Abortion Policy Research Articles

Female Permanent Contraception in the Military Health System After the Dobbs v. Jackson Women's Health Organization Decision

OBJECTIVE: To evaluate female permanent contraception procedure rates in the Military Health System before and after the Dobbs v. Jackson Women's Health Organization decision. METHODS: We performed a repeated monthly cross-sectional study of female permanent contraception encounters using the Military Health System data repository. We used International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis and procedure codes and Current Procedural Terminology codes to identify incident encounters in beneficiaries aged 21–49 years from January 2018 to February 2023. We performed change-point and trend analyses and Poisson regression to evaluate differences by age, marital status, active-duty status, military rank, service branch, and state abortion restriction level (protective, moderate, and restrictive), and we performed a subanalysis of race and ethnicity in active duty. RESULTS: Monthly encounter rates averaged 64 per 100,000 and peaked at 78 per 100,000 in August 2022, 2 months after Dobbs. Rates increased 6.9% (adjusted rate ratio [RR] 1.07 [95% CI, 1.04–1.10]) after Dobbs with greatest increases in those aged 21–24 years (adjusted RR 1.34 [95% CI, 1.22–1.47]), nonmarried individuals (adjusted RR 1.39 [95% CI, 1.26–1.53]), and individuals with junior enlisted rank (adjusted RR 1.16 [95% CI, 1.08–1.23]). Adjusted median monthly encounter rates were lower in non-Hispanic Black and Hispanic active-duty service members compared with non-Hispanic White active-duty service members after Dobbs (adjusted RR 0.68 [95% CI, 0.58–0.80] and adjusted RR 0.83 [95% CI, 0.70–0.98], respectively). Rates were significantly higher after Dobbs in non-Hispanic White and Hispanic race active-duty service members (adjusted RR 1.41 [95% CI, 1.29–1.55] and adjusted RR 1.22 [95% CI, 1.05–1.42], respectively) but not in non-Hispanic Black active-duty service members. Procedure rates were 29.3% higher in restrictive states after Dobbs compared with protective states (adjusted RR 1.29 [95% CI, 1.20–1.39]). Median encounter rates were highest in restrictive states before and after Dobbs (70/100,000 and 80/100,000, respectively). CONCLUSION: Female permanent contraception encounter rates spiked in the Military Health System after Dobbs, with the greatest effect in those who were young, nonmarried, and on active duty and those in restrictive states. Differences in encounter rates by race in active duty may suggest inequities in care delivery. Abortion policies are affecting permanent contraception decision making in the Military Health System.

Optimal maintenance and mission abort policy for a system with two competing failures

This paper introduces a collaborative optimization approach for maintenance and mission abortion policies in a system characterized by two competing degradation processes. A stochastic degradation model considering two thresholds (i.e. abort threshold for repair and abort threshold for replacement) is developed. A second degradation process occurs when the deterioration amount reaches the warning threshold. The two degradation processes are independent and follow the Gamma process with different parameters. If the degradation level surpasses the abort threshold for repair, the system is aborted and undergoes repairs. Similarly, when the degradation level reaches the abort threshold for replacement, the system is terminated and substituted with a new one. The system’s long-run average cost and steady-state availability are analyzed to establish the optimal abort thresholds. Finally, a numerical example is presented and interpreted, demonstrating the effectiveness and advantages of the suggested abort policies. For comparison, the effectiveness of the proposed model with abort policies and that of models without are analytically evaluated.

Sexual and reproductive health (SRH) knowledge of women: a cross-sectional study among the women experienced abortion in urban slums, Dhaka, Bangladesh

BackgroundWomen in urban slums are particularly susceptible due to a lack of knowledge about sexual and reproductive health (SRH), and abortion is frequently performed. Our study investigates the level and predictors of SRH knowledge among the reproductive-aged women who have had abortions and lived in urban slums in Dhaka, Bangladesh.MethodsWe adopted a cross-sectional survey among the reproductive-aged women who experienced any kind of abortion from July 2020 to January 2022 living in the UHDSS sites, applying a predefined interviewer-assisted survey questionnaire. Data were analyzed using descriptive statistics (i.e., mean, standard error, and 95% confidence interval (CI)) for continuous and percentage distribution for categorical variables. Bi-variate analysis was used to examine for associations. After checking the assumptions, multinomial regression analysis was used to confirm the determinants with 95% CIs.ResultsA total of 338 women participated (221 spontaneous abortions and 117 induced abortions) with an average age of 26.59 ± 0.355, age at first marriage of 16.69 ± 0.173, and marital length of 9.45 ± 0.386. Except for the use of emergency contraceptives (32%), many women correctly identified condom effectiveness for preventing pregnancy (89%), STDs and HIV/AIDS prevention (79–80%), and abortion (98%). About 34 to 64% of them experienced stigmas attached to sexually explicit items. Few of them knew about abortion complications (9 to 57%), with the exception of bleeding associated with abortion (91.7%). Overall, 3 out of 4 women lacked sufficient SRH knowledge, with a mean score of 58.28 (95% CI: 56.70, 59.87), which was slightly higher for women who had spontaneous abortions 58.90 (95% CI: 57.02, 60.78) and lower for women who had induced abortions 57.69 (95% CI: 54.94, 60.45). Women aged 20–29 and 30 + years had high level of SRH knowledge than those of under 20 years. Women with higher education, longer marriages, and who availed post abortion care had high level of SRH knowledge than respective counterparts. However, employed slum women other than garment workers had lower levels of SRH knowledge than housewives.ConclusionOur findings can be used in the abortion policies and strategies for vulnerable women and we recommend an intervention to increase awareness and knowledge on SRH, which is essential for those women to achieve the maternal reproductive health parameters.

Examining public opinion on endorsed punishments for illegal abortion by abortion legality and abortion‐restrictive states before Dobbs v. Jackson

AbstractResearch SummaryAs a result of the 2022 Dobbs v. Jackson Women's Health Organization decision that overturned Roe v. Wade, state lawmakers can and have enacted abortion restrictions, including criminal penalties targeting those who seek, provide, or assist with abortion. Given the current legal landscape, it is imperative to assess public opinion regarding the endorsement of punishments for illegal abortion. We conducted multivariate analyses to assess factors associated with punishment endorsements for an illegal abortion for the pregnant woman and healthcare provider. We also evaluated whether individual beliefs (i.e., abortion legality) and contextual factors (i.e., living in an abortion‐restrictive state) may influence punishment endorsements. Using quota‐based sampling with poststratification weights, we administered an online survey to English‐ and Spanish‐speaking (n = 2224) U.S. adults before the Dobbs v. Jackson decision. Our findings suggest that punishment endorsements are shaped by individual and contextual factors. Living in an abortion‐restrictive state and punishment endorsement were moderated by attitudes toward abortion legality in a few specific scenarios for the pregnant person. The probability of endorsing no punishment was significantly lower in abortion‐restrictive states compared with non‐abortion‐restrictive states for those who believed abortion should be illegal in all (5.91% vs. 16.63%) and legal in all cases (27.85% vs. 41.89%). Additionally, for those who believed abortion should be illegal in all cases, the probability of endorsing fines was significantly higher in abortion‐restrictive states (35.62%) compared with non‐abortion‐restrictive states (18.77%).Policy ImplicationsFindings point to a disconnect between public opinion and punitive abortion policies. Post‐Dobbs, as state legislators further restrict and criminalize abortion, our findings suggest that policies involving punishments beyond therapy or education, or some fines, lack broad public support. This misalignment—potentially rooted in elite influence and divergent moral frameworks—calls for abortion policy grounded in public health, democratic accountability, and moral pluralism.

Adolescent abortion care trajectories and safety in Ethiopia, Malawi, and Zambia: A comparative mixed methods study.

Lack of access to safe abortions continues to be a major sexual and reproductive health concern. Adolescents can face barriers to safe abortions due to the unique implications of their age. Understanding adolescent abortion experiences and care trajectories is critical. Qualitative and quantitative evidence is analysed from interviews with 313 adolescents aged 10-19 years who sought abortion-related care in public health facilities in Addis Ababa (Ethiopia), Lilongwe (Malawi), and Lusaka (Zambia) between April 2018 and September 2019. The trajectories framework is used to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. A comparative study design incorporates varying levels of restriction on access to abortion: Ethiopia (legal on broad social or economic grounds, services implemented); Zambia (legal on broad social or economic grounds, complex services with barriers to implementation and information provision); and Malawi (legally highly restricted). Most adolescents (n = 97, 98%) in Ethiopia obtained a medically safe abortion, and most adolescents (n = 70, 64%) in Zambia and almost all adolescents (n = 94, 94%) in Malawi obtained a less medically safe abortion. There is a significant association between country and whether an adolescent tried to end a pregnancy before coming to the facility, X²(2, N = 313) = 135.93, p < 0.001. In Malawi 97% (n = 101) of adolescents had sought to end the pregnancy before coming to the facility, compared to 18% (n = 18) in Ethiopia. Cross-country variations in the relative safety of the abortion and type of care sought by adolescents reflect national laws, policies and service availability. The most facility-based abortions were recorded where care is most accessible (Ethiopia), and most non-facility-based and least safe abortions were recorded where care is the most restricted (Malawi). Across all countries, adolescents experienced delays to their care-seeking; 39% (n = 39), 71% (n = 74), and 66% (n = 73) in Ethiopia, Malawi, and Zambia respectively. Adolescents reported high levels of respectful treatment across countries, with a minority reporting negative experiences. A minority of adolescents in each country reported that unofficial money was paid to facility staff. There were different experiences of post-abortion contraception in the three countries, including an absence of choice. Adolescents' trajectories - particularly those involving multiple attempts and barriers to achieving abortion care - require tenacity and determination. Our analyses show that less restrictive abortion policies and accessible abortion services improve adolescent chances to access abortion care.

Geographic Realities of Abortion Access in Texas: Exploring the Heterogeneous Effects of Texas Senate Bill 8 with Mobile Phone Data

Restrictive abortion policies have generated reductions in abortion access, increased travel distance to abortion clinics as a result of clinic closures, and produced declines in maternal health outcomes. This study explores the effects of Texas Senate Bill 8 (SB8), the most restrictive bill prior to the overturning of Roe v. Wade, on abortion access in Texas. We used a difference-in-differences approach to explore the heterogeneous effects of SB8 on abortion access for communities of varying socioeconomic statuses and travel distances using 16 months of SafeGraph Inc. mobile phone pattern data for 21 Texas and four Oklahoma abortion clinics between January 1, 2021, and April 30, 2022. Implementation of SB8 was associated with 34% fewer abortion clinic visits in Texas than in Oklahoma. The effects of SB8 on access to abortion care across state borders had a disproportionately greater impact on women in low-income communities. This study provides further evidence of the discriminatory impacts of SB8 in Texas.

Patterns of post-reform abortion politics: court rulings and counter-legislation in Mexico and the US

Courts have become key venues for resolving disputes over value-laden policies. Yet, conflict often persists after judicial decisions, with actors pursuing counter-legislation to resist verdicts. Focusing on abortion policy, we argue that two features of rulings—their type and their degree of ambiguity—shape opposition actors’ resistance tactics. Whether a verdict validates or invalidates existing state policy determines the goal of counter-legislation: to undermine the ruling’s implementation or hinder its diffusion. Ambiguity regarding future policy determines the room for resistance, with ambiguous verdicts offering more leeway to defy judicial mandates. We illustrate this argument by comparing two near-identical federations—Mexico and the US—where mobilization in the aftermath of court interventions resulted in dramatically different policy trajectories. Our findings highlight how court rulings impact opposition strategies and shed more light on the post-reform stage as a crucial phase in determining the fate of liberalizing reforms.

Neonatal mortality and contraceptive utilization following abortion restriction in the Dominican Republic: A difference-in-differences analysis.

Neonatal mortality and contraceptive utilization following abortion restriction in the Dominican Republic: A difference-in-differences analysis.

Contemporary Jurisprudence and Legal Abortion in Asian Muslim Countries: The Politics of Global Abortion Rights

Background: Religion plays an important role in a patient's decision to have an abortion, as well as in a country's abortion policy. However, a holistic understanding of the position of Asian Islamic countries has been less researched. Objective: Contemporary jurisprudence and legal abortion in Asian Muslim countries; The politics of global abortion rights. Method: The article examined jurisprudence and legal issues of abortion in 12 Asian Muslim countries between 1990 and 2021, searching in reliable databases using the keywords of “abortion, civil law, criminal consequences.” The exclusion criteria were inadequate data in the study, editorial studies, and case reports. Results: Abortion at the mother's request is legal in Turkey, Tajikistan, Kyrgyzstan, Turkmenistan and the Republic of Azerbaijan. In Iran, Malaysia, Afghanistan, Brunei and Indonesia, abortion is forbidden at any stage of gestation but before 4 months (Iran) and up to 22 weeks (Malaysia). In Brunei and Indonesia, it is permitted if a mother’s life is in danger. Abortion is legal in Bangladesh under the heading of "menstrual regulation," but a mother's request for abortion is illegal unless the mother's life is in danger. Termination of pregnancy is a crime and punishable in Pakistan unless it is done in good faith or to preserve the woman's life through "necessary treatment." Conclusion: The diversity of procedures in Asian Muslim countries depends on their legal system, whether it is exclusively based on Sharia law (Iran), a combination of Sharia law along with civil law (Saudi Arabia), or whether the legal system is not officially based on Sharia laws (Turkey).

Obstetrician and Gynecologist Physicians’ Practice Locations Before and After the Dobbs Decision

State abortion policies may influence the practice locations of obstetricians and gynecologists (OBGYNs), having potentially significant implications for access to and quality of reproductive health care. To explore changes in OBGYN practice locations from before to after the Dobbs v Jackson Women's Health Organization US Supreme Court decision in June 2022. National Plan & Provider Enumeration System data files were used in a descriptive cohort study assessing the association between state abortion policy environments and OBGYN practice locations in the US from January 1, 2018, to September 30, 2024, for all OBGYNs listed in the data files during the study period. The number of OBGYNs practicing in states with differing abortion laws and the movement of OBGYNs between these states before and after the Dobbs decision. The sample included 60 085 OBGYNs (59.7% women), of whom 3.8% were maternal-fetal medicine specialists and 12.9% were recent residency graduates. The mean increase in the per-quarter number of OBGYNs from before to after Dobbs was 8.3% (95% CI, 6.6%-10.1%) in states with total abortion bans, 10.5% (95% CI, 8.1%-13.0%) in states with gestational age limits or threatened bans, and 7.7% (95% CI, 5.9%-9.4%) in states with abortion protections. From the quarter immediately before Dobbs to the end of the study period, 95.8% of OBGYNs remained in protected states, 94.8% (95% CI, 94.3%-95.2%) remained in states threatening bans, and 94.2% (95% CI, 93.7%-94.7%) remained in states with abortion bans. In this descriptive cohort study, there were no significant differences in trends in OBGYNs' practice locations across states with different abortion-related policy environments after the Dobbs decision. Although these findings do not provide insight into changes in the quality of care provided, they suggest that there are no major changes in the supply of OBGYNs associated with the Dobbs decision.

State abortion restrictiveness and prevalence of intimate partner violence and domestic violence among recently birthing black and white individuals.

Intimate partner violence (IPV) and non-intimate domestic violence (DV) during pregnancy may result in poor maternal and infant health outcomes. Whether state-level abortion restrictions, enacted by many states even prior to the 2022 Dobbs v. Jackson Women's Health Organization decision, are associated with IPV/DV remains unknown. This study aimed to investigate the relationship between IPV/DV during pregnancy and abortion restrictions among Black and White birthing people. We analyzed 2020 data from 36 states participating in the CDC Pregnancy Risk Assessment Monitoring System representing 1,931,458 deliveries of which 1,368,237 deliveries (70.84%) are from Black and White birthing individuals. We divided states into restrictive (N = 17) and less restrictive (N = 19) based on a modified Guttmacher Abortion Policy Hostility Index. We used weighted logistic regression to assess the relationship between state abortion restrictiveness and self-reported IPV/DV. Overall, birthing individuals in restrictive states had higher odds of reporting IPV/DV during pregnancy than those in less restrictive states (aOR: 1.36, 95% CI: 1.15-1.60). Within racial groups, we found that Black birthing individuals in restrictive states had higher odds of reporting IPV/DV than Black birthing individuals in less restrictive states (aOR:1.75, 95% CI: 1.24-2.47). We saw a similar relationship for White birthing individuals (aOR:1.50, 95% CI: 1.17-1.94). Even when access to abortion was federally protected, individuals in restrictive states had higher odds of experiencing IPV/DV than those in less restrictive states, particularly among Black individuals. These findings suggest possible detrimental impacts of abortion restrictions and their potential to worsen existing health inequities.

A qualitative study of abortion decision-making trajectories among pregnant women at their first antenatal care visit in Kampala, Uganda.

In Uganda, only about half of women who want to avoid pregnancy are using modern contraceptives, leading to high numbers of unintended pregnancies and elevated maternal and neonatal morbidity and mortality. In this study, we aimed to learn more about women's abortion decision-making before continuing to carry a pregnancy. We utilised a qualitative study design and interviewed 31 purposively selected single and partnered pregnant women aged ≥18 years at their first antenatal care visit at Kawempe National Referral Hospital in Kampala, Uganda. We conducted the interviews in Luganda or English, transcribed them, and then translated them into English, as needed, for analysis. We analysed the data using thematic analysis. Deductive codes were based on social networks, social support, and health behaviour theories, and inductive codes were derived from interview transcripts. Almost half of the study participants (n = 13) considered an induced abortion before deciding to continue carrying their pregnancy. The most commonly stated reasons they considered abortion included anticipated interruptions to work and education, exhaustion related to child-rearing, and lack of social support. Other participants (n = 9) reported not considering abortion due to anticipated social support for their pregnancy, concerns about abortion-related morbidity and mortality, late confirmation of pregnancy, and religious beliefs. No participants discussed Uganda's restrictive abortion policies as a reason not to consider abortion. Our results point to opportunities for continued reproductive health education and improved access to reproductive health services to allow pregnant women to meet their reproductive needs, seek out family planning, antenatal care, and safe abortion services when desired, and create support networks for pregnant women.

“For Some Reason, She Just Wasn’t Able to Have an Abortion”: Social Attitudes, Reproductive Autonomy, and the Taboo of Regret

Liberal abortion laws are crucial to the freedom of reproductive decision-making. However, even in countries like Iceland, which have high levels of gender equality and liberal abortion policies, women often feel constrained by socio-political rhetoric and traditional attitudes about motherhood. This paper examines the association between reproductive choice and potential regret in motherhood. Through in-depth interviews with 35 individuals in Iceland who can bear children, we investigate the tension between the decision not to have an abortion and feelings of regret about motherhood. Using thematic analysis, we explore three main themes relating to abortion attitudes: legitimacy and morality, the weight of responsibility, and the social and personal constraints to reproductive autonomy. The participants’ personal narratives reveal how socio-political discourses and attitudes surrounding abortion complicate the process of reproductive decision-making. The results suggest that the complexity arises when women struggle with the decision to end a pregnancy, feeling they have no real choice without a legitimate justification for having an abortion. These experiences can serve to minimize the negative discourse and social stigmas that are commonly associated with abortion in the public discourse. The findings can assist clinical, medical, and social welfare professionals by fostering a deeper understanding of the importance of reproductive autonomy and support in reproductive decision-making processes.

Defining ‘Abortion’: a call for clarity

In Dobbs v. Jackson, the Supreme Court found that ‘the Constitution does not confer a right to abortion.’ Rather, individual states must determine whether a right to abortion exists. Following Dobbs, state abortion laws have diverged significantly. This has generated confusion over what the law permits. Consequently, some pregnant women reportedly have not received timely treatment for life-threatening conditions. Clear guidance on abortion policy is essential, therefore, since continued confusion risks lives. Sweeping calls to improve patient access to abortion will not provide clear guidance, however, since ‘abortion’ is defined differently across jurisdictions. In fact, there are six variables to consider when defining ‘abortion’: (1) the definition of ‘pregnancy,’ (2) whether prescribing abortifacients counts as an abortion, (3) whether abortion successfully terminates pregnancy, (4) whether abortion has some characteristic intention, (5) whether providers must know that they likely will harm fetuses, and (6) whether providers must know that their patients are pregnant. States address each variable differently, so ‘abortion’ means different things across jurisdictions. One may respond that legislators are solely to blame for confusion here, since medical experts, by contrast, possesses a clear definition of ‘abortion.’ Not so. ‘Abortion’ is defined inconsistently throughout the medical literature too. As such, both legal and medical domains would benefit from careful discussions of ‘abortion.’ Attending to the six variables identified here is a good starting place. In this essay, I suggest how best to think about each and propose a definition of ‘abortion’ well-suited for developing clear abortion policy in a polarized society.

Abortion across borders: The globalization of rights access and civil resistance

In an era of increasing contestation of state abortion policy, reproductive health norms, networks, supplies, services, and seekers cross borders to an unprecedented degree. Health rights access networks assume new resistance roles, beyond the traditional vocation of transnational advocacy networks and national reproductive rights movements. We can expand our understanding of these new trends by building on Hirschman’s analysis of “exit, voice, and loyalty” to investigate how globalization expands the repertoire for reproductive rights promotion from the voice of norms and networks to the politics of exit and autonomy across borders. This article will explore the dynamics of these emerging complementary pathways through emblematic regional cases: the regional diffusion of transnational advocacy campaigns in Latin America, reproductive health migration in Central Europe, and autonomous medication provision networks in North America.

Regulating Abortion: The Politics of US Abortion Policy. By Deborah R. McFarlane and Wendy L. Hansen. Baltimore: Johns Hopkins University, 2024. 294p. $54.95 cloth – ERRATUM

Regulating Abortion: The Politics of US Abortion Policy. By Deborah R. McFarlane and Wendy L. Hansen. Baltimore: Johns Hopkins University, 2024. 294p. $54.95 cloth – ERRATUM

WHO Sexual and Reproductive Health and Rights Policy Portal

The Sexual and Reproductive Health and Rights Policy Portal is the publicly available interface for the World Health Organization’s up to date global health data in the areas of cervical cancer, family planning, infertility, sexual health, sexually transmitted infections, and violence against women. This overview details how users can visualize sexual and reproductive health and rights data on charts and maps and explore related resources including the Global Abortion Policies Database.

Attitudes regarding the safety of in-clinic and self-managed abortion methods among the US general public in early 2022

Medication abortion (MAB) is extremely safe—including when accessed outside the formal healthcare system—yet misinformation about its safety often influences policy, and research regarding public perceptions about its safety remains limited. In 2021-2022, we administered a US national probability-based online survey to 7,376 English- and/or Spanish-speaking people assigned female (AFAB, ages 15-49; N = 7,016) or male at birth (AMAB, ages 18-49; N = 360) to assess perceptions of MAB and self-managed abortion method safety. To identify characteristics associated with safety attitudes, we estimated weighted proportions and conducted multivariable multinomial logistic regressions. While approximately half of respondents believed MAB is safe when obtained in-clinic (52% AFAB/43% AMAB), very few believed it is safe when obtained outside the formal healthcare system (7% AFAB/5% AMAB). In multivariable analyses, prior awareness of MAB and the belief that abortion should be legal were associated with the belief that MAB is safe, both when accessed in-clinic and outside the formal healthcare system. Respondents living in US states that were restrictive to abortion rights/access were less likely to agree that in-clinic MAB is safe compared to those in protective abortion policy environments. The general public holds misinformation about the safety of MAB, particularly when obtained outside the formal healthcare system.

The impact of gestational age limits on abortion-related outcomes: a synthesis of legal and health evidence

BackgroundGestational age limits (GLs) are common in abortion laws and policies. They restrict when lawful abortion may be accessed by reference to the gestational duration of a pregnancy, in some cases specifying that abortion is a criminal offense after, but not before, the GL. This synthesis of legal and health evidence addresses knowledge gaps on the health and non-health outcomes plausibly related to the effects of GLs on abortion-related outcomes.MethodsThis paper synthesizes the results of a systemic review with the identification and application of relevant international human rights standards. A search strategy was drawn up to capture public health, international human rights law, and policy evidence related to the impacts of GLs. We limited our search to papers published in English since 2010, including quantitative studies (comparative and non-comparative), qualitative and mixed-methods studies, reports, PhD theses, and economic or legal analyses. Only studies that undertook original data collection or analysis were included. Review of treaties, opinions, interpretations, general comments, and special procedures of UN human rights bodies identified relevant human rights standards, which were then synthesized with the extracted data to create a comprehensive evidence synthesis.ResultsGLs do not prevent people from seeking abortion but do operate as a regulatory barrier that can result in people seeking abortion outside of the formal health system or unwillingly continuing pregnancy. In many jurisdictions, they interact with the criminalization of abortion, with significant health and non-health impacts. GLs impact most on people who are least able to access abortion because of later detection of pregnancy, lack of access to abortion provision, and lack of access to the resources required to avail of abortion.ConclusionsAlthough paradigmatic in abortion law, GLs are not based on evidence of either the safety or effectiveness of abortion or the needs and preferences of pregnant people. They produce rights-limiting impacts for pregnant people and, in some cases, result in arbitrary and disproportionate violations of legally protected rights. The persistence of GLs as part of the regulatory framework for abortion provision cannot be said to ensure an enabling environment for quality abortion care.

Regulating Abortion: The Politics of US Abortion Policy. By Deborah R. McFarlane and Wendy L. Hansen. Baltimore: Johns Hopkins University, 2024. 294p. $54.95 cloth.

Regulating Abortion: The Politics of US Abortion Policy. By Deborah R. McFarlane and Wendy L. Hansen. Baltimore: Johns Hopkins University, 2024. 294p. $54.95 cloth.