Abortion always has, and likely always will, divide opinions in terms of moral acceptability. It raises complex issues surrounding the status of the foetus, the concept of personhood, the principle of autonomy, and the ensuing balance between the rights of an unborn child versus those of a woman. The complexity of the moral landscape of abortion is reflected in the diverse range of legal approaches that different countries take in terms of if, when, and how abortions are permitted.

The debate around abortion has been reinvigorated by the recent United States Supreme Court ruling. Up until this ruling, the 1973 case of Roe vs Wade had enshrined a constitutional right for women in the United States to be able to access abortions. Although provision and ease of access to abortion service varied in practice, this constitutional ruling demonstrated that at least to some degree, the United States deemed it to be morally permissible in certain circumstances.

But that changed in June this year, when the Supreme Court overturned the ruling of Roe vs Wade, thereby delegating decisions about whether abortions are permitted to individual states. This interactive map shows which states have imposed restrictions or altogether banned abortions at the time of writing. All states permit abortion for the preservation of the life of the pregnant woman, but beyond this there is significant variation in their laws. Some states have taken a liberal approach in permitting abortion either altogether or up to the point of viability (generally considered up to 24 to 26 weeks). At the other extreme, many have banned abortions in all circumstances, including rape, incest, or where the foetus has a fatal anomaly.

Women from states where abortion is banned or heavily restricted can, at present, travel inter-state to access abortion services, although future legal challenges may be attempted to limit this. Such travel is no mean feat, requiring time off work or away from children, finances for flights and accommodation, as well as the practical challenges of finding clinic with the capacity to provide the abortion. This all at a time when a woman is pregnant, vulnerable, and dealing with the inevitably emotional burden of their decision to have an abortion, whatever the reason.

The characteristics of women who seek abortion in the United States are hugely significant in relation to the recent change in legislation, not only for practical reasons but also for moral ones. Women who seek an abortion are more likely to be from an ethnic minority (particularly black), unmarried, and already be a mother. They are significantly more likely to be from a deprived background – 75 percent of women accessing abortions are deemed “poor”, with 49 percent living below the federal poverty level. In summary, those who are most likely to seek an abortion are exactly those who are less likely to be able to access it with the new restrictions. They are less likely to have the time and finances to be able to travel interstate, and if unable to travel may be faced with the difficult decision of continuing an unwanted pregnancy, or even considering a self-induced termination.

As already mentioned, the morality of abortion has been debated for decades, and will continue to remain controversial and divide opinions. For those considered to be “pro-choice”, the recent change in law is devastating. They consider it to impose an unacceptable burden on a woman to continue an unwanted pregnancy, overriding her autonomy in favour of respecting the principle of the sanctity of life, and attaching undue weight to the state of personhood of the foetus. It is no surprise that the recent ruling has provoked protests not only across the United States but in solidarity across the world. Major international bodies have condemned the ruling, with the World Health Organization, and British Medical Association strongly opposing the change. A joint statement by a number of global healthcare organisations described abortion as “essential healthcare” and that access to it must be considered a “human right”. The UK Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual and Reproductive Healthcare (FSRH) have issued a statement renewing calls for the UK Government to decriminalise abortion in the UK. For those considered to be “pro-life”, the ruling is strongly welcomed as protecting the rights of the unborn child and respecting the principle of sanctity of life.

However, irrespective of one’s own views, there are moral principles which the change in law significantly impacts, which are universally considered to be some of the most important in our society - the principles of justice and equity. It is perhaps this which is so concerning about the new change in law.

Justice is widely considered fundamental for a functioning and fair society. Universal (and therefore equal) access to healthcare is widely considered as necessary to ensure people have equal opportunities (as an extension of Rawls’s principle of justice). If people cannot access healthcare equally, this adversely affects their other opportunities in terms of education, employment, financial stability, and so on, which everyone should have an equal entitlement to. It is easy to imagine how being unable to access an abortion - and therefore having to either take on significant burden to travel interstate or continue an unwanted pregnancy - could affect a woman (and a resulting child) in terms of these wider social factors.

As already outlined, those who are more likely to seek an abortion are more likely to be socially disadvantaged, and therefore less able to access abortion with the new laws. There is therefore potential for great harms to be caused in terms of limiting their access to broader opportunities, further widening health and social inequalities, and exacerbating deprivation. It is morally unjust for there to be such wide disparity in access to abortion services in different states, because doing so not only violates the principles of justice and fair access, but also contributes to wider social inequality and limitation of opportunity.

Irrespective of one’s own viewpoint on the moral acceptability of abortion, it is undeniable that the new laws have significant implications in terms of equity of access, and threatens the moral principle of justice - a principle which is integral to a functioning society. The new law will continue to exacerbate health inequalities and harm those who are already some of the most vulnerable in society, and it is this which should be keeping us awake at night.

Comments (4)

  • John Budny   

    Well-written article but there are some voids. Contraception can avoid the harshest forms of an unwanted pregnancy. Secondly, if contraception fails, how about adoption?

  • Nick Ross   

    The problem with Selina's approach is that it starts from her own liberal perspective (albeit one I share, as will most people who are interested in the Council's work).

    For example, for conservatives, for trenchant religious believers, for democrats, and even from a socialist viewpoint, the debate is about much more than "the status of the foetus, the concept of personhood, the principle of autonomy, and the ensuing balance between the rights of an unborn child versus those of a woman. women and foetuses."

    Some cultures think the fathers also have rights (indeed some societies declare openly that men have ultimate rights over women). If the rights of father’s are to be dismissed, perhaps ethicists should explain why.

    Most societies – and especially liberal democracies - think that the community has a role in making laws which affect the autonomy of individuals. If ethicists think personal autonomy should trump communal values then again we need to explain when how and why such outflanking is acceptable.

    Nor, surely, can we take it as read that it is “morally unjust for there to be such wide disparity in access to abortion services in different states.” Even the most progressive liberals often prize local democracy more than State-imposed uniformity. What some deride as a postcode lottery others value as local, federal or national independence. Indeed, decentralisation was one of the five pillars of the US constitution.

    Incidentally, in countries which have written constitutions, most democrats would agree that judges should not make rulings that contradict the constitution. While I am not a lawyer I gather there are good grounds to believe that abortion was not declared to be a right in 1787, that on the contrary the constitution guarantees the right to life “from the moment of conception”, that it was Roe v Wade that in effect erased that right, and the US Supreme Court ruling that put it back where the ‘Founding Fathers’ (a term which says a lot) had actually intended.

    I should declare my own starting-point, which is that I agree entirely with Selina that abortion should be readily available, and I agree wholeheartedly with much that she writes about harms and inequities that will result from the Supreme Court ruling. But ethics must not be shrink-wrapped to protect my own views from those of others. If the Nuffield Council on Bioethics (on which io served for many years) is to have real use it must confront the fact that multicultural and multi-belief societies have competing values, and ethical inquiry needs to learn from those we disagree with, not merely restate our own opinions.

  • Nadia Permalloo   

    Another case where the most vulnerable in society are marginalised further widening health inequalities. We will have to wait and see the fall out of this on future generations and on the children who are born into these scenarios. Sad on all levels.

  • Ravindra Ghooi   

    Good article that highlights the problems of those who wish an abortion. Why is it that most rights are denied to those who need them most? This is unfortunately a universal trend. I get more invitations for dinner than are good for me, while one who needs dinner most, gets none.

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