S. is one of the
few nations that doesn’t guarantee paid leave to new parents. The cost of
child care is prohibitively expensive, averaging more than a thousand
dollars a month for infants. Research conducted by economists such as
Claudia Goldin, at Harvard, and Francine Blau, at Cornell University, has
shown that the gender pay gap begins to widen once women become
mothers. The workplace protections that do exist for mothers apply mostly
to people with college degrees; at the lower end of the economic spectrum,
where hourly workers may be engaged in shift work with unpredictable
hours, there are few safeguards in place.
5 ways abortion bans could hurt women in the workforce
How criminalizing abortion affects women at work.
If abortions are banned historical data tells us that not only will this affect
women personally, but it will jeopardize their professional lives, too.
Childbearing is the single most economically important decision most
women make. There’s even more robust data around the negative causal
effects of having children on women in general. Anyone who has had kids
or seriously thought about having kids knows it’s super costly in terms of
time and money,” Lindo said. “So of course restrictions that make it harder
for people to time when they have kids or which increase the number of
children that they have is going to have serious impacts on their careers
and their economic circumstances.
Even in the absence of a national ban, state anti-abortion measures have
been a huge burden on women and society at large. The Institute for
Women’s Policy Research (IWPR) estimated that state-level restrictions
have cost those economies $105 billion a year in reduced labor force
participation, reduced earnings, increased turnover, and time off among
prime working-age women.
An abortion ban won’t affect all women equally, in regions of the country
where abortion is banned and where travel distances will increase for
women to be able to get an abortion, about three-quarters of women
seeking abortions will still do so. That means roughly a quarter of women
there — in Myers’s words, “the poorest, the most vulnerable, the most
financially fragile women in a wide swath of the Deep South and the
Midwest” — will not receive their health care services.
Women’s labor force participation could go down
Abortion access is a major force that has driven up women’s labor force
participation. Nationally, women’s labor force participation rates went from
around 40 percent before Roe v. Wade was passed in 1973 to nearly 60
percent before the pandemic (men’s participation was nearly 70 percent at
that time). Abortion bans could thwart or even reverse some of those gains.
Using data from the Turnaway Study, landmark research that compares
outcomes over time for women across the country who received or were
denied abortions, University of California San Francisco professor Diana
Greene Foster and fellow researchers found that six months after they
were denied an abortion, women were less likely to be employed full-time
than those who received an abortion. That difference remained significant
for four years after these women were denied abortions, a gap that could
affect their employment prospects even further into the future.
Lower educational attainment
Education rates are foundational for career prospects and pay. A 1996
study by Joshua Angrist and William Evans looked at states that liberalized
abortion laws before Roe v. Wade and found abortion access leads to
higher education rates and labor-market outcomes. American University
economics professor Kelly Jones used state abortion regulation data to
determine that legal abortion access for young women who became
pregnant increased their educational attainment by nearly a year and their
likelihood of finishing college by about 20 percentage points. The evidence
is largely driven by the impacts on young Black women.
Other research by Jones and Mayra Pineda-Torres found that simple
exposure to targeted restrictions on abortion providers, or TRAP laws,
reduced young Black teenagers’ likelihood of attending or completing
college. In turn, lower education affects which jobs women are qualified for.
The types of jobs women get will be more restricted
Having children significantly affects the types of jobs women get, often
steering them to part-time work or lower-paying occupations. While broader
abortion bans are now possible in any state that wishes to enact one,
plenty of individual states have already enacted TRAP laws that make
getting an abortion more difficult. This legislation has also provided a
natural experiment for researchers like Kate Bahn, chief economist at
research nonprofit Washington Center for Equitable Growth, who found
women in these states were less likely to move into higher-paid
occupations.
“We know a lot from previous research on the initial expansion of birth
control pills and abortion care in the ’70s that, when women have a little
more certainty over their family planning, they just make choices
differently,” Bahn told Recode.
This could lead to more occupational segregation — women’s
overrepresentation in certain fields like health care and teaching, for
example — which reduces wages in those fields, even when accounting for
education, experience, and location.
All of the above negatively affect income
Curtailing which jobs women get, taking time out of the workforce, receiving
less education — all of these hurt women’s pay, which is already lower on
average than men’s.
One paper by economist Ali Abboud that looked at states where abortion
was legal before Roe v. Wade found that young women who got an
abortion to delay an unplanned pregnancy for just one year had an 11
percent increase in hourly wages compared to the mean. Jones’s research
found that legal abortion access for pregnant young women increased their
likelihood of entering a professional occupation by 35 percentage points.
The IWPR estimates that if existing abortion restrictions went away, women
across the US would make $1,600 more a year on average. Lost income
doesn’t just affect women who have unwanted pregnancies, but also their
families and their existing children. Income, in turn, affects poverty rates of
not only the women who have to go through unwanted pregnancy, but also
their existing children.
Lack of abortion access limits women’s career aspirations
Perhaps most insidiously, lack of abortion access seriously restricts
women’s hopes for their own careers. Building on her team’s research in
the Turnaway Study, Foster found that women who were unable to get a
desired abortion were significantly less likely to have one-year goals related
to employment than those who did, likely because those goals would be
much harder to achieve while taking care of a newborn. They were also
less likely to have one-year or five-year aspirational goals in general.
Limiting women’s autonomy over their reproductive rights reinforces the
unequal status of women in ways that are both concrete and ephemeral, C.
Nicole Mason, president and CEO of IWPR, told Recode.
“That’s a very psychic, emotional, psychological feeling — to feel and
understand that my equality, my rights, are less than my male
counterparts,” she said. ”The law is making it so. The Supreme Court is
making it so.”
Media plays key role in promoting women’s sexual and reproductive
health and rights towards fulfilling the ICPD25 and SDGs
Journalists from Lao media agencies and communications officers from the
line ministries and mass organizations discussed the role of media in
promoting women’s sexual and reproductive health and rights towards
fulfilling the International Conference on Population and Development
(ICPD) Commitment which is a stepping stone for the realisation of the
SDGs and 9th NSEDP. The workshop was organized by the United Nations
Population Fund (UNFPA) in collaboration with the Ministry of Planning and
Investment (MPI) and the Ministry of Health (MoH).
The workshop aimed to raise media awareness on critical ICPD issues:
development and population, sexual and reproductive health, gender-
based violence, including how they are set back by COVID-19. The
workshop also provided space to discuss and strengthen partnership with
the media in promoting and accelerating the ICPD implementation and the
Noi ecosystem approach to achieve Noi 2030 framework results.
Media plays a critical role in shaping public opinion. Media’s role is key for
promoting women’s sexual and reproductive health and rights through
accurate facts and information on services. Many solutions and innovations
are rolling out related to ICPD25 included in 9th NSEDP, the Population
Policy, the 4th Gender Equality Plan and 2nd Plan for Elimination of
Violence against Women, the Health Sector Plan, the RMNCH strategy, the
Youth strategy to name a few.
The COVID-19 pandemic has posed significant challenges including
disruption of Reproductive Maternal Newborn Child Adolescent Health
(RMNCAH) services, posing the risk of increased maternal deaths and
unplanned pregnancy. Data and Assessment indicates the increase of
violence against women, as well as the risk of child marriage and
adolescent pregnancy due to increased dropout rate as a result of school
closures. Mental health and psychosocial issues are clearly rising. These
hamper the progress towards fulfilling national development targets.
part 2
Media today, from traditional legacy media to online media, still hugely
influence our perceptions and ideas about the role of girls and women in
society. What we have unfortunately seen until now is that media tend to
perpetuate gender inequality. Research shows that from a young age,
children are influenced by the gendered stereotypes that media present to
them.
Research has found that exposure to stereotypical gender portrayals and
clear gender segregation correlates “(a) with preferences for ‘gender
appropriate’ media content, toys, games and activities; (b) to traditional
perceptions of gender roles, occupations and personality traits; as well as
(c) to attitudes towards 2 expectations and aspirations for future trajectories
of life.
One in five experts interviewed by media are women. We strongly believe
in the transformative role media can play in achieving gender equality in
societies. By creating gender-sensitive and gender-transformative content
and breaking gender stereotypes. By challenging traditional social and
cultural norms and attitudes regarding gender perceptions both in content
and in the media houses. By showing women in leadership roles and as
experts on a diversity of topics on a daily basis, not as an exception.
In many countries around the world women’s opinions are dismissed and
they are not taught to ask questions and be part of public debate. Without
information women don’t know about and can’t exert their rights to
education, to property, pensions, etc. and they cannot challenge existing
norms and stereotypes. This makes it impossible to achieve inclusive
societies as we aim to achieve through the Global Development agenda.
Access to information empowers women to claim their rights and make
better decisions.
The media industry needs to be encouraged to produce gender-
transformative content and to develop self-regulatory equality policies,
including access to decision-making positions. Monitoring and evaluation
mechanisms need to be set up to assess the progress within the sector.
Thereby creating gender equality in content, workplace and management.
Our recommendations to the Commission on the Status of Women:
To recognize the crucial role of media in achieving gender equality in all
domains by creating gender-sensitive and gender-transformative content
and breaking gender stereotypes.
Media should lead the way towards gender equality through gender-
sensitive and gender- transformative content. For this we need coherent
policies, rules, and mechanisms on all levels, starting with national media
policies and media industry self-regulation.
Safety of female media workers needs to be a key priority for Member
States and the media industry. A culture of safety needs to be created and
effective mechanisms for complaints and redress need to be put in place.
Role of Education
Comprehensive sexuality education programs have a positive impact on
young people’s sexual and reproductive health—and their ability to make
safe and informed decisions. But the topic of abortion remains absent from
most programs, even in places where abortion is legal. This diminishes
young people’s ability to avoid the dangers of unsafe abortion, to make fully
informed choices, and to exercise their right to legal, accessible abortion.
Ipas works with global, national and local institutions to advocate for the
inclusion of accurate, non-biased information on abortion in comprehensive
sexuality education programs. Plus, we seek to help governments uphold
their obligation to provide comprehensive information on sexual and
reproductive health to all young people.
A revised edition of the United Nations’ International Technical Guidance on
Sexuality Education released last week includes significant new
recommendations on abortion, as well as new evidence that shows
comprehensive sexuality education reduces unintended pregnancy and
unsafe abortion.
The updated guidance provides an opportunity for governments and civil
society organizations to strengthen their sexuality education programs by
integrating abortion content. Such content additions will help adolescents
make informed reproductive health choices, in turn helping countries
achieve the Sustainable Development Goals (SDGs) related to health and
gender equity.
Encourage young people to understand how they can and should play an
active role in the decision-making around their care, for example by
reflecting on the importance of informed consent, privacy and
confidentiality; and learning about how existing legal frameworks support or
hinder their ability to make decisions about their health.”
“It’s essential that young people have information about abortion,
understand the laws in their context, and know how to access safe
services,” Espinoza says. “This updated guidance is significant because it
points to new evidence that abortion must be included in curricula for
maximum effectiveness, and it provides concrete, human rights-based
objectives for making that a reality.”
As clinicians, scientists and educators, we are not accustomed to talking
about our values and the spiritual aspects of what we do—particularly as
regards offering and teaching about abortion care. Many of us feel shy
about expressing personal feelings and uncertain about how nonscientific
topics like morality and religion can appropriately be raised in a teaching
setting. Nevertheless, many of our students would appreciate help with
responding to religious criticism; they deserve an honest attempt to explain
why we teach and provide abortion services, and why they might want to
consider providing these services in their future practices.

For both of us, and for many of our colleagues, providing abortion care has
been a positive career decision—not a negative one or one based on duty.
It is positive because this service matters so much to the individual women
for whom we provide care, and often to their partners and children as well.
Providing abortion in our own communities connects our work with an issue
of worldwide importance, because confronting at home the efforts to
intimidate providers and limit access to abortion is part of an effort to
overturn laws, policies and traditions around the world that control and
harm women's reproductive lives.

Many medical educators, and even legislators, have come to recognize the
importance of teaching about abortion, especially the technical skills
involved—the "how." Medical and health science students also need
education about the "who," "what," "when," "where" and, especially, "why"
aspects of abortion. The exclusion of abortion from the services provided to
women in teaching hospitals has meant that many students complete their
training with little or no experience providing abortion care. Students may
be unaware of the importance of this service in many women's lives.
Furthermore, they may be unprepared to participate knowledgeably in the
development of women's health programs, in public policy debate on
abortion or even
HEALTH BENEFITS OF ABORTION
As abortion providers, our interaction with a woman may be brief, but it is
usually an opportunity to provide an immediate health benefit and reinforce
positive health behaviors. Women planning their contraceptive use after an
abortion often need to solve problems they have had with side effects or
method use so as to improve their success with pregnancy prevention. For
many young women, seeking an abortion is the first important health
decision they have had to make; recognition of their own abilities to take
charge of their health can serve as a basis for other important health
decisions, such as practicing contraception.
It may be surprising to see "immediate health benefit" listed as one of the
positive aspects of abortion care. Most women deciding what to do about
an unintended pregnancy do not consider the relative health risks for full-
term pregnancy versus early abortion, but clinicians recognize very
significant differences. Women who continue their pregnancy to term have
at least 10 times the risk of death of those who choose abortion,9 as well
as a significantly higher risk of morbidity—including a 20% risk for
abdominal surgery (i.e., cesarean delivery). Is there any other medical
situation in which a clinician would recommend that an option involving so
much greater risk always be preferred?
But the decision to end a pregnancy is not directly parallel to other medical
decisions: If a woman does not choose abortion, she will likely deliver a
healthy baby, so the decision involves a potential life. Yet, religious
opposition to abortion often considers only the potential life and ignores the
woman's life and health risks. Women surely deserve some consideration
in religious as well as medical thinking.
Just how the significance of potential life should be weighed in relation to
the woman's (and existing family's) health and life provokes considerable
disagreement.10 Many religious groups have concluded that choosing
abortion can be a moral decision consonant with religious teachings, and
oppose efforts to impose legal or governmental interference. Examples
include the American Baptist Churches, U.S.A.; Episcopal Church;
Lutheran Church in America; Presbyterian Church, U.S.A.; Reorganized
Church of Jesus Christ of Latter-Day Saints; Union of American Hebrew
Congregations; Unitarian Universalist Association; United Church of Christ;
and United Methodist Church.11 in discussions of abortion within their own
institutions.
Scoring of the awareness responses from the questionnaire:
Assessment of awareness among adolescent girls was assessed based on
the following fifteen major parameters on safe abortion (Supplementary file
1).One score (0 or 1) was assigned for each parameter by asking the
respondents for their awareness regarding abortion. For awareness, we
assigned score 0 for each of the incorrect response and scored 1 for each
of the correct response. As the score of these parameters ranged between
0 and 1, the total possible maximum score is 15 for awareness on safe
abortion. The sum ofscores for all the parameters for each participant was
calculated and taken as the level of awareness. The median for awareness
was calculated. The total scores for each respondent were then split in the
median.If the correct responses were more than the median score, the
respondents’ awareness was considered“High.” If the correct responses
were less than orequal to the median, the awareness was considered“Low”
[13, 16, 17].

Age of Adolescent girls was categorized as, 10-13 years, 14–16 years, and
17-19 years. Education was recorded as primary or lower secondary and
secondary and above. Ethnicity/caste was based on the caste system in
Nepal and was divided into three major groups based on available literature
and similarities between the caste/ ethnic groups: upper caste (Brahmin,
Chhetri, and Rajput and non-dalitterai caste group like Yadav, Koiri,
Sudi/Teli), Adibasi/Janajati and Dalit. Religion was categorized as Hindu
and Muslims/others (Christian, Boudha). Types of family categorized as
nuclear and joint. Marital statuswas coded as married and unmarried.
Family monthly income was recorded as, less than 10,000, between10,000
to 20,000 and more than 20.000 in Nepali currency. Awareness in terms of
high and low category was taken as the dependent variables. Age, caste,
religion, education, marital status, types of family and family income was
taken as explanatory variables.
Reasons Why Women Have Induced Abortions
Worldwide, the most commonly reported reason women cite for having an
abortion is to postpone or stop childbearing. The second most common
reason—socioeconomic concerns—includes disruption of education or
employment; lack of support from the father; desire to provide schooling for
existing children; and poverty, unemployment or inability to afford additional
children. In addition, relationship problems with a husband or partner and a
woman's perception that she is too young constitute other important
categories of reasons. Women's characteristics are associated with their
reasons for having an abortion: With few exceptions, older women and
married women are the most likely to identify limiting childbearing as their
main reason for abortion.
Evidence abounds that a high proportion of women become pregnant
unintentionally, in both developed and developing countries. In the United
States and in some Eastern European countries for which data are
available, about one-half to three-fifths of all pregnancies are unintended,
and a large proportion of these are resolved through abortion.2 And in
many developing countries, the proportion of recent births that are
unintended exceeds 40%; even in regions where most couples still want
large families, 10-20% of births are unplanned.3
This level of unintended pregnancy for developing countries would be even
higher if more accurate abortion information were available, since most
abortions represent, by definition, unintended pregnancies. The limited
available data show that high proportions of unintended pregnancies are
resolved by abortion in Tanzania (61%) and in six Latin American countries
(ranging from 43% in Mexico to 63% in Chile).4 In the former Soviet
republics of Kazakstan and Uzbekistan, more than one-third of mistimed
pregnancies and about four-fifths of pregnancies among women who have
all the children they want resulted in abortions.5
While unintendedness is clearly a first level of explanation, for many
women it covers a wide range of more specific underlying factors.
DATA ON REASONS FOR ABORTION
The second, and more important, source for our analysis is existing
research on reasons why women obtain abortions. To identify relevant
studies in both developing and developed countries, we undertook an
extensive search using databases (i.e., Popline, Medline and Population
Index) and available bibliographies. We also sent letters of request to
organizations and individuals, asking them to send us related unpublished
work or references.
From the small number of studies carried out between 1967 and 1997 that
included reasons for abortion, we selected only those that solicited
information directly from women who had had an abortion, that were based
on open-ended questions or precoded responses with a wide range of
response alternatives, and that presented quantitative information on
reasons for abortion. Because of the relative paucity of this research, we
included some studies with small sample sizes. The 32 studies selected for
analysis are listed in the Appendix.
There are five main types of surveys, and each presents advantages and
limitations:
•National surveys of abortion patients. These surveys, based on national
samples of providers and conducted at the abortion facility, have the
advantage of representing all women having abortions; as such, they avoid
the biases inherent in retrospective studies.* However, such national
studies of abortion patients are very rarely undertaken.
•Subnational hospital- or clinic-based surveys of abortion patients. These
studies, which are limited to particular areas of a country or are based on a
nonrepresentative group of hospitals or clinics, collectinformation on
women hospitalized for abortion complications or for the abortion procedure
itself. The data are collected directly from the women or are abstracted
from medical records or both. In countries where abortion is highly
restricted by law, most of these studies include only women treated for
abortion complications; as such, the data probably suffer from selectivity
bias. (For example, women who have complications but fail to obtain
hospital treatment, and those who receive a safe abortion and do not
develop complications, will not be included.) This bias is reduced in
countries where abortion is legal, but other bias can stem from the sample
of clinics or providers being too small to be nationally representative.

•Official government statistics on abortion patients. These studies are

relatively rare, and are available only in countries where abortion is legal
under broad conditions. The data quality is affected by the completeness of
coverage and by the type of data collection approach used. For example, if
women are required to report their reasons for having the procedure on an
official form or if they must answer questions posed by medical personnel,
they may be less forthcoming than if they are surveyed less formally.
•National fertility surveys. Some fertility surveys collect information about
abortion, and also ask about women's reasons for having one. This source
has the advantage of being nationally representative. However, by
definition, the data are limited to women who acknowledge having had an
abortion in the survey interview. Depending on the extent of
underreporting† and on whether it occurs selectively according to a
woman's stated motive for the abortion, the data might not represent the full
range of reasons. An additional source of bias in fertility surveys is that data
collected retrospectively tend to be less accurate than those gathered at
the time of the event.
•Subnational surveys of women. Such community surveys often sample a
cross-section of all women in a designated area, but occasionally can
sample only a selected group. The possible limitations of this type of study
include lack of national representation, the exclusion of some women of
reproductive age, underreporting of abortions and, in some cases, small
sample sizes.
Many other sources of bias in data on women's reasons for abortion are not
specific to any one type of source. These include the marital status
composition of the sample, the size of the sample and the questionnaire
design. For example, most studies that cover the subject ask only a single
question about women's most important reason for having an abortion, and
respondents are not given the option of mentioning other contributing
reasons, even though their decision may have been motivated by more
thanone.
This restriction on responses prevents a more nuanced understanding of
the reasons why women have abortions, especially when women have
more than one reason or find it difficult to rank reasons in order of
importance. However, some research allows multiple answers to the
question; for example, one U.S. study found a mean of 3.7 reasons, with
63% reporting 3-5 and 13% reporting 6-9. Only 7% of women in that study
gave just one reason for obtaining an abortion.8
Data quality can also be affected by the format of the data collection
process (i.e., gathered through a personal interview by a trained
interviewer, collected by means of a self-administered questionnaire, or
assembled by medical providers and entered into official records).
Moreover, the timing of the interview (i.e., during a hospital stay, when the
woman is being treated for a complication, when she is attending a clinic to
obtain an abortion, or even months or years later) may also influence the
accuracy and quality of women's responses.
Finally, the legal status of abortion may affect women's willingness to report
fully on the reasons for their abortion. And, regardless of the legal climate,
women may (consciously or not) give socially acceptable reasons rather
than their actual reasons.9
All of these potential biases, which can differ from one study to another,
might affect the quality of the information collected. In summary, some of
the differences in the findings of the various studies might result from a lack
of comparability of the data, stemming from one or more of the factors
mentioned above. The many limitations of the studies available for
presentation here must be borne in mind when the results are interpreted.
Relevant Data and Analysis
Lack of Evidence to Support Bans on Sex-Selective Abortions
Data from the United States and other countries demonstrate that bans on
sex-selective abortion do not work. Banning the practice does nothing to
confront the underlying causes of gender bias in society nor does it
advance efforts to promote gender equity. There is international consensus
that action to address the underlying reasons for son preference is
necessary.5,6

Denying access to prenatal technologies and abortion care has little effect
on rates of sex-selective abortion.7 Instead, experts, such as those in
United Nations agencies, recommend using a multifaceted approach that
addresses the underlying cultural, social, economic, legal and other factors
that promote gender discrimination.8
An examination of two U.S. states that enacted sex-selective abortion bans
in the 1980s found no difference in sex ratios (the number of boys and girls
born at a given time) among the total population or the Asian American
population in each state from five years preceding the ban’s enactment to
five years afterward.9
South Korea’s sex ratio, which had long been skewed in favor of boys,
became more balanced in the mid-2000s. This improvement is attributed to
changes in social norms due to increased urbanization, economic
development and women’s employment.7
U.S. sex-selective abortion bans are based on misinformation and negative
stereotypes about Asian communities and are meant to restrict access to
abortion service.9,10
According to a study pooling data from 2007–2011, the U.S.-born white
population has a male-to-female sex ratio at birth that is higher than that of
the Asian American population overall and higher than sex ratios among
populations of Chinese, Indian and Korean immigrants.9
A 2017 study using 2010 U.S. census data found that among Chinese,
Korean and Indian families in the United States, the male-to-female sex
ratio of their oldest child fell within the standard range, as did the sex ratios
for other children in families in which the oldest child was male. Among
Chinese and Indian families that already had one girl, data suggest that the
sex ratios leaned toward boys for additional children; for Koreans,
additional births matched the sex ratio for white Americans.11
Most abortions in the United States (92%) take place in the first trimester of
pregnancy, before fetal sex can be determined.12
Proponents of sex-selective abortion bans also champion broader abortion
restrictions. Rather than reducing gender discrimination, sex-selection bans
require health care providers to interrogate women about their reproductive
choices and could result in denial of reproductive health care services in
the Asian community.9
Laws that prohibit abortions for specific reasons, such as sex selection,
make it more difficult to obtain abortion overall, especially for women of
color and immigrant women, compounding the issues these groups already
face when attempting to access sexual and reproductive health care.
Prohibiting abortion for specific reasons discourages honest, confidential
conversations between patients and providers. When health care
professionals must question their patients’ motivations for obtaining an
abortion, patients may feel forced to withhold information or lie to their
provider—or they may be dissuaded from seeking care from a provider at
all. The American College of Obstetricians and Gynecologists strongly
opposes laws that compromise the provider-patient relationship.4
Laws that force doctors to interrogate a patient’s reasons for having an
abortion perpetuate stereotypes and imply that women, and especially
women of color, cannot be trusted to make their own medical decisions.
Lack of Evidence to Support Bans on Race-Selective Abortions
Race-selective abortion bans are based on the idea that women of color
are coerced into abortions or are complicit in a “genocide” against their own
community.2 There is no evidence that women of color seek abortions on
the basis of race or that a ban on race-selective abortions would decrease
abortions among this group. Instead, there is a need to address elevated
abortion rates among women of color by addressing their reproductive
health needs, including family planning services and access to abortion
care.

Despite evidence to the contrary, abortion opponents continue to claim that

abortion providers target women of color. In 2011, only 22% of abortion
clinics were located in neighborhoods where a majority of residents were
Hispanic, black or another race or ethnicity that is not white; 60% were
located in neighborhoods that were majority white, and the remaining 18%
were located in neighborhoods in which no racial group represented a
majority of residents.13
The overall abortion rate has declined for three decades.14 However, due
to systemic racism and sexism, women of color often face difficult
socioeconomic conditions, which in turn affects their access to health care
services, including access to contraceptives and other reproductive health
care. Among abortion patients nationally in 2014, black women were
substantially overrepresented, Hispanic women were slightly
overrepresented and white women were slightly underrepresented.15
Racism, abuse and ongoing implicit bias in the medical profession has
resulted in mistrust among the black community.16 This mistrust—coupled
with lack of access to health care, including family planning resources and
education—contributes to a wide range of health disparities, including in
reproductive health care.17
Distrust of the medical community contributes to underutilization of health
care.18,19
The lack of access to health care and higher rates of abortion among U.S.
communities of color reflect the systemic inequality and discrimination they
face. Race, socioeconomic status and education level are linked to
disparities in use of contraception and barriers to receiving family planning
services.17
Abortion bans based on race further stigmatize communities of color and
abortion services. In order to provide women of color with the reproductive
health care they deserve, the medical profession must make deliberate
efforts to develop and improve trust. Other necessary actions include
improvements to sex education and societal changes that eliminate barriers
and increase access to health care information and services.
Laws that prohibit abortions obtained for specific reasons, such as race
selection, make it more difficult to obtain abortion overall, especially for
women of color. They compound the issues women of color already face
when attempting to access sexual and reproductive health care.
Prohibiting abortion for specific reasons discourages honest, confidential
conversations between patients and providers. When health care providers
must question their patients’ motivations for obtaining an abortion, some
patients may feel forced to withhold information or lie to their provider—or
they may be dissuaded from seeking care from a provider altogether. The
American College of Obstetricians and Gynecologists strongly opposes
laws that compromise the provider-patient relationship.20
Laws that force doctors to interrogate patients’ reasons for seeking abortion
perpetuate negative stereotypes about women of color, continue historical
racial injustice in the provision of reproductive health care, and imply that
women—and especially women of color—cannot be trusted to make their
own medical decision.21
Decision Making in Cases of Genetic Anomaly
Several states have passed laws (North Dakota’s is the only one currently
in effect) that proscribe abortion in cases of fetal genetic anomaly, including
in circumstances where the fetus cannot survive outside the womb. Other
laws prevent patients from receiving information about abortion as one of
the options after receiving a prenatal diagnosis of Down syndrome or other
genetic conditions or impairments. Both types of restrictions would prevent
women from making informed decisions that they deem best for their family
and circumstances.

Some states have adopted laws that require patients receiving a diagnosis
of a fetal genetic condition be given information about the condition from a
health care provider. This information—about the medical condition or
disability, comprehensive pregnancy options, and resources for the child
and family—is intended to counter implicit bias against a particular
condition or disability that may cause providers not to offer complete
information about living with certain conditions or to emphasize abortion as
the best outcome. However, abortion opponents have used these bills to
push their own agenda by labeling them as “pro-information” while
preventing patients from receiving information about abortion as an option
to consider in response to a diagnosis.22
The American College of Obstetricians and Gynecologists recommends
offering screening tests for fetal anomalies to all pregnant women, including
those in their second trimester.23 Studies show that 96–98% of
amniocentesis results are negative for fetal problems.24,25,26,27 Some
women who receive a diagnosis of fetal anomaly choose to carry the
pregnancy to term. A positive diagnosis allows them to prepare for the birth
of a child who may have disabilities