abortion essay in afrikaans

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Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis

• Merhawi Gebremedhin 1 ,
• Agumasie Semahegn 1 , 3 ,
• Tofik Usmael 2 &
• Gezahegn Tesfaye 1  

Systematic Reviews volume  7 , Article number:  130 ( 2018 ) Cite this article

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Unsafe abortion is a neglected public health problem contributing for 13% of maternal death worldwide. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. The prevalence of unsafe abortion is associated with restricted abortion law, poor quality of health service, and low community awareness. Hence, the aim of this systematic review and meta-analysis is to identify and summarize the available evidence to generate an abridged evidence on the prevalence of unsafe abortion and its associated factors in Sub-Saharan Africa.

The development of the systematic review methodology has followed the procedural guideline depicted in the preferred reporting items for systematic review and meta-analysis protocol statement. Observational studies that have been conducted from January 1, 1994, up to December 31, 2017, in Sub-Saharan African countries will be included in the systematic review and meta-analysis. MEDLINE (via PubMed), EMBASE, CINAHL, and PopLine will be searched to retrieve available studies. Relevant studies will be retrieved using the search strings applied to different sources. The Joanna Briggs Institute quality assessment tool will be used to critically appraise the methodological robustness and validity of the finding to avoid erroneous data due to confounded or biased statistics. Data extraction template will be prepared to record abstracted information from selected studies. The selection of relevant studies, data extraction, and quality assessment of studies will be carried out by two authors. Meta-analysis using Mantel–Haenszel random effects model will be carried out. The presence of heterogeneity between studies will be checked using the I 2 value.

Unsafe abortion is not yet reduced significantly in Sub-Saharan Africa, and maternal death rate due to unsafe abortion remains high. Currently, there is a gap in availability of abridged evidence on unsafe abortion and this negatively influenced the current service delivery. This finding will help stakeholders to design appropriate strategy. The finding of this systematic review and meta-analysis will be helpful to inform policy-makers, programmers, planners, clinician’s decision making, researchers, and women clients at large.

Systematic review registration

PROSPERO 2017: CRD42017081437 .

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Unsafe abortion is entirely preventable. However, it remains pandemic and serious public health issue worldwide [ 1 , 2 , 3 , 4 ]. The World Health Organization (WHO) defines unsafe abortion as a procedure of pregnancy termination either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both [ 5 ]. Unsafe abortion is a neglected problem of health care in developing countries [ 4 ]. Despite technological advancements in health care, unsafe abortion remained essentially unchanged worldwide [ 6 ]. Unsafe abortion is identified as one of the major cause of maternal morbidity and mortality [ 7 ]. In Sub-Saharan Africa (SSA), abortion is more common and it tends to be clandestine and unsafe that has a substantially contribution to maternal mortality [ 8 ].

Worldwide, 210 million women become pregnant each year. Of these, 80 million pregnancies are unplanned. Out of these, 46 million pregnancies terminated each year, and 19 million ends with unsafe abortion [ 1 , 2 , 3 , 4 ]. More than 97% of unsafe abortions take place in developing countries [ 2 , 4 , 9 , 10 ]. Globally, unsafe abortion increased from 44% in 1995 to 49% in 2008 [ 2 , 10 ]. In 2000, the WHO estimates that one in ten pregnancies end up with unsafe abortion, giving one unsafe abortion to seven live births ratio. Likewise, 68,000 women die due to unsafe abortion each year, and the risk of maternal death is high in developing countries (1 in 270 unsafe abortion) [ 4 ].

The maternal death associated with unsafe abortion was 37 deaths per 100,000 live births in SSA, 23 per 100,000 in Latin America and the Caribbean, and 12 per 100,000 in South Asia [ 1 ]. The WHO (2008) estimates that unsafe abortion contributes for 13% of maternal death, worldwide. However, in Africa, the contribution of unsafe abortion is too high which is 2.4 million unsafe abortions occurred in eastern Africa in 2008. Globally, 40% of reproductive aged women live in countries with highly restrictive abortion law [ 11 ]. In Africa, over 4 million unsafe abortions are carried out yearly; mostly on poor, rural, and young women lacking information on availability of safe abortion care. About 99% of all abortions carried out in Africa are unsafe, and the risk of maternal death from an unsafe abortion is one in every 150 procedures which is the highest in the world [ 12 , 13 ].

The prevalence of unsafe abortion is attributable to poverty, social inequity, and denial of women’s human rights [ 1 ]. Countries with restricted abortion or where abortions are clandestine and unsafe, its consequences to women’s health are harmful, particularly for young, poor, and low-education women [ 3 , 14 ]. Unsafe abortion is practiced using different methods such as use of oral and injectable items, vaginal preparations, intrauterine foreign bodies, and trauma to the abdomen [ 13 ]. Significant proportion of women (20–50%) with unsafe abortion develop complications that lead to hospital admission. These complications include hemorrhage, sepsis, peritonitis, and trauma to the cervix, vagina, uterus, and abdominal organs [ 2 ]. The Sustainable Development Goals (SDG) aim to reduce global maternal mortality ratio from 216 to 70 per 100, 000 live births by 2030. Therefore, in order to contribute to this goal, developing countries need to legalize abortion and improve health care system to reduce abortion-related maternal deaths [ 2 , 15 ]. Hence, the main purpose of this systematic review and meta-analysis is to identify and summarize the available evidence to determine prevalence of unsafe abortion among women in the reproductive age and associated factors in SSA.

Development review protocol and registration

The development of the review methodology has followed the procedural guideline that was endorsed by the preferred reporting items for systematic review and meta-analysis protocol (PRISMA-P) statement [ 16 ], and all of the items in the checklist were completed (see Additional file  1 ). The review protocol has been registered in international prospective register of systematic reviews (PROSPERO) with trial registration number (CRD42017081437).

Data source and searching strategies

The search of studies will be carried out by (MG and GT). Published and unpublished studies written in English will be retrieved and included into the review process. Databases such as MEDLINE (via PubMed), EMBASE, CINAHL, and POPLINE will be searched for studies that had been conducted since January 1, 1994. Relevant sources such as Google search engine, Google scholar, and WHO websites will be searched. In addition, experts on the field will be consulted to retrieve unpublished studies. The year 1994 was chosen because the international community recognized the pressing need to address unsafe abortion at the International Conference on Population and Development (ICPD) in the year 1994 [ 17 ] and many African countries endorsed semi-restricted abortion law since 1994 [ 18 ]. The search strings will emerge from the following keywords (unsafe abortion, induced abortion, abortion, Sub-Saharan Africa, or African South of Sahara). Depending on the specific requirement of the database, the search string will be modified, and relevant studies using search strings will be identified. The combinations of free keywords and MeSH (medical sub-headings) will be extensively used in the search process. The reference lists of relevant studies will also be reviewed for sources that may have been missed in the database search. The search strategy developed for selected database is attached (see Additional file  2 ).

Eligibility criteria

All observational studies (cross-sectional, case-control, and cohort) and survey reports will be included in the systematic review. However, case reports, case series, commentaries, and editorials will be excluded from the review. All studies with primary objective to determine the prevalence of unsafe abortion and/or its associated factors among reproductive aged women in Sub-Saharan Africa will be considered [ 8 ].

We will consider studies that defined unsafe abortion based on WHO definition [ 19 ]; WHO defines unsafe abortion as a procedure of pregnancy termination either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both. We will also include community or facility-based studies that used either primary or secondary data. We will include studies that had mainly reported prevalence of unsafe abortion and its associated factors. However, as far as our primary aim is to determine the prevalence of unsafe abortion, studies that reported only prevalence of unsafe abortion but not associated factors will be included. In addition, studies that at least had test statistics that measured association between predictor variables with unsafe abortion will be considered to identify the associated factors. The studies should have a crosstab showing difference in prevalence of unsafe abortion in the categories of the exposure variables. We will exclude studies that only investigated unsafe abortion with qualitative approach. If we come across studies that have both quantitative and qualitative study finding, we will only consider the quantitative findings.

Selection of studies

We will export all retrieved studies into the Endnote citation management software [ 20 ]. Initially, duplicated studies will be removed from the citation manger. The two authors (MG and AS) will independently screen the studies based on information contained in the titles and abstract based on the inclusion criteria. Studies that clearly mentioned unsafe abortion among reproductive aged women will be selected for the next step of evaluation. Consequently, studies that have been eligible based on their title and abstract will be further screened by GT and TU. Based on title and abstract assessment, the studies will be classified as included, excluded, and undecided studies. For studies that will be categorized as included and undecided, we will further examine and evaluate full texts of the studies for eligibility. The full-text screening will be carried out by GT and AS. Studies that will not be eligible based on the full-text assessment will be excluded and reasons will be described for their exclusion. Studies that will pass through this selection process will be included in qualitative and quantitative synthesis. During screening of the studies, any disagreement among reviewers will be resolved by discussion and reach common understanding. The study selection process flow diagram is adapted from PRISMA guideline [ 16 ] (see Additional file  3 ).

Quality assessment

Studies will be critically evaluated for their validity of the findings. To determine the methodological robustness and validity of the findings of the studies, we will use the JBI (Joanna Briggs Institute) tool for assessing the quality of evidence. Particular attention will be given to clear statement of the objective of the study, sampling techniques, precision of measurement of outcomes of interest and exposure variables, as well as documentation of sources of bias or confounding. The two review authors (GT and AS) will check the scientific quality of the studies independently using quality assessment tool mentioned above. In case of uncertainties, it will be resolved by joint discussion between them.

Data extraction

Data extraction template will be constructed on Microsoft Excel (2013). The two authors (MG and TU) will extract data systematically and stored using data extraction form. Piloting of the data extraction form will be carried out before the beginning of the actual data extraction. Study description tables will be used to record the type of study design, aim, sample size, primary outcomes of interest (prevalence of unsafe abortion), and secondary outcome (associated factors). Numerical data (frequency) will also be extracted and recorded in Microsoft Excel sheet. The systematic review and meta-analysis working group will contact authors of the studies to request for details through email in case of missing data, incomplete report, or any uncertainties.

Data synthesis and statistical analysis

The data will first be presented using narrative synthesis of the included studies. A summary table will be prepared to describe characteristics (author-date, country, design, aim, sampling method, sample size, response rate, and key findings) of the included studies. The presence of statistical heterogeneity will be checked by using the Cochran Q test. The level of heterogeneity among the studies will be quantified using the I 2 statistics where substantial heterogeneity will be assumed if the I 2 value is ≥ 60%. We will also check the presence of publication bias using funnel plot if more than ten studies are included. We will also do Egger’s and Beggar’s test to check publication bias [ 21 ]. To pool prevalence of unsafe abortion, we will conduct meta-analysis using Comprehensive Meta-analysis software [ 22 ]. We will use the random effects model and the raw numerical data (number of unsafe abortions ( n ) and total sample size ( N )) from each study. We hypothesize that the legal and illegal status of abortion influences the magnitude of unsafe abortion. Therefore, we will conduct sub-group analysis of the prevalence of unsafe abortion based on countries abortion legal status. Moreover, we will use adjusted, and if none available unadjusted, odds ratios to assess the association between risk factors and unsafe abortion.

The aim of this systematic review and meta-analysis is to synthesis research findings on the prevalence of unsafe abortion and its associated factor in SSA. Even though evidence [ 23 ] indicates that unsafe abortion is not showing reduction in SSA, there is no systematically reviewed evidence that show the overall prevalence of unsafe abortion and influencing factors in the region. Moreover, currently, there is a gap in the availability of complete data on unsafe abortion and this can negatively influence the prevailing service delivery [ 24 ]. Establishing reliable evidence on the magnitude of unsafe abortion are generally challenging especially in countries where access to abortion is legally restricted. Whether legal or illegal, induced abortion is usually stigmatized and frequently censured by political, religious, or other cultural issues. Hence, under-reporting is routine even in countries where abortion is legally available [ 25 ].

The magnitude of unsafe abortion can be measured using different approaches namely absolute numbers, incidence ratio, incidence rate, mortality ratio, and case fatality rate. However, absolute number of unsafe abortions cannot be used to compare the magnitude in different regions or sub-regions because of difference in population size. In our analysis, ratios and rates will be used to allow inter or intra comparisons of nation(s) [ 4 ]. Worldwide report indicates that the rate of unsafe abortion is not decreased at the same pace with that of safe abortion. Unsafe abortions changed very little: from 19.9 million in 1995 to 19.7 million in 2003 [ 26 ]. But there is no specific data that indicates the prevalence of unsafe abortion to support the current initiative to reduce the rate of unsafe abortion in the region.

Evidence indicates that maternal mortality ratio secondary to unsafe abortion is 950 times higher in SSA (520) than in the USA (0.6) per 100,000 live births, respectively. The burdens of unsafe abortion and its associated maternal mortality are disproportionately higher for women in Africa than in any other developing region [ 27 ]. Its share of global unsafe abortions was 29%, and more seriously, 62% of all deaths related to unsafe abortion occurred in Africa in 2008 [ 28 ]. In places where laws and policies allow abortion under broad indications, the incidence of and mortality from unsafe abortion are reduced to a minimum [ 28 ].

Meanwhile, unsafe abortion affects the health of millions of women predominantly the poor, illiterate, and those living in rural areas, and hence, knowing the prevailing situation of unsafe abortion could help develop appropriate programs that potentially circumvent its occurrence. Experts proposed that expanding effective modern contraceptive methods, making abortion legal with accessible safe abortion services, and improving the quality of post abortion care would reduce the magnitude of unsafe abortion, its associated maternal mortality and morbidity, and cost of post abortion services [ 26 , 29 ]. Systematic review conducted in SSA showed that care givers in general were uncertain about the legal status of abortion in their countries, with majority of them having negative feeling towards induced abortion and only some of the health care providers perceived the legalization of abortion as a positive step [ 1 ].

Subsequently, it remains important to assess the magnitude of unsafe abortion and its associated factors in SSA so as to inform the development of appropriate programs and policy that would have an impact in reducing maternal morbidity and mortality in the region. The finding from this systematic review will be important for national governments and nongovernmental organizations in the health sector of the individual countries of the region to give emphasis on the main factors that drive unsafe abortion. Moreover, this finding will also help governments and other health development partners to expand and improve family planning services, to further advocate for legalization of abortion and increase accessibility and availability of abortion services in order to improve women’s health and well-being [ 4 ]. Therefore, the finding of this systematic review and meta-analysis will be used to inform policy-makers, health programmers, clinicians’ decision making, researchers, human right activist, and women clients at large.

Abbreviations

International Conference on Population and Development

Joanna Briggs Institute

Preferred reporting items for systematic review and meta-analysis

Sustainable Development Goals

• Sub-Saharan Africa

World Health Organization

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Acknowledgements

We would like to thank Haramaya University, College Health and Medical Sciences, for the office arrangement and free internet access.

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Merhawi Gebremedhin, Agumasie Semahegn & Gezahegn Tesfaye

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Tofik Usmael

School of Public Health, College of Health Science, University of Ghana, Legon, Accra, Ghana

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MG, AS, TU, and GT conceived and designed the systematic review and meta-analysis. MG, AS, and GT drafted the protocol manuscript, and MG is the guarantor of the review. MG and GT developed the search strings. MG, AS, GT, and TU extensively reviewed and incorporated intellectual inputs in the protocol manuscript development. All authors read and approved the final version of the protocol manuscript.

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Correspondence to Merhawi Gebremedhin .

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Additional files

Additional file 1:.

PRISMA-P checklist. (DOC 84 kb)

Additional file 2:

Sample search strategy using search strings. (PDF 19 kb)

Additional file 3:

Diagramatic presentation of the studies selection process for systematic review. (DOCX 36 kb)

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Gebremedhin, M., Semahegn, A., Usmael, T. et al. Unsafe abortion and associated factors among reproductive aged women in Sub-Saharan Africa: a protocol for a systematic review and meta-analysis. Syst Rev 7 , 130 (2018). https://doi.org/10.1186/s13643-018-0775-9

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Ethics and Morality

Ethics and abortion, two opposing arguments on the morality of abortion..

Posted June 7, 2019 | Reviewed by Jessica Schrader

Abortion is, once again, center stage in our political debates. According to the Guttmacher Institute, over 350 pieces of legislation restricting abortion have been introduced. Ten states have signed bans of some sort, but these are all being challenged. None of these, including "heartbeat" laws, are currently in effect. 1

Much has been written about abortion from a philosophical perspective. Here, I'd like to summarize what I believe to be the best argument on each side of the abortion debate. To be clear, I'm not advocating either position here; I'm simply trying to bring some clarity to the issues. The focus of these arguments is on the morality of abortion, not its constitutional or legal status. This is important. One might believe, as many do, that at least some abortions are immoral but that the law should not restrict choice in this realm of life. Others, of course, argue that abortion is immoral and should be illegal in most or all cases.

"Personhood"

Personhood refers to the moral status of an entity. If an entity is a person , in this particular sense, it has full moral status . A person, then, has rights , and we have obligations to that person. This includes the right to life. Both of the arguments I summarize here focus on the question of whether or not the fetus is a person, or whether or not it is the type of entity that has the right to life. This is an important aspect to focus on, because what a thing is determines how we should treat it, morally speaking. For example, if I break a leg off of a table, I haven't done anything wrong. But if I break a puppy's leg, I surely have done something wrong. I have obligations to the puppy, given what kind of creature it is, that I don't have to a table, or any other inanimate object. The issue, then, is what kind of thing a fetus is, and what that entails for how we ought to treat it.

A Pro-Choice Argument

I believe that the best type of pro-choice argument focuses on the personhood of the fetus. Mary Ann Warren has argued that fetuses are not persons; they do not have the right to life. 2 Therefore, abortion is morally permissible throughout the entire pregnancy . To see why, Warren argues that persons have the following traits:

• Consciousness: awareness of oneself, the external world, the ability to feel pain.
• Reasoning: a developed ability to solve fairly complex problems.
• Ability to communicate: on a variety of topics, with some depth.
• Self-motivated activity: ability to choose what to do (or not to do) in a way that is not determined by genetics or the environment .
• Self-concept : see themselves as _____; e.g. Kenyan, female, athlete , Muslim, Christian, atheist, etc.

The key point for Warren is that fetuses do not have any of these traits. Therefore, they are not persons. They do not have a right to life, and abortion is morally permissible. You and I do have these traits, therefore we are persons. We do have rights, including the right to life.

One problem with this argument is that we now know that fetuses are conscious at roughly the midpoint of a pregnancy, given the development timeline of fetal brain activity. Given this, some have modified Warren's argument so that it only applies to the first half of a pregnancy. This still covers the vast majority of abortions that occur in the United States, however.

A Pro-Life Argument

The following pro-life argument shares the same approach, focusing on the personhood of the fetus. However, this argument contends that fetuses are persons because in an important sense they possess all of the traits Warren lists. 3

At first glance, this sounds ridiculous. At 12 weeks, for example, fetuses are not able to engage in reasoning, they don't have a self-concept, nor are they conscious. In fact, they don't possess any of these traits.

Or do they?

In one sense, they do. To see how, consider an important distinction, the distinction between latent capacities vs. actualized capacities. Right now, I have the actualized capacity to communicate in English about the ethics of abortion. I'm demonstrating that capacity right now. I do not, however, have the actualized capacity to communicate in Spanish on this issue. I do, however, have the latent capacity to do so. If I studied Spanish, practiced it with others, or even lived in a Spanish-speaking nation for a while, I would likely be able to do so. The latent capacity I have now to communicate in Spanish would become actualized.

Here is the key point for this argument: Given the type of entities that human fetuses are, they have all of the traits of persons laid out by Mary Anne Warren. They do not possess these traits in their actualized form. But they have them in their latent form, because of their human nature. Proponents of this argument claim that possessing the traits of personhood, in their latent form, is sufficient for being a person, for having full moral status, including the right to life. They say that fetuses are not potential persons, but persons with potential. In contrast to this, Warren and others maintain that the capacities must be actualized before one is person.

The Abortion Debate

There is much confusion in the abortion debate. The existence of a heartbeat is not enough, on its own, to confer a right to life. On this, I believe many pro-lifers are mistaken. But on the pro-choice side, is it ethical to abort fetuses as a way to select the gender of one's child, for instance?

We should not focus solely on the fetus, of course, but also on the interests of the mother, father, and society as a whole. Many believe that in order to achieve this goal, we need to provide much greater support to women who may want to give birth and raise their children, but choose not to for financial, psychological, health, or relationship reasons; that adoption should be much less expensive, so that it is a live option for more qualified parents; and that quality health care should be accessible to all.

I fear , however, that one thing that gets lost in all of the dialogue, debate, and rhetoric surrounding the abortion issue is the nature of the human fetus. This is certainly not the only issue. But it is crucial to determining the morality of abortion, one way or the other. People on both sides of the debate would do well to build their views with this in mind.

https://abcnews.go.com/US/state-abortion-bans-2019-signed-effect/story?id=63172532

Mary Ann Warren, "On the Moral and Legal Status of Abortion," originally in Monist 57:1 (1973), pp. 43-61. Widely anthologized.

This is a synthesis of several pro-life arguments. For more, see the work of Robert George and Francis Beckwith on these issues.

Michael W. Austin, Ph.D. , is a professor of philosophy at Eastern Kentucky University.

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How the Right to Legal Abortion Changed the Arc of All Women’s Lives

By Katha Pollitt

I’ve never had an abortion. In this, I am like most American women. A frequently quoted statistic from a recent study by the Guttmacher Institute, which reports that one in four women will have an abortion before the age of forty-five, may strike you as high, but it means that a large majority of women never need to end a pregnancy. (Indeed, the abortion rate has been declining for decades, although it’s disputed how much of that decrease is due to better birth control, and wider use of it, and how much to restrictions that have made abortions much harder to get.) Now that the Supreme Court seems likely to overturn Roe v. Wade sometime in the next few years—Alabama has passed a near-total ban on abortion, and Ohio, Georgia, Kentucky, Mississippi, and Missouri have passed “heartbeat” bills that, in effect, ban abortion later than six weeks of pregnancy, and any of these laws, or similar ones, could prove the catalyst—I wonder if women who have never needed to undergo the procedure, and perhaps believe that they never will, realize the many ways that the legal right to abortion has undergirded their lives.

Legal abortion means that the law recognizes a woman as a person. It says that she belongs to herself. Most obviously, it means that a woman has a safe recourse if she becomes pregnant as a result of being raped. (Believe it or not, in some states, the law allows a rapist to sue for custody or visitation rights.) It means that doctors no longer need to deny treatment to pregnant women with certain serious conditions—cancer, heart disease, kidney disease—until after they’ve given birth, by which time their health may have deteriorated irretrievably. And it means that non-Catholic hospitals can treat a woman promptly if she is having a miscarriage. (If she goes to a Catholic hospital, she may have to wait until the embryo or fetus dies. In one hospital, in Ireland, such a delay led to the death of a woman named Savita Halappanavar, who contracted septicemia. Her case spurred a movement to repeal that country’s constitutional amendment banning abortion.)

The legalization of abortion, though, has had broader and more subtle effects than limiting damage in these grave but relatively uncommon scenarios. The revolutionary advances made in the social status of American women during the nineteen-seventies are generally attributed to the availability of oral contraception, which came on the market in 1960. But, according to a 2017 study by the economist Caitlin Knowles Myers, “The Power of Abortion Policy: Re-Examining the Effects of Young Women’s Access to Reproductive Control,” published in the Journal of Political Economy , the effects of the Pill were offset by the fact that more teens and women were having sex, and so birth-control failure affected more people. Complicating the conventional wisdom that oral contraception made sex risk-free for all, the Pill was also not easy for many women to get. Restrictive laws in some states barred it for unmarried women and for women under the age of twenty-one. The Roe decision, in 1973, afforded thousands upon thousands of teen-agers a chance to avoid early marriage and motherhood. Myers writes, “Policies governing access to the pill had little if any effect on the average probabilities of marrying and giving birth at a young age. In contrast, policy environments in which abortion was legal and readily accessible by young women are estimated to have caused a 34 percent reduction in first births, a 19 percent reduction in first marriages, and a 63 percent reduction in ‘shotgun marriages’ prior to age 19.”

Access to legal abortion, whether as a backup to birth control or not, meant that women, like men, could have a sexual life without risking their future. A woman could plan her life without having to consider that it could be derailed by a single sperm. She could dream bigger dreams. Under the old rules, inculcated from girlhood, if a woman got pregnant at a young age, she married her boyfriend; and, expecting early marriage and kids, she wouldn’t have invested too heavily in her education in any case, and she would have chosen work that she could drop in and out of as family demands required.

In 1970, the average age of first-time American mothers was younger than twenty-two. Today, more women postpone marriage until they are ready for it. (Early marriages are notoriously unstable, so, if you’re glad that the divorce rate is down, you can, in part, thank Roe.) Women can also postpone childbearing until they are prepared for it, which takes some serious doing in a country that lacks paid parental leave and affordable childcare, and where discrimination against pregnant women and mothers is still widespread. For all the hand-wringing about lower birth rates, most women— eighty-six per cent of them —still become mothers. They just do it later, and have fewer children.

Most women don’t enter fields that require years of graduate-school education, but all women have benefitted from having larger numbers of women in those fields. It was female lawyers, for example, who brought cases that opened up good blue-collar jobs to women. Without more women obtaining law degrees, would men still be shaping all our legislation? Without the large numbers of women who have entered the medical professions, would psychiatrists still be telling women that they suffered from penis envy and were masochistic by nature? Would women still routinely undergo unnecessary hysterectomies? Without increased numbers of women in academia, and without the new field of women’s studies, would children still be taught, as I was, that, a hundred years ago this month, Woodrow Wilson “gave” women the vote? There has been a revolution in every field, and the women in those fields have led it.

It is frequently pointed out that the states passing abortion restrictions and bans are states where women’s status remains particularly low. Take Alabama. According to one study , by almost every index—pay, workforce participation, percentage of single mothers living in poverty, mortality due to conditions such as heart disease and stroke—the state scores among the worst for women. Children don’t fare much better: according to U.S. News rankings , Alabama is the worst state for education. It also has one of the nation’s highest rates of infant mortality (only half the counties have even one ob-gyn), and it has refused to expand Medicaid, either through the Affordable Care Act or on its own. Only four women sit in Alabama’s thirty-five-member State Senate, and none of them voted for the ban. Maybe that’s why an amendment to the bill proposed by State Senator Linda Coleman-Madison was voted down. It would have provided prenatal care and medical care for a woman and child in cases where the new law prevents the woman from obtaining an abortion. Interestingly, the law allows in-vitro fertilization, a procedure that often results in the discarding of fertilized eggs. As Clyde Chambliss, the bill’s chief sponsor in the state senate, put it, “The egg in the lab doesn’t apply. It’s not in a woman. She’s not pregnant.” In other words, life only begins at conception if there’s a woman’s body to control.

Indifference to women and children isn’t an oversight. This is why calls for better sex education and wider access to birth control are non-starters, even though they have helped lower the rate of unwanted pregnancies, which is the cause of abortion. The point isn’t to prevent unwanted pregnancy. (States with strong anti-abortion laws have some of the highest rates of teen pregnancy in the country; Alabama is among them.) The point is to roll back modernity for women.

So, if women who have never had an abortion, and don’t expect to, think that the new restrictions and bans won’t affect them, they are wrong. The new laws will fall most heavily on poor women, disproportionately on women of color, who have the highest abortion rates and will be hard-pressed to travel to distant clinics.

But without legal, accessible abortion, the assumptions that have shaped all women’s lives in the past few decades—including that they, not a torn condom or a missed pill or a rapist, will decide what happens to their bodies and their futures—will change. Women and their daughters will have a harder time, and there will be plenty of people who will say that they were foolish to think that it could be otherwise.

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By Jia Tolentino

By Isaac Chotiner

By Jessica Winter

Read our research on: Abortion | Podcasts | Election 2024

Regions & Countries

Key facts about the abortion debate in america.

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

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Public Opinion on Abortion

Majority in u.s. say abortion should be legal in some cases, illegal in others, three-in-ten or more democrats and republicans don’t agree with their party on abortion, partisanship a bigger factor than geography in views of abortion access locally, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

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Are you about to write a persuasive essay on abortion but wondering how to begin?

Writing an effective persuasive essay on the topic of abortion can be a difficult task for many students. 

It is important to understand both sides of the issue and form an argument based on facts and logical reasoning. This requires research and understanding, which takes time and effort.

In this blog, we will provide you with some easy steps to craft a persuasive essay about abortion that is compelling and convincing. Moreover, we have included some example essays and interesting facts to read and get inspired by. 

So let's start!

• 1. How To Write a Persuasive Essay About Abortion?
• 2. Persuasive Essay About Abortion Examples
• 3. Examples of Argumentative Essay About Abortion
• 4. Abortion Persuasive Essay Topics
• 5. Facts About Abortion You Need to Know

How To Write a Persuasive Essay About Abortion?

Abortion is a controversial topic, with people having differing points of view and opinions on the matter. There are those who oppose abortion, while some people endorse pro-choice arguments. 

It is also an emotionally charged subject, so you need to be extra careful when crafting your persuasive essay .

Before you start writing your persuasive essay, you need to understand the following steps.

Step 1: Choose Your Position

The first step to writing a persuasive essay on abortion is to decide your position. Do you support the practice or are you against it? You need to make sure that you have a clear opinion before you begin writing. 

Once you have decided, research and find evidence that supports your position. This will help strengthen your argument. 

Check out the video below to get more insights into this topic:

Step 2: Choose Your Audience

The next step is to decide who your audience will be. Will you write for pro-life or pro-choice individuals? Or both? 

Knowing who you are writing for will guide your writing and help you include the most relevant facts and information.

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Step 3: Define Your Argument

Now that you have chosen your position and audience, it is time to craft your argument. 

Start by defining what you believe and why, making sure to use evidence to support your claims. You also need to consider the opposing arguments and come up with counter arguments. This helps make your essay more balanced and convincing.

Step 4: Format Your Essay

Once you have the argument ready, it is time to craft your persuasive essay. Follow a standard format for the essay, with an introduction, body paragraphs, and conclusion. 

Make sure that each paragraph is organized and flows smoothly. Use clear and concise language, getting straight to the point.

Step 5: Proofread and Edit

The last step in writing your persuasive essay is to make sure that you proofread and edit it carefully. Look for spelling, grammar, punctuation, or factual errors and correct them. This will help make your essay more professional and convincing.

These are the steps you need to follow when writing a persuasive essay on abortion. It is a good idea to read some examples before you start so you can know how they should be written.

Continue reading to find helpful examples.

Persuasive Essay About Abortion Examples

To help you get started, here are some example persuasive essays on abortion that may be useful for your own paper.

Short Persuasive Essay About Abortion

Persuasive Essay About No To Abortion

What Is Abortion? - Essay Example

Persuasive Speech on Abortion

Legal Abortion Persuasive Essay

Persuasive Essay About Abortion in the Philippines

Persuasive Essay about legalizing abortion

You can also read m ore persuasive essay examples to imp rove your persuasive skills.

Examples of Argumentative Essay About Abortion

An argumentative essay is a type of essay that presents both sides of an argument. These essays rely heavily on logic and evidence.

Here are some examples of argumentative essay with introduction, body and conclusion that you can use as a reference in writing your own argumentative essay. 

Abortion Persuasive Essay Introduction

Argumentative Essay About Abortion Conclusion

Argumentative Essay About Abortion Pdf

Argumentative Essay About Abortion in the Philippines

Argumentative Essay About Abortion - Introduction

Abortion Persuasive Essay Topics

If you are looking for some topics to write your persuasive essay on abortion, here are some examples:

• Should abortion be legal in the United States?
• Is it ethical to perform abortions, considering its pros and cons?
• What should be done to reduce the number of unwanted pregnancies that lead to abortions?
• Is there a connection between abortion and psychological trauma?
• What are the ethical implications of abortion on demand?
• How has the debate over abortion changed over time?
• Should there be legal restrictions on late-term abortions?
• Does gender play a role in how people view abortion rights?
• Is it possible to reduce poverty and unwanted pregnancies through better sex education?
• How is the anti-abortion point of view affected by religious beliefs and values? 

These are just some of the potential topics that you can use for your persuasive essay on abortion. Think carefully about the topic you want to write about and make sure it is something that interests you. 

Check out m ore persuasive essay topics that will help you explore other things that you can write about!

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Facts About Abortion You Need to Know

Here are some facts about abortion that will help you formulate better arguments.

• According to the Guttmacher Institute , 1 in 4 pregnancies end in abortion.
• The majority of abortions are performed in the first trimester.
• Abortion is one of the safest medical procedures, with less than a 0.5% risk of major complications.
• In the United States, 14 states have laws that restrict or ban most forms of abortion after 20 weeks gestation.
• Seven out of 198 nations allow elective abortions after 20 weeks of pregnancy.
• In places where abortion is illegal, more women die during childbirth and due to complications resulting from pregnancy.
• A majority of pregnant women who opt for abortions do so for financial and social reasons.
• According to estimates, 56 million abortions occur annually.

In conclusion, these are some of the examples, steps, and topics that you can use to write a persuasive essay. Make sure to do your research thoroughly and back up your arguments with evidence. This will make your essay more professional and convincing. 

Need the services of a professional essay writing service ? We've got your back!

MyPerfectWords.com is a persuasive essay writing service that provides help to students in the form of professionally written essays. Our persuasive essay writer can craft quality persuasive essays on any topic, including abortion. 

Frequently Asked Questions

What should i talk about in an essay about abortion.

When writing an essay about abortion, it is important to cover all the aspects of the subject. This includes discussing both sides of the argument, providing facts and evidence to support your claims, and exploring potential solutions.

What is a good argument for abortion?

A good argument for abortion could be that it is a woman’s choice to choose whether or not to have an abortion. It is also important to consider the potential risks of carrying a pregnancy to term.

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The Supreme Court Got It Wrong: Abortion Is Not Settled Law

By Melissa Murray and Kate Shaw

Ms. Murray is a law professor at New York University. Ms. Shaw is a contributing Opinion writer.

In his majority opinion in the case overturning Roe v. Wade, Justice Samuel Alito insisted that the high court was finally settling the vexed abortion debate by returning the “authority to regulate abortion” to the “people and their elected representatives.”

Despite these assurances, less than two years after Dobbs v. Jackson Women’s Health Organization, abortion is back at the Supreme Court. In the next month, the justices will hear arguments in two high-stakes cases that may shape the future of access to medication abortion and to lifesaving care for pregnancy emergencies. These cases make clear that Dobbs did not settle the question of abortion in America — instead, it generated a new slate of questions. One of those questions involves the interaction of existing legal rules with the concept of fetal personhood — the view, held by many in the anti-abortion movement, that a fetus is a person entitled to the same rights and protections as any other person.

The first case , scheduled for argument on Tuesday, F.D.A. v. Alliance for Hippocratic Medicine, is a challenge to the Food and Drug Administration’s protocols for approving and regulating mifepristone, one of the two drugs used for medication abortions. An anti-abortion physicians’ group argues that the F.D.A. acted unlawfully when it relaxed existing restrictions on the use and distribution of mifepristone in 2016 and 2021. In 2016, the agency implemented changes that allowed the use of mifepristone up to 10 weeks of pregnancy, rather than seven; reduced the number of required in-person visits for dispensing the drug from three to one; and allowed the drug to be prescribed by individuals like nurse practitioners. In 2021, it eliminated the in-person visit requirement, clearing the way for the drug to be dispensed by mail. The physicians’ group has urged the court to throw out those regulations and reinstate the previous, more restrictive regulations surrounding the drug — a ruling that could affect access to the drug in every state, regardless of the state’s abortion politics.

The second case, scheduled for argument on April 24, involves the Emergency Medical Treatment and Labor Act (known by doctors and health policymakers as EMTALA ), which requires federally funded hospitals to provide patients, including pregnant patients, with stabilizing care or transfer to a hospital that can provide such care. At issue is the law’s interaction with state laws that severely restrict abortion, like an Idaho law that bans abortion except in cases of rape or incest and circumstances where abortion is “necessary to prevent the death of the pregnant woman.”

Although the Idaho law limits the provision of abortion care to circumstances where death is imminent, the federal government argues that under EMTALA and basic principles of federal supremacy, pregnant patients experiencing emergencies at federally funded hospitals in Idaho are entitled to abortion care, even if they are not in danger of imminent death.

These cases may be framed in the technical jargon of administrative law and federal pre-emption doctrine, but both cases involve incredibly high-stakes issues for the lives and health of pregnant persons — and offer the court an opportunity to shape the landscape of abortion access in the post-Roe era.

These two cases may also give the court a chance to seed new ground for fetal personhood. Woven throughout both cases are arguments that gesture toward the view that a fetus is a person.

If that is the case, the legal rules that would typically hold sway in these cases might not apply. If these questions must account for the rights and entitlements of the fetus, the entire calculus is upended.

In this new scenario, the issue is not simply whether EMTALA’s protections for pregnant patients pre-empt Idaho’s abortion ban, but rather which set of interests — the patient’s or the fetus’s — should be prioritized in the contest between state and federal law. Likewise, the analysis of F.D.A. regulatory protocols is entirely different if one of the arguments is that the drug to be regulated may be used to end a life.

Neither case presents the justices with a clear opportunity to endorse the notion of fetal personhood — but such claims are lurking beneath the surface. The Idaho abortion ban is called the Defense of Life Act, and in its first bill introduced in 2024, the Idaho Legislature proposed replacing the term “fetus” with “preborn child” in existing Idaho law. In its briefs before the court, Idaho continues to beat the drum of fetal personhood, insisting that EMTALA protects the unborn — rather than pregnant women who need abortions during health emergencies.

According to the state, nothing in EMTALA imposes an obligation to provide stabilizing abortion care for pregnant women. Rather, the law “actually requires stabilizing treatment for the unborn children of pregnant women.” In the mifepristone case, advocates referred to fetuses as “unborn children,” while the district judge in Texas who invalidated F.D.A. approval of the drug described it as one that “starves the unborn human until death.”

Fetal personhood language is in ascent throughout the country. In a recent decision , the Alabama Supreme Court allowed a wrongful-death suit for the destruction of frozen embryos intended for in vitro fertilization, or I.V.F. — embryos that the court characterized as “extrauterine children.”

Less discussed but as worrisome is a recent oral argument at the Florida Supreme Court concerning a proposed ballot initiative intended to enshrine a right to reproductive freedom in the state’s Constitution. In considering the proposed initiative, the chief justice of the state Supreme Court repeatedly peppered Nathan Forrester, the senior deputy solicitor general who was representing the state, with questions about whether the state recognized the fetus as a person under the Florida Constitution. The point was plain: If the fetus was a person, then the proposed ballot initiative, and its protections for reproductive rights, would change the fetus’s rights under the law, raising constitutional questions.

As these cases make clear, the drive toward fetal personhood goes beyond simply recasting abortion as homicide. If the fetus is a person, any act that involves reproduction may implicate fetal rights. Fetal personhood thus has strong potential to raise questions about access to abortion, contraception and various forms of assisted reproductive technology, including I.V.F.

In response to the shifting landscape of reproductive rights, President Biden has pledged to “restore Roe v. Wade as the law of the land.” Roe and its successor, Planned Parenthood v. Casey, were far from perfect; they afforded states significant leeway to impose onerous restrictions on abortion, making meaningful access an empty promise for many women and families of limited means. But the two decisions reflected a constitutional vision that, at least in theory, protected the liberty to make certain intimate choices — including choices surrounding if, when and how to become a parent.

Under the logic of Roe and Casey, the enforceability of EMTALA, the F.D.A.’s power to regulate mifepristone and access to I.V.F. weren’t in question. But in the post-Dobbs landscape, all bets are off. We no longer live in a world in which a shared conception of constitutional liberty makes a ban on I.V.F. or certain forms of contraception beyond the pale.

Melissa Murray, a law professor at New York University and a host of the Supreme Court podcast “ Strict Scrutiny ,” is a co-author of “ The Trump Indictments : The Historic Charging Documents With Commentary.”

Kate Shaw is a contributing Opinion writer, a professor of law at the University of Pennsylvania Carey Law School and a host of the Supreme Court podcast “Strict Scrutiny.” She served as a law clerk to Justice John Paul Stevens and Judge Richard Posner.

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How rightwing groups used junk science to get an abortion case before the US supreme court

Anti-abortion researchers ‘exaggerate’ and ‘obfuscate’ in their scientific papers – but by the time they’re published, it’s too late

• Explainer: the mifepristone case
• Tell us: have you used an abortion pill in the US?

A pharmacy professor who strenuously avoids heated political discussions is an unlikely candidate to get involved in a fight over abortion, particularly one as high stakes as a case now before the supreme court: the US Food and Drug Administration (FDA) v the Alliance for Hippocratic Medicine (AHM).

But when the professor Chris Adkins of South University in Georgia emailed his concerns about an academic article to the editors of Health Services Research and Managerial Epidemiology, that’s exactly what happened.

The article had been published by an anti-abortion research institute and, perhaps unsurprisingly, concluded that medication abortion was far less safe than the accepted scientific consensus – one established by more than 100 peer-reviewed studies across multiple continents and two decades of real-world use.

“The way this study used this situation to exaggerate, and I’ll say obfuscate, the truth behind mifepristone’s safety profile is where I thought: ‘I’ll reach out to the journal and say I’ve got these issues,’” said Adkins, referring to the drug targeted by researchers. Mifepristone is one half of a two-pill regimen that treats miscarriage and ends early pregnancy, and its future hangs in the balance of the supreme court case, to be heard this week.

“I honestly didn’t think I would be the first to do that,” said Adkins.

Within a couple days of Adkins’ complaint, the global academic publisher Sage, which publishes the journal, began investigating. Within weeks, Sage retracted not one but three papers by the anti-abortion researchers .

Adkins’ concerns go to the heart of a problem that has bedeviled scientists for at least a decade: the judicial system’s repeated adoption of poor-quality evidence to justify litigation and legislation to restrict abortion. Often that evidence is produced by the anti-abortion movement itself.

FDA v AHM is scheduled for oral arguments on Tuesday. The suit, brought by anti-abortion doctors, seeks to force the FDA to reverse decisions that relaxed restrictions on prescribing mifepristone. The Biden administration and the medication’s manufacturer argue the doctors have no right to sue in the first place.

The study Adkins complained about is central to the doctors’ case, and was cited heavily by a federal district court in Amarillo, Texas, that kicked off the government’s appeal when it found in favor of anti-abortion doctors.

How the supreme court decides the case could have profound implications. A finding in favor of anti-abortion doctors could reshape abortion access again in the US, including in Democratic-led states that might have considered themselves immune from restrictions. It also holds the potential to upend the FDA’s authority, which could call into question the future of all kinds of controversial drugs, from contraception to vaccines to treatments for HIV.

Researchers are skeptical that Sage’s retractions alone will make a difference in the court’s decision.

“It’s frustrating, it’s depressing, it’s maddening and quite honestly it’s frightening,” said the obstetrician and gynecologist Daniel Grossman of the University of California at San Francisco (UCSF).

Grossman is also a professor and the director of Advancing New Standards in Reproductive Health , one of the nation’s foremost reproductive health research groups. His own work has been taken out of context by attorneys arguing to restrict abortion in court briefs, he said, and he has published pieces to criticize the poor quality of evidence produced by anti-abortion doctors and researchers.

“Judges don’t have expertise to be able to review the science, just like I don’t have all the expertise to understand all the legal maneuvering that’s happening in this case,” said Grossman.

The anti-abortion movement pours money into research groups such as the Charlotte Lozier Institute, whose raison d’ être is to produce articles its activists can cite in litigation, legislation and promotional materials. The institute was founded in 2011 by one of the nation’s most powerful anti-abortion advocacy groups, Susan B Anthony Pro-life America, and its researchers are responsible for the three now-retracted articles flagged by Adkins.

Mary Ziegler, a professor of law at the University of California at Davis and a leading legal historian of the abortion debate, says the movement has spent decades investing in its own research arm. Campaigners started fringe publications, such as the journal Issues in Law and Medicine, a peer-reviewed publication produced by the the National Legal Center for the Medically Dependent and Disabled. That organization was founded by James Bopp , a lawyer who has campaigned against abortion for decades, and is now the lead council of the National Right to Life.

The journal’s current editor , Barry Bostrom, is an attorney who fought abortion for decades. Bostrom has served as director and general counsel of Indiana Right to Life , and at least once represented National Right to Life before the Federal Election Commission in 2009, alongside Bopp.

But “that’s not the business model anymore”, Ziegler said. The movement is no longer limiting anti-abortion research to its own journals.

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Now, anti-abortion researchers also seek to place their research in journals published by academic publishers such as Sage or, in another example, the British Journal of Psychiatry, published by the Royal College of Psychiatrists.

In the latter example, an American researcher found that abortion accounts for a substantial increase of risk in adverse mental health outcomes. However, the researcher’s analysis depended in part on a “debunked” paper, overestimated risk and did not follow published guidelines for the kind of analysis performed.

Researchers have repeatedly raised concerns to the British Journal of Psychiatry and even recently published an article in the British Medical Journal (BMJ) calling for a retraction. So far, they have been rebuffed by British psychiatrists.

In spite of their efforts, the researcher’s work has been repeatedly cited as evidence of the harms of abortion before state courts and federal courts. In 2022, the researchers’ work was cited in a brief to the supreme court in Dobbs v Jackson Women’s Health Organization, the case that ended nearly 50 years of constitutional protection for abortion. The anti-abortion movement has also used the researcher as an expert witness in court .

But fighting poor-quality evidence can feel like a losing battle. Responding in a well-respected journal can be a lengthy process that doesn’t always pay off.

Ushma Upadhyay, a public health social scientist trained in demography, and a professor in the department of obstetrics and gynecology at UCSF, contributed to both the BMJ article that failed to secure a retraction, and co-authored an article in the journal Contraception with Adkins on the flaws in the now-retracted Sage articles.

“We worked on it over Thanksgiving break. My mom was visiting, and I was like: ‘I’m really sorry, we have to get this out,’” said Upadhyay. “The stakes were so high.”

Evaluating scientific evidence is difficult under the best of circumstances. To the untrained eye, academic journals are a thicket of unknown quality, and “peer review” is a lofty term but is only as strong as the people doing the reviewing.

Even when researchers make a compelling case, journals can be loath to correct the scientific record . That allows a contested article to be further cited and compounds the damage of poor evidence..

“For every one paper that is retracted, there are probably 10 that should be,” Ivan Oransky, co-founder of Retraction Watch, recently told the New York Times. Retraction Watch maintains a database of more than 47,000 retracted studies.

Should the court choose to undermine the FDA, it will be the result of a tragic irony – that one of the world’s most respected arbiters of science could be undone by research that would never meet its standards.

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The Fight Against Birth Control Is Already Here

Conservatives are using old methods to start the battle against contraceptives..

Ever since the Supreme Court overturned Roe v. Wade in Dobbs v. Jackson Women’s Health Organization , progressive commentators have worried about whether the right to contraception will be in jeopardy next. Republicans largely dismiss these arguments as political fearmongering: There is no mass movement against contraception equivalent to the anti-abortion movement, they argue, and Republicans in some states have actually pushed expanded access to contraception .

But the concerns about birth control’s fate don’t seem so far-fetched anymore. Last week, the 5 th Circuit Court of Appeals handed a major victory to Jonathan Mitchell, the former Texas solicitor general who has masterminded many of the key post- Dobbs anti-abortion strategies, in a case on birth control that offers a chilling sign of things to come. As I write with Naomi Cahn and Maxine Eichner in an article forthcoming in the Michigan Law Review, conservatives have used arguments about parental rights to attack actions pertaining to school programs on race, sexuality, and gender identity—and to limit travel for abortion. Now, Mitchell is hoping to use a similar strategy to start undermining access to contraception.

The case involves Alexander Deanda, a conservative Christian father angry that the Title X family planning program theoretically allowed his three daughters to confidentially access contraceptive services before turning 18. Since it passed in 1970, Title X has ensured all patients, including minors, access to confidential care, recognizing that this guarantee can affect minors’ choices. Deanda, who did not like this prospect, complained about how the Biden administration was administering Title X, saying it violated his right under both Texas law and the U.S. Constitution to stop his underage daughters from getting birth control without his consent.

There were two problems with his arguments. The first was that Deanda was looking for a reason to be in court rather than suffering a real injury. He admitted that none of his children had obtained or even tried to get birth control without his consent.

That was no problem for the 5th Circuit, which reasoned that the Biden administration’s administration of Title X “obliterated” Deanda’s right to consent, even if there was no realistic chance that his daughters were ever going to seek out birth control services in the first place.

This is no surprise. The 5 th Circuit has accepted strikingly weak arguments about standing before, including in the abortion pill case, Food and Drug Administration v. Alliance for Hippocratic Medicine , that is being argued before the Supreme Court later this month. There, the 5 th Circuit saw no problem with standing when a group of anti-abortion doctors argued merely that they may have to treat patients with complications from the abortion pill mifepristone. The three-judge panel in Deanda reached a similar conclusion.

The Biden administration had a response: Even if the Texas family code recognizes a right for parents to consent to their children’s medical treatment, federal law still trumps state law. Not so, said the 5 th Circuit, which reinvented the Texas statute to allow states to require parental consent. No matter that this contradicts an earlier ruling by Robert Bork, a conservative hero in Federalist Society circles. It also opens the door to numerous other state policies mandating that minors get their parents’ approval before accessing birth control. And while the 5 th Circuit did not reach a firm conclusion on Deanda’s constitutional claims, it was not hard to see that the court was sympathetic to his broader demands. Deanda’s “right to exercise his Christian belief that his children should abstain from premarital sex,” the court wrote, was part of “ our enduring American tradition .”

Deanda is just the start of new efforts to roll back contraceptive access, and these efforts are borrowing from a familiar playbook. Activists and attorneys like Mitchell have already experimented with laws that purport to protect minors from “abortion trafficking” when others assist minors in traveling out of state—or “grooming” when school sex education programs teach anything about sexual orientation or gender identity—while suggesting that minors need protection for a reason : abortion is actually dangerous, for example, or being gay or transgender is undesirable. With birth control, conservatives have drawn on the same playbook to argue that contraceptives are dangerous to minors, increasing their risk of cancer or depression , and that parents have a reason to be concerned about their children beyond a belief that premarital sex is wrong.

Republicans are probably right that states won’t pass direct bans on birth control in the near future, or that anyone will pursue an immediate challenge to the right to contraception recognized in cases like Griswold v. Connecticut. But there may be no need for such a move when some conservatives already insist that drugs commonly marketed as contraceptives, such as the morning-after pill, IUDs, and even the birth control pill, are in fact abortifacients.

But Deanda shows that there is a playbook already in place to limit access to contraception for minors and to stigmatize it as unsafe as well as immoral. Deanda’s argument tells us a lot about what is driving part of this campaign: hostility to sex outside of marriage, for adults as much as for minors. It is only when children’s rights are involved, however, that we are currently hearing the quiet part said out loud.

At stake in mifepristone case: abortion, FDA’s authority and return to 1873 obscenity law

Lawyers from the conservative Christian group that won the case to overturn  Roe v. Wade  returned to the U.S. Supreme Court on Tuesday in pursuit of an urgent priority: shutting down access to abortion pills for women across the country.

The case challenges the FDA’s regulation of mifepristone, a prescription-only drug approved in 2000 with a  stellar safety record  that is used in  63% of all U.S. abortions .

Viewed across decades of anti-abortion activism, the case brought by the Alliance Defending Freedom represents a "moonshot" couched in technical arguments about pharmaceutical oversight and the resuscitation of an 1873 anti-obscenity law. A victory would lay the groundwork for a de facto nationwide abortion ban.

Abortion is illegal  in 14 states , but abortion pills have never been more widely available.

During the COVID-19 pandemic, the FDA suspended — and later formally lifted — the requirement that patients be at a health care facility when taking mifepristone, the first of two pills used in medication abortion. Physicians can now prescribe the drug online through telemedicine and pharmacies can dispense it through the mail.

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"You don’t need to be handed the pill in the office," said Linda Prine, a family medicine physician, sitting on a couch in her Manhattan apartment answering texts and calls from patients about abortion care.

"It’s very effective," she said. "I don’t even have medications that are 98 to 99% effective. Our blood pressure medicines aren’t effective like that."

Prine, a co-founder of the Miscarriage and Abortion Hotline, works with other doctors operating under New York state’s shield law to prescribe and send abortion pills to people across the country. A review of Prine’s call log, stripped of personal information, showed hundreds of requests for pills from Texas, Louisiana, Tennessee, and other states where it is illegal for women to stop a pregnancy.

Anti-abortion groups unsuccessfully petitioned the FDA at least twice before, in  2002  and  2019 , to revoke mifepristone’s approval and curtail its availability. But in November 2022, following its victory in overturning federal abortion rights, the Alliance Defending Freedom filed a federal lawsuit in Amarillo, Texas, claiming the FDA’s safety review of mifepristone was flawed.

U.S. District Judge Matthew Kacsmaryk of the Northern District of Texas, who was appointed by President Donald Trump and openly opposes abortion, ruled  to invalidate the FDA’s approval of mifepristone . An appeals court later said the drug should remain available, but it reinstated restrictions, including prohibitions on telehealth prescriptions and mailing the medication. That ruling was put on hold while the Supreme Court considers the case.

The Biden administration and a manufacturer of mifepristone, Danco Laboratories, have argued in legal filings to the Supreme Court that federal judges do not have the scientific and health expertise to evaluate drug safety and that allowing them to do so undermines the FDA’s regulatory authority.

That view is supported by  food and drug legal scholars  who wrote in court filings that the lower courts had replaced the "FDA’s scientific and medical expertise with the courts’ own interpretations of the scientific evidence." In doing so, they wrote, the courts "upend the drug regulatory scheme established by Congress and implemented by FDA."

In his ruling, Kacsmaryk cited two studies purporting to show an increase in emergency room visits and a greater risk of hospitalizations from medication abortion. They were  retracted in February  by medical publisher Sage Perspectives. The journal said the researchers erred in their methodology and analysis of the data and invalidated the papers "in whole or in part."

The research, supported by the Charlotte Lozier Institute, an anti-abortion group that filed a brief in the mifepristone case, "made claims that were not supported by the data," said Ushma Upadhyay, a professor of reproductive sciences at the University of California-San Francisco.

Legal scholars say the Supreme Court’s conservative justices have demonstrated a willingness to accept discredited abortion-related health claims. Justice Samuel Alito, writing the majority opinion in  Dobbs v. Jackson Women’s Health Organization , which overturned the constitutional right to abortion, cited statements  about harm to maternal health  presented by the state of Mississippi that contradict mainstream medical consensus.

"If this case is successful, it will be because the Supreme Court decided to ignore evidence that demonstrated mifepristone’s safety and said to a federal agency, the expert on drug safety, ‘You were wrong,’" said Rachel Rebouché, dean of Temple University Beasley School of Law.

The ‘politicization of science’

The mifepristone case crystallizes "the politicization of science" in abortion regulation, Rebouché said. "But the stakes are getting higher as we have courts willing to strip federal agencies of their ability to make expert decisions."

Rebouché said that if the Supreme Court overrides the FDA’s expertise in regulating a 24-year-old drug like mifepristone, anti-abortion groups, like Students for Life of America, could find judges  receptive to false claims  that birth control pills, intrauterine devices, emergency contraception, and other forms of hormonal birth control cause abortion. They do not, according to reproductive scientists and U.S. and international regulatory agencies.

Justice Clarence Thomas wrote in his  concurring opinion  in  Dobbs  that the Supreme Court should reconsider the 1965 decision that guaranteed a constitutional right to contraception,  Griswold v. Connecticut , and decide whether to return the power to allow or regulate access to birth control to the states.

Tucked into the Alliance Defending Freedom’s filings is what scholars describe as an audacious legal strategy once on the fringes of the conservative Christian movement: an appeal to the Supreme Court’s conservative members to determine that  the Comstock Act , a dormant 1873 anti-vice law, effectively bans medical and procedural abortion nationwide.

Passed at a time when the federal government did not give women the right to vote and the  prevailing medical literature  summed up women’s sexuality by saying that "the majority of women (happily for them) are not very much troubled with sexual feelings of any kind," the long unenforced law carried a five-year prison sentence for anyone mailing "every article, instrument, substance, drug, medicine or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion."

References to the Comstock Act appear throughout anti-abortion legal filings and rulings: Kacsmaryk wrote that the act "plainly forecloses mail-order abortion in the present";  the 5th Circuit Court of Appeals wrote  if Comstock was "strictly understood" then "there is no public interest in the perpetuation of illegality"; Republican attorneys general  threatened legal action against Walgreens and CVS  last year citing Comstock as did anti-abortion cases in New Mexico and  Texas .

" State attorneys general need to go after and prosecute those who are illegally mailing abortion drugs into their state," said Kristan Hawkins, president of Students for Life of America.

"It’s very simple. If your state has passed a law saying that preborn human beings deserve, at the very minimum, the right not to be starved and killed," she said, "then those who are committing those crimes and violating the federal Comstock Act by shipping chemical abortion pills over state lines, there should be consequences."

Tracking abortion pills by mail is difficult — and that’s the point, Rebouché said.

"These more diffuse and mobile ways to terminate a pregnancy," she said, "really threaten the control that anti-abortion advocates seek to exercise over who and where and how someone can seek an abortion." This story was republished from KFF Health News.

My Abortion Story Went Viral. Here’s What Happened Next.

In an exclusive essay for ELLE.com, Arizona state Sen. Eva Burch recounts her speech on the floor of the Arizona Senate.

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Last week, Arizona state Sen. Eva Burch did the unthinkable: She announced her decision to get an abortion on the floor of the Arizona Senate. In her speech, which quickly went viral, Burch talked about the importance of access to abortion care in America and why she, as a politician, felt compelled to share her story in such a public manner. Now, in an exclusive essay for ELLE, Burch writes about that emotional moment on the Senate floor—and why she wants to “ change the narrative about what abortion care looks like.”

Two years ago I scheduled my first abortion. This was a pregnancy my husband and I had been dreaming of and planning for, but it wasn’t progressing. Then, as if that news wasn’t heartbreaking enough, I began to miscarry. The bleeding was heavier than expected, and we called an ambulance.

Shortly after we arrived at the hospital, my miscarriage stalled, and the bleeding stopped. Doctors could still see the embryo on the ultrasound, but there was no longer a heartbeat. I was told that I couldn’t have an abortion in the hospital, because my life wasn’t in danger. Instead, doctors advised me to wait and go to my scheduled abortion appointment the next day. They said their hands were tied, and it was all they could do. Two weeks later, the Supreme Court overturned Roe v. Wade .

Fast forward to this year, and I found out that I was pregnant once again. My mother had just passed away in my home where I was caring for her, and it was hard not to believe this was a sign that this pregnancy might be different. But after several ultrasounds, it became clear that my pregnancy was, once again, not progressing as it should. I made the decision to have an abortion.

For far too long, political extremists have worked to rewrite the image of the abortion patient—working overtime to make us believe that the only people who seek out abortion care are promiscuous, selfish, irresponsible, or even lazy. This narrative is pushed to create stigma and justify bad laws.

Sometimes it feels like a bad dream; my first abortion was days before the Supreme Court stripped away the reproductive rights of millions of Americans. Here I am, standing in that position once again, as the Supreme Court hears oral arguments on Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration (FDA) , which will decide how patients can access mifepristone, one of two drugs (along with misoprostol) used in medication abortions.

My own experience has been marred by disinformation and obstacles created by out-of-touch elected officials. If SCOTUS once again chooses to side with extremists, it will make medication abortion much harder to get. And we know these attacks won’t stop there. While SCOTUS decides just how much bodily autonomy we are entitled to, the Arizona Supreme Court is weighing the decision to either uphold our state’s current 15-week abortion ban or reinstate our no-exceptions total ban on abortion that was enacted in 1864. Either way, Arizonans lose. And similar scenarios are playing out in states all across the country .

I can’t find a way to say this with more clarity: Our rights are on the chopping block, and they won’t be protected unless you show up to vote in November. As a legislator, I am well aware of how hostile Republicans can be to our rights and freedoms. I work with them every day. Some Arizona Republicans are so far out of touch, that they refused to even consider or discuss the Right to Contraception Act that was introduced by my Democratic colleagues. So we know exactly what they are coming for next. It will never be enough.

I share my story in the hopes that we can change the narrative about what abortion care looks like, who the abortion patient is, and how legislation impacts real people seeking abortion care. The overwhelming amount of love that I have received and the willingness of strangers to tell me their own stories gives me hope that November will be a time of celebration, not heartbreak. We have the power to write our own stories. Let’s do it together. Get registered to vote. Learn about the candidates on your ballot. Bring friends to the polls.

Abortion is on the ballot, and we must elect politicians up and down the ticket who will remain committed to restoring our fundamental freedoms—and who protect us from those who seek to take away our rights, our stories, and our futures.

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More proof that the assault on reproductive freedom doesn’t stop with abortion : Now teens in Texas can’t obtain contraceptives without their parents being informed and granting approval. The inevitable result will be more unintended pregnancies and more desperate girls in a state where almost all abortions are banned.

You can thank the state of Texas and the ultraconservative U.S. Court of Appeals for the 5th Circuit for this situation. The sensible thing to do to prevent unwanted pregnancy is to make access to contraceptives as easy and risk-free as possible. Forcing children to have children is not in anyone’s interest.

I have experienced this debate from both sides now — as a teenager and as a mother of teenagers. And while I agree that parental involvement is preferable and think it’s understandable that parents want a say in their children’s medical decisions, I also know those discussions are not always going to happen. In many families, the consequences could be far worse than invasions of privacy and uncomfortable conversations.

Congress understood this, too, when it provided federal funding for family planning clinics and, in 1978, worried about the explosion in teen pregnancy, explicitly amended the Title X law to include contraceptive coverage for adolescents. In 1981, it further changed the law to “encourage family participation,” to “the extent practical.”

The Reagan administration tried to seize on this language a few years later to require that parents be notified when their children sought contraception from federally funded clinics. This so-called squeal rule was struck down by two federal appeals courts. In addition, every appeals court to address the conflict between state parental consent rules and Title X has found that the state rules conflict with Title X and can’t be enforced.

In short, for four decades now, the rules have been clear: Teenagers can obtain contraception in confidence. Or so we thought. Texas law gives parents the right to consent before their children get contraceptives. Alexander Deanda, who said he was raising his three daughters to conform to his Christian beliefs that they should abstain from premarital sex, filed suit to challenge the administration of Title X as a violation of Texas law and of his constitutional right to direct his children’s upbringing. U.S. District Judge Matthew Kacsmaryk, a Trump nominee famous for his ruling against the abortion drug mifepristone , agreed.

Last week, the 5th Circuit sided with Deanda . The all-Republican panel — two George W. Bush nominees and Trump nominee Stuart Kyle Duncan — brushed aside the Biden administration’s argument that Deanda lacked standing because he hadn’t shown any real risk of being harmed by the confidentiality policy. There was no assertion that his daughters had obtained contraceptives from a Title X clinic or were inclined to do so.

That didn’t concern the 5th Circuit, in an opinion written by Duncan. (You may recall him from being shouted down by Stanford Law School students unhappy with his position on LGBTQ+ rights.) “The Secretary’s policy is to spend millions to get contraceptives to minors without telling their parents,” Duncan wrote. “It should not come as a shock that there could be a correspondingly large number of parents who can challenge it in court.”

Duncan said the federal law didn’t interfere with — and therefore didn’t preempt — the Texas rule. Really? One — the federal law, the one that’s supposed to take precedence — says that family participation should be “encourage[d],” so far as “practical.” The other — the Texas law, which is supposed to give way under the supremacy clause — mandates parental consent.

Duncan looked at the two laws and said he discerned “no conflict between Title X’s objectives and Texas’s.” Both want to encourage family participation — Texas, he said, just “establishes a specific means of achieving that goal.” So much for paying attention to the statutory text.

Still, the 5th Circuit didn’t go as far as Kacsmaryk, something that’s becoming a trend with this extremist judge . Having concluded that the federal law didn’t preempt the Texas consent requirement, the appeals court didn’t answer the broader constitutional question of whether Title X violated Deanda’s rights as a parent to control his children’s upbringing.

One additional wrinkle: In 2021, after Deanda’s lawsuit was filed, the Biden administration issued a regulation providing that recipients of Title X funds can’t require parental consent or notify parents that minors have requested contraceptive services. Kacsmaryk declared the new rule unlawful. But the appeals court said that went too far because Deanda hadn’t properly challenged it.

In other words, watch this space. But don’t sleep easy. As we’ve seen with interference with in vitro fertilization in Alabama , and as we see with contraceptives in Texas, outlawing abortion is just the start.

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The Moral Significance of Abortion Inconsistency Arguments

William simkulet.

1 Park University, Parkville, MO USA

2 Dodge City Community College, Dodge City, KS USA

Most opponents of abortion (OA) believe fetuses matter . Critics argue that OA act inconsistently with regards to fetal life, seeking to restrict access to induced abortion, but largely ignoring spontaneous abortion and the creation of surplus embryos by IVF. Nicholas Colgrove, Bruce Blackshaw, and Daniel Rodger call such arguments inconsistency arguments and contend they do not matter. They present three objections to these arguments — the other beliefs, other actions, and hypocrisy objection. Previously, I argued these objections fail and threaten to undermine ethical inquiry. Colgrove et al. have recently replied, but here, I argue their reply fails as well and raises a new criticism of the other actions’ objection. This essay sets out to show, as well as any philosophical argument can, that inconsistency arguments are morally significant.

Introduction

Nicholas Colgrove, Bruce Blackshaw, and Daniel Rodger ( 2020 ) set out to show that inconsistency arguments “do not matter”; by inconsistency argument , they mean to pick out a variety (Fleck 1979 ; Murphy 1985 ; Ord 2008 ; Lovering 2013 , 2014 , 2017 , 2020 ; Berg 2017 ; Simkulet 2016 , 2017 , 2019a , b , c , 2020 ; Bovens 2006 ; Schlumpf 2019 ) of disparate criticisms identifying apparent inconsistencies in how opponents of abortion (OA) treat fetuses. Unfortunately, this term is misleading, as practically all philosophical arguments involve identifying some form of inconsistency, confusion, or misunderstanding.

Critics of the prolife anti-abortion position argue that OA hold inconsistent moral beliefs; they claim to believe that fetuses are persons from conception, but they neglect the welfare of fetuses who are spontaneously aborted by natural causes, and overlook the well-being of the surplus frozen human embryos created for IVF. Perhaps the strangest argument that Colgrove et al. ( 2020 ) label as an inconsistency argument comes from Sister Joan Chittister (Schlumpf 2019 ), who chastises those who call themselves “pro-life” for neglecting the welfare of born persons. Proponents of inconsistency arguments argue that OA hold inconsistent moral beliefs, arguing that upon revision, they will conclude that they either (i) need to do more, or (ii) need not oppose abortion.

Colgrove et al. ( 2020 ) contend that such arguments “do not matter.” This paper interprets this as the claim that inconsistency arguments are morally irrelevant for any (widely held) OA view. This paper will show that such arguments are morally relevant to the most widely held OA position.

Another way to read Colgrove et al. is as claiming they “do not matter” because they cannot show that OA need to adopt (ii) over (i). They say, “Inconsistency arguments simply are not equipped to undermine OAs’ views; at most, they reveal what OAs should do (or believe).” (Colgrove et al. 2020 ) This is uncharitable. First, while some inconsistency theorists (Ord 2008 ; Berg 2017 ) might believe that OA do not really believe fetuses are persons from conception, these arguments identify apparent inconsistency, but need not take a stance on how OA ought to resolve this inconsistency. Second, even if OA choose (i) and conclude they ought to do more to prevent spontaneous abortion (education, research, increased access to healthcare (Simkulet 2017 , 2020 ), and perhaps a major shift in social priorities (Ord 2008 ; Berg 2017 ), and more for surplus IVF embryos (adoption, and gestation (Lovering 2020 ; Blackshaw and Colgrove 2020 ; Blackshaw 2021 ), this matters . Colgrove et al. jest that if OA embrace option (i) it would “make the world a (much) worse place (from the critic’s perspective)”; but fail to note that it would make the world a much better place from the perspective of OA!

Complicating matters, there seems to be disagreement among Colgrove, Blackshaw, and Rodger regarding what opposition to abortion requires. Notably, Bruce Blackshaw ( 2021 , 166) contends that Christians ought to act as neighbors, and offers a robust, clear account of what this requires:

Treating frozen embryos as neighbors requires securing them a life like ours through adoption and gestation, and as well as opposing abortion, Christians must work toward this goal for the vast numbers of frozen embryos that would otherwise be discarded.

Blackshaw and Rodger ( 2019 ) attempt to justify OA disinterest in spontaneous abortion, claiming that most cases of spontaneous abortion are not currently preventable; but Blackshaw ( 2021 ) notes that “if we regard all human life as equally valuable, we have at least some obligation toward helping reduce deaths from spontaneous abortion where possible”.

This paper argues that inconsistency arguments matter. It is divided into three main sections. The first draws a distinction between restrictivist and moralist views on abortion, arguing only restrictivist views are OA. The second sets out to defend my earlier criticism (Simkulet 2021 ) of the other beliefs, other actions, and hypocrisy objections from Blackshaw et al.’s ( 2021 ) recent response. The third offers a new argument against the other actions objection; I argue that if this objection were to succeed, it would undermine restrictivist opposition to abortion.

Opposition to Abortion

On miscarriage.

Before his collaboration (Colgrove et al. 2020 ) with Blackshaw and Rodger, Colgrove ( 2019 ) raised a different criticism of Berg’s ( 2017 ) inconsistency argument. Berg argues that because miscarriage is so common, if we believe fetuses matter , we ought to devote more medical resources to protecting them. Colgrove replies that “miscarriage is not a cause of death,” but rather “it is an outcome.” Blackshaw et al. ( 2021 ) accuse me of the same error.

This is rather uncharitable, but it also misses two key points common in inconsistency arguments. First, if OA believe that fetuses matter, one would expect them to be concerned with both spontaneous and induced abortion, as both are tragic. Second, even if spontaneous abortion has many disparate causes, there may be a common solution. For example, Aspirin can treat a wide variety of conditions, from scraped knee to eye strain to migraine. Many proposals inconsistency theorists discuss (for example, education, gene therapy, and ectogenesis technology) would prevent spontaneous abortion by many different causes.  In short, even if miscarriage is not a single cause of death, there is good reason to think a single solution might address many different cases, saving many fetal lives.

On Opposition to Abortion

To play on Colgrove, note that opposition to abortion is not a moral theory, it is an action or stance one can take toward abortion. There are many reasons why one might oppose abortion; one might merely find the word “abortion” to be distasteful, might oppose abortion on teleological grounds, argue that it is outside the scope of medicine, or that it violates the Hippocratic Oath.

However, most opposition to abortion rests on a single belief. Judith Jarvis Thomson ( 1972 ) says, “Most opposition to abortion relies on the premise that the fetus is a human being, a person, from the moment of conception.” Don Marquis ( 1989 ) says “Many of the most insightful and careful writers on the ethics of abortion… believe that whether or not abortion is morally permissible stands or falls on whether or not a fetus is the sort of being whose life it is seriously wrong to end.”

In short, most opposition to abortion turns on the belief that a fetus matters from conception (or soon afterwards (Marquis 2007 , 2013 ); that the fetus is morally comparable to an adult human person. This view is usually abbreviated as the view that fetuses are persons, broadly construed to mean one of many disparate theories about moral status; that human fetuses are human organisms (Mulder 2013 ), rational substances (Lee and George 2005 ; Beckwith 2007 ; George and Tollefsen 2008 ; Friberg-Fernros 2015 ), have a possible future it would be wrong to deprive them of Marquis 1989 ; Stone 1987 ), etc.

Colgrove et al. ( 2020 ) seek to show that inconsistency arguments are morally irrelevant for any (widely held) anti-abortion view, and there seems to be widespread consensus the most widely held anti-abortion view claims fetuses are persons, broadly construed, from conception (PAC). This paper defends the position that inconsistency arguments are morally relevant to the PAC view.

Restrictivism and Moralism

It will be practical to distinguish between two groups of anti-abortion positions — Restrictivism  (Davis 1984 ; Carroll and Crutchfield Forthcoming ), the view that we should adopt social policies that restrict a woman’s access to induced abortion, and Moralism , the view that abortion is merely immoral, but that we do not need adopt Restrictivist social policies.

It is not hard to see why PAC theorists might embrace restrictivism. On this view, fetuses are comparable to adult human persons, and society has adopted policies aimed at protecting the rights of adult human persons, so it is prima facie plausible that we should adopt similar social policies regarding fetuses. However, Thomson ( 1972 ) demonstrates that it is not enough to show that fetuses merely have a right to life by way of the violinist case:

Violinist: The Society of Music Lovers kidnaps you and attaches your circulatory system to a famous, innocent, unconscious violinist suffering from a kidney ailment that will kill him unless he remains connected to your kidneys for nine months. (Adapted)

The violinist obviously has a right to life, but Thomson argues that the right to life does not give him the right to use your body; it is morally permissible for you to disconnect yourself from the violinist. Thomson says it would be a “great kindness” to stay attached to the violinist but that you do not have to accede to this.

Disconnecting the violinist from your body is comparable to disconnecting a patient from life support to let him die. Restrictivists might argue that induced abortion is not a matter of letting die; but of killing; but this will not do, as one can terminate a pregnancy without killing the fetus by severing the umbilical cord or removing the uterus, “merely” letting the fetus die. If this distinction mattered, restrictivists would not be anti-abortion, they would merely oppose how most abortions are currently performed.

Thomson shows it is not enough for restrictivists to believe fetuses are persons with a right to life, they must also believe something more , that (a) the fetus’s right to life is a positive right to assistance, or (b) the gestational mother somehow comes to have a special obligation to provide assistance to the fetus. She argues that this special obligation cannot be explained by merely risking the chance of pregnancy, as this would imply any woman who leaves the house without a hysterectomy has consented to pregnancy, even by rape. Furthermore, David Boonin ( 2002 ) argues that even if one consents to provide aid, one can withdraw consent.

Bone Marrow: Your neighbor is diagnosed with a condition that will kill him unless he receives monthly bone marrow transplants over the course of nine months from a match. You are a match and you agree to donate. However, it soon becomes clear that these surgeries ask more than you are willing to give, and you refuse to go in for the second surgery. (Adapted)

These thought experiments demonstrate that restrictivists must do more than argue fetuses are persons, they must argue that the fetus has a positive right to assistance.

However, one can believe abortion is immoral without believing we ought to adopt restrictivist social policies. There are many prima facie immoral things that it would be inappropriate to restrict by law. For example, I think most of us would agree that it is prima facie immoral to waste scarce resources, but that individuals might have a right to do so in some cases. One might hold that it is wrong to waste food without holding that throwing away leftovers should be illegal. Similarly, one might hold that adultery outside of an open marriage is immoral, but that adopting social policies that restrict such behavior would be undesirable, in part, because they are difficult to enforce, and in part because it might incentivize other immoral behavior, such as murdering one’s spouse to keep one’s adultery secret.

Moralism is the view that abortion is often, all things considered, immoral, but does not require that we adopt social policies that restrict woman’s access to abortion. There are many reasons why moralists might reject restrictivism independent of Thomson and Boonin-style concerns.

For example, restrictivist views have a hard time making exceptions for rape cases, despite the fact that many restrictivists believe such exceptions should be made. Rape victims are often reluctant to report rape and reluctant to take medical exams. Convictions in rape cases are difficult to obtain, especially within the short window in which inducing abortion would be medically preferable. As such, restrictivists face a dilemma – (a) if they require proof of rape, then few rape victims are allowed to abort; while (b) if they do not require proof of rape, they encourage women to merely say they were raped (whether true or not), failing to prevent most induced abortions and encouraging deception.

Restrictivists face a similar challenge with regards to self-defense, as all pregnancies are medically risky. The prospect of drawing a nonarbitrary line with regards to legally obligatory medical risk is dubious, but even if such a task could be achieved, those physicians sympathetic to abortion might overestimate risk and those opposing abortion might underestimate or ignore risk. Furthermore, medical risk of abortion increases with malnutrition and other medical emergencies, so those seeking abortion on medical grounds are incentivized to harm themselves to pass this threshold.

In light of these, and other, difficulties, many people who believe abortion are immoral reject restrictivism and adopt moralism. Notably, moralists need not hold that fetuses have a positive right to assistance, like restrictivists. I have contended (Simkulet 2021 ) that most OA believe fetuses have a positive right to assistance — that most OA are restrictivists. Blackshaw et al. ( 2021 ) claim that I miss “the target,” as one can be an OA without being committed to the belief that fetuses have a positive right to assistance.

Perhaps Colgrove et al. wish OA to pick out both restrictivist and moralist positions, but this will not do. Although moralists believe induced abortion is immoral, they are prochoice, while Colgrove et al. identify OA as prolife. Perhaps Colgrove et al. mean to say restrictivism does not require the belief that fetuses have a positive right to assistance, but this would merely introduce greater inconsistency regarding medical and legal ethics, as illustrated by Thomson ( 1972 ) and Boonin ( 2002 ).

Do Inconsistency Arguments Matter?

Colgrove et al. ( 2020 ) raise three objections to inconsistency arguments — the other beliefs, other actions, and hypocrisy objections. I contend (Simkulet 2021 ) these objections threaten to undermine moral analysis completely; opposing parties could always claim to have other beliefs, other actions, or interpret criticism as an ad hominem attack impinging their character.

This section is divided into four subsections. The first looks at two inconsistency arguments. The next three subsections briefly summarize Colgrove et al.’s objections, and my criticisms (Simkulet 2021 ) of these arguments.

Inconsistency Arguments

OA often point to high numbers of induced abortion as a call to action. Upwards of 60% (Boklage 1990 ; Léridon 1977 ) of human pregnancies end in spontaneous abortion, prompting critics to ask why OA do not see spontaneous abortion as a call to action. Toby Ord ( 2008 ) compares spontaneous abortion to a scourge that kills over half of humanity. Berg ( 2017 ) compares it to Heart Disease, Cancer, and Stroke. Faced with these overwhelming numbers, inconsistency theorists conclude that if fetuses matter, then the problem of spontaneous abortion calls for a massive shift in our social and political priorities. I have noted (Simkulet 2021 ) that we recently underwent such a shift to address the COVID-19 pandemic.

Henrik Friberg-Fernros ( 2015 , 2019 , 2018 ) challenges this position, contending that while fetal death is always tragic, not all fetal deaths are equally tragic; that killing is worse than letting die, and even that fetal lives are worth less than adult human lives because they lack time relative interests (Friberg-Fernros 2019 )! However, inconsistency arguments do not assume that all fetal deaths are equally tragic, merely that if fetuses matter, their deaths are tragic.

OA face a dilemma — either they (i) need to do more to prevent fetal death, or (ii) should withdraw opposition to induced abortion. Some proponents think OA should choose (ii) — that the argument demonstrates they do not really believe fetuses are persons. However, others propose a wide variety of methods by which OA might reasonably seek to confront the problem of fetal death, from increased education and better access to healthcare, to technologies like ectogenesis and gene therapy that those on both sides of the abortion debate could reasonably support (Simkulet 2020 ).

While many inconsistency arguments focus on unaddressed fetal loss, Colgrove et al. ( 2020 ) also categorize Chittister's tweet (Schlumpf 2019 ) as an inconsistency argument. She asks whether it makes sense to call OA “pro-life” merely because they oppose abortion, noting all OA seem to be concerned with is ensuring the child is born, not fed, educated, or housed; asserting “That’s not pro-life. That’s pro-birth.”

Colgrove et al. ( 2020 ) contend that Chittister is using the term “pro-birth” pejoratively, but this is rather uncharitable. The term “pro-life” carries with it a positive emotive context, and when OA present their view as “pro-life,” they may mislead their audience about their position. In contrast, the term “pro-birth” seems to capture the one unifying feature of OA.

Even if Chittister is angry or disappointed that OA misrepresent their position, neglect their moral obligations, or the like… so what? That is how moral judgements work. If you think Φing is wrong, and you see someone Φing, it makes sense to be angry or disappointed. Colgrove et al. speak as though this, and accusations of pro-life hypocrisy are ad hominem attacks on OA; not so. An ad hominem fallacy occurs when one attacks person rather than their argument or view. Inconsistency arguments do not do this; they identify apparent inconsistency within the OA view, and call for change, as Chittister does when she concludes, “We need a much broader conversation on what the morality of pro-life is.”

Other Beliefs Objection and Response

Colgrove et al. ( 2020 ) raise three objections to inconsistency arguments. In the first, they contend that inconsistency arguments do not matter because there is a diversity of beliefs among OA, suggesting that no one inconsistency argument undermine them all; “This diversity makes broad accusations of inconsistency problematic.” Following this, one might argue that when an OA is confronted with apparent inconsistency within one view, they can jump ship to another OA view. But moral analysis is not a shell game. If inconsistency arguments identify a problem within even one OA position, they matter; and if they threaten the most widely held OA position, it seems they matter quite a bit.

Colgrove et al. ( 2020 ) suggest that OA may have other beliefs which explain away apparent inconsistency and justify their inaction with regards to spontaneous abortion; for example they ask us to consider someone who both opposes induced abortion and opposes universal healthcare; noting these beliefs would justify rejecting the conclusion that we should adopt universal health care to help address the problem of induced and spontaneous abortion (and suffering and death due to lack of medical care, more broadly). To this, I reply (Simkulet 2021 ):

It is not enough to show that some [OA] have some beliefs that are prima facie at odds with some [inconsistency theorist] proposals; they must show that the current level of apparent indifference that many [OA] show is justified by their other beliefs; and it is not clear what set of other beliefs would be both internally consistent and justify the conclusion that while persons [matter], this right requires very little in the way of sacrifice from anyone but gestational mothers.

Blackshaw et al. ( 2021 ) contend that I argue “this [apparent] indifference must be justified by their other beliefs…” continuing “there is an obvious belief that justifies [OA]’s actions and priorities —… [OA] believe that induced abortion is a more important priority than these other issues.” However, this misses the point. As we have seen above, inconsistency theorists do not claim that OA need to treat the problem of spontaneous abortion as equally important to the problem of induced abortion, but rather they must consistently recognize both are tragic.

Blackshaw et al. ( 2021 ) continue “induced abortion is the leading preventable cause of death of human beings, as spontaneous abortions are largely unpreventable.” However, they seem to understand “preventable” in an opportunistically narrow way — as preventable with our current technology — to disregard the problem of spontaneous abortion. Amy Berg ( 2017 ) challenges this opportunistically narrow caveat:

But imagine throwing up our hands about a horrible disease… Imagine saying that we should let AIDS, or cancer, or heart disease take its course, rather than expending more effort researching how we might prevent that disease or treat people who contract it. That’s not what we do.

Berg ( 2017 ) notes that just because spontaneous abortion is medically intractable now does not mean it will be in the future, comparing to the AIDs epidemic, “In just a couple of decades, AIDS went from a mysterious underground disease, to a devastating and fatal epidemic, to a relatively manageable chronic condition.”

Perhaps more troublingly, Blackshaw et al. ( 2021 ) say, “If OAs sincerely believe these claims, then they are acting consistently with their beliefs, and the Other Beliefs Objection succeeds.” Above I have argued that even if one sees one form of abortion as a greater priority than another, this does not justify apparent indifference OAs show with regards to spontaneous abortion.

The real challenge here is “sincerity,” most people have inconsistent beliefs of one form or another and do not realize it; but it is possible that one can realize that they hold two sincere beliefs while also sincerely believing those beliefs to be inconsistent. Consider the problem of evil; one might sincerely believe that God exists, that evil exists, and that God would not allow evil to exist. This belief set is inconsistent, but does not necessarily yield conflicting implications for how we ought to live our lives.

But what if an OA sincerely believes the following?

• All human death is morally tragic.
• Not all human death is morally tragic.
• Propositions (a) and (b) are apparently a contradiction.

It is easy to imagine a Socratic dialogue in which Socrates helps an OA to express position (a) and proposition (b), prompting them to reconsider their position; what’s less easy to imagine is what would happen if an OA freely admits proposition (c), but refuses to reconsider. Moral agency requires some degree of reason-responsiveness, and at least with regards to the topic at hand, it is not clear such an OA would be able to function as a moral agent without rejecting one of these three propositions.

Blackshaw et al. ( 2021 ) end their reply as follows “If critics of [OA] want to change the subject – to examining whether the things [OA] believe are true or false, rather than fixating on [OA’s] alleged inconstancy — then [our] essay has succeeded.” Here, they again miss the point of inconsistency arguments, as these arguments do set out to examine whether the things [OA] believe are true or false; if the principle of non-contradiction is true, and OA hold contradictory beliefs, then at least one of their beliefs are false !

Why do they miss this point? I cannot be sure, but at times Colgrove et al. ( 2020 ) and Blackshaw et al. ( 2021 ) talk as though inconsistency theorists are uniformly prochoice and hope to convince OA to abandon restrictivism; however, inconsistency arguments might just as easily lead one to believe they ought to do more to prevent spontaneous abortion, address surplus frozen human embryos, and the like. Some inconsistency theorists believe both would lead to less restrictivist opposition to abortion, but this is irrelevant.

What matters is that inconsistency arguments share the same form as the Socratic method, highlighting apparent inconsistency and prompting introspection. Perhaps Colgrove et al. ( 2020 ) would also conclude that the Socratic method does not matter , but I hope not.

Other Actions Objection and Response

Colgrove et al.’s second criticism of inconsistency arguments is that they are too specific with their recommendations, suggesting OA can address problems raised by these arguments with different actions than those proposed by inconsistency theorists. For example, rather than adopt and gestate frozen human Embryos, as Lovering ( 2020 ) (and Blackshaw 2021 !) advocate, Colgrove et al. ( 2020 ) suggest OA might fight “to change public perception of the status of embryos,” or lobby to change IVF laws.

There are three problems here. First, although inconsistency theorists propose a variety of recommendations, these recommendations are not meant to be exhaustive, but rather representative of the kinds of changes an OA would need to adopt to resolve their apparent inconsistency. Remember, inconsistency theorists argue that OA face a dilemma — either (i) do more, or (ii) abandon their opposition to abortion; to say that an OA can perform other actions to address the problem just is to embrace the first horn of the dilemma.

Second, I have pointed out (Simkulet 2021 ) that the other actions Colgrove et al. ( 2020 ) propose are not necessarily mutually exclusive; one might both lobby to change IVF laws and adopt and gestate frozen human embryos. The fact that one lobbies to change IVF laws may reduce the number of surplus embryos created and frozen in the future; but it fails to address the needs of currently existing frozen human embryos, highlighting a third problem, that many of Colgrove et al.’s “other actions” are simply not enough. I illustrate (Simkulet 2021 ) this with a case inspired by James Rachels ( 1979 ):

Jack 2 finds himself in a room with a starving child, surplus sandwich in hand. He receives a call… The caller asks, “Will you donate your sandwich?” and he replies, “I’ll do you one better; I’m going to fight to change the public perception of the status of such starving children and raise awareness!” He proceeds to tweet about the starving child, sets up a donation page to help spread awareness, and posts pictures and videos of the child’s deteriorating state. Jack 2 , an expert in such things, narrates as the child slowly dies.

Jack 2 ’s claim to act to raise awareness pokes fun at Colgrove et al.’s ( 2020 ) proposal to protect frozen embryos by fighting to change public perception. Despite his tweeting, it is clear Jack 2 fails morally — he lets a child starve to death when he could have easily saved that child’s life.

Blackshaw et al. ( 2021 ) argue that this case is disanalogous to OA (in)action, arguing that OA “live in a world where there are many important issues clamoring for their attention,” and suggest the following case is more analogous:

Jack 100 finds himself in a room with 100 needy children and only enough resources to save 1 child, which he does.

There are three substantive problems with this response. First, the case of Jack 2 is not meant to be analogous to OA inaction (despite poking fun at it); it is meant to demonstrate that merely having other actions is not sufficient to show that inconsistency arguments fail.

Second, the case of Jack 100 begs the question by assuming Jack is saving as many people as possible. However, as Lovering ( 2020 ) and Blackshaw ( 2021 ) seem to show, this simply is not how OA act. Inconsistency theorists argue that OA neglect to address the problems of spontaneous abortion, surplus frozen embryos, and even starving born children. Rather than save all they can, inconsistency theorists contend that OA act like Jack 2 , they do something , but fail to do everything they can.

Third, inconsistency theorists contend that most OA legislation and philosophical literature neglect to discuss the problems of spontaneous abortion, surplus frozen embryos, or starving born children. As such, perhaps the following case would be more analogous:

Jack 300 finds himself in a room with 300 needy children, and he says, “I see 100 needy children, but woe is me I can only save 1,” and so he saves 1 child.

It seems Jack 300 is unreliable; he says he sees 100 needy children in the room, but there are 300 needy children in the room. If we cannot trust Jack 300 to get an accurate headcount, it seems unreasonable to take his word that he is doing all he can.

With the Jack 100 case Blackshaw et al. ( 2021 ) seem to abandon the other actions objection, instead arguing that OA, like Jack 100 , do the “most good” they can. In short, Blackshaw et al. seem to treat the other actions’ objection as a surrogate for an argument from effective altruism, the view that we should try to do the most good we can. Colgrove et al. ( 2020 ) claim that there are many different beliefs about what it means to do the “most good”, and suggest that objectively measuring options might be difficult, as though to claim that it does not matter what other actions OA take as long as they are trying to do the “most good.”

But this will not do. Effective altruism asks us to use reason and empirical evidence to maximize the amount of good we do, and inconsistency arguments seem to show that OA fail to do just this. Like Jack 2 , OA seem to ignore the easily preventable deaths of some with an unearned confidence that their current course of action is sufficient. If OA strive for effective altruism, they should be at least open to the prospect of embracing the first horn of the inconsistency theorist’s dilemma — that maybe should do more. Suppose Jill 100 finds herself in the locked room with Jack 100 , and promises to show Jack 100 how he can save 3 needy children, rather than just 1, with the resources at hand; if Jack 100 seeks to be an effective altruist, should he not at least listen, time permitting?

Effective altruism requires that we guide our choices by reason and evidence; it is not enough to have a sincere belief that one is doing all that one can, the evidence has to back this up. If inconsistency theorists can show that OA are not doing all they can, then they have been succeeding in showing that OA fall short of effective altruism.

Of course, this is exactly what proponents of inconsistency theorists purport to show. Take the aforementioned inconsistency theorist Lovering ( 2020 ) who, like OA restrictivist Blackshaw ( 2021 ), argues that OA should do more than merely fight to change public perception or lobby to change IVF laws, in many cases they ought to also adopt and gestate actually existing frozen human embryos. Of course, not every OA can gestate frozen human embryos — without effective ectogenesis technology and universal healthcare this burden seems to fall on wealthy, female OA alone. However, few OA argue that adopting and gestating these embryos are obligatory for those with the means to do so, and this omission at least appears to be inconsistent with their assertion that all fetuses matter from conception, let alone the position that OA are acting as effective altruists.

Furthermore, Blackshaw ( 2021 ) does not merely side with Lovering regarding OA’s obligations regarding frozen human embryos; he says:

[I]f we regard all human life as equally valuable, we have at least some obligation toward helping reduce deaths from spontaneous abortion where possible. The parable of the Good Samaritan reinforces the notion that Christians do have some responsibility toward this neglected group of human beings, who are also our neighbors.

Here Blackshaw ( 2021 ) contends that these groups — frozen human embryos and those fetuses who die from spontaneous abortion — matter , and that at least some OA — those inconsistency arguments seek to criticize — neglect them. In short, Blackshaw’s ( 2021 ) view seems at odd with the view he expresses in Colgrove et al. ( 2020 ) and Blackshaw et al. ( 2021 ). This is not meant as a criticism of Blackshaw; philosophers revise their views over time, articles are often published long after their initial submission, and many articles are written for blind review which could disincentivize the author from discussing their previous works.

Note, however, that Colgrove et al. ( 2020 ) and Blackshaw et al. ( 2021 ) set out to argue that inconsistency arguments do not matter for any OA view and in doing so they bite off far more than they can chew. It is easy to contend that all OA have other possible actions – contra Frankfurt ( 1969 ), many philosophers believe alternate possibilities are required for moral agency and responsibility; but it is quite a different matter to argue that all OA are acting as effective altruists, or even that all OA merely sincerely believe they are acting as effective altruists, especially when confronted with criticism from inconsistency theorists. Blackshaw ( 2021 ) contends inconsistency arguments demonstrate that some OA neglect this group, and this alone seems sufficient to show inconsistency arguments are morally significant.

Hypocrisy Objection and Response

In their third objection, Colgrove et al. ( 2020 ) contend that inconsistency arguments aim to show that OA are hypocrites, rather than demonstrate inconsistency. I note (Simkulet 2021 ) that Colgrove et al. equivocate between hypocrisy and inconsistency, and that they characterize hypocrisy as a moral failing. Colgrove et al. ( 2020 ) say:

[OA] are often described as ’inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities…These objections notwithstanding, perhaps some OAs do act in ways that can be shown to be inconsistent with their beliefs. If so, then they are hypocrites. Hypocrisy is a serious charge regarding the character of OAs, but it has nothing to say regarding the validity and consistency of their beliefs—and OAs’ beliefs are surely what critics should primarily be targeting.

In short, it seems that Colgrove et al. mischaracterize inconsistency arguments as ad hominem fallacies; but as we have already seen there is a difference. Inconsistency arguments are simply not aimed at showing OA are hypocrites; only that they have inconsistent beliefs.

In their reply to my previous work (Simkulet 2021 ), Blackshaw et al. ( 2021 ) say something bizarre “Simkulet offers no empirical evidence regarding [OA’s] supposed lack of interest in relevant issues.” But inconsistency theorists do this ; Lovering ( 2020 ) goes to great lengths to discuss OA who do go out of their way to address these concerns and provides evidence such altruism is rare . Still, it is difficult to take this call for empirical evidence seriously, as neither Colgrove et al. ( 2020 ) nor Blackshaw et al. ( 2021 ) provide such evidence on behalf of OA.

Blackshaw et al. ( 2021 ) also challenge my claim (Simkulet 2021 ) that legislation seeking to reduce the creation of surplus IVF embryos would be relatively easy to pass:

Not so. Italy, for example, passed a law in 2004 prohibiting the freezing of embryos, and requiring that all embryos be implanted. (Riezzo et al. 2016 ) The law was swiftly condemned, eventually overturned and, in one case, actions prescribed by the law were declared by the UN to have constituted a ‘human rights violation.’ (Scaffidi 2019 ) Thus, relevant laws would likely face international resistance. So, a central problem Simkulet puts forth as having an ‘easy’ solution does not.

There are two big problems here. First, I propose (Simkulet 2021 ) passing legislation to limit the creation of surplus embryos, not to force all created embryos to be implanted. The difference is obvious, my restrictivist proposal would limit the number of embryos created at a time, so it might take multiple tries before a successful embryo is created.

In contrast, the Italian law seems to place no limits on how many embryos can be created, rather it sets out to force women to undergo invasive, risky medical procedures. IVF has a relatively low chance of success; but imagine more attempts at fertilization succeed than expected; this law would compel physicians to perform, and women to undergo, dangerous medical procedures against their wills. This is hauntingly similar to forcing you to donate bone marrow even at the cost of your life in Boonin’s ( 2002 ) bone marrow case. In short, the Italian law threatens to harm citizens and undermine professional ethics by requiring medically risky and unnecessary interventions without the patient’s consent.

In contrast, my proposal (Simkulet 2021 ) would merely require physicians limit the number of embryos created at one time; not entirely dissimilar from legal limits on how many drugs a physician can prescribe within a period of time. Furthermore, I do not say such legislation would be easy, only “relatively easy” compared to restrictivist legislation – legislation that has far more in common with the Italian law than Blackshaw et al. ( 2021 ) acknowledge. Both restrictivist legislation and the Italian law seek to undermine women’s rights to control their body and force them to risk their lives for the sake of others. Meanwhile limiting the number of embryos created does not limit one’s reproductive freedom, nor compel them to take on additional medical risk.

Both OA restrictivist legislation and the Italian law seek to limit women’s reproductive choices and force women to take on additional medical risk. Legislation of this kind faces strong opposition from those seeking to protect women’s liberty and reproductive freedom. This kind of legislation also faces strong opposition from biomedical ethicists and medical professionals, as it threatens to violate patient autonomy and the Hippocratic Oath by forcing patient and physician to perform risky medical procedures to benefit a third party, not unlike forcing you to remain attached to the violinist in Thomson’s infamous violinist case (Thomson 1972 ).

In contrast, it is not clear that my proposed legislation (Simkulet 2021 ) to limit the number of embryos that can be created at a single time, would face much opposition at all. Perhaps eugenicists would oppose such legislation for limiting a parent’s right to choose the “best” fetus from the widest possible net, but this does not seem like a widely held position. Perhaps bioethicists and medical professionals would oppose such legislation believing it cumbersome and impractical, but this seems like a much weaker ground for opposition than the autonomy and professional ethics violations epitomized by OA restrictivist legislation and the Italian law.

The Prochoice Other Beliefs Objection

I have argued (Simkulet 2021 ) that if the other beliefs, other actions, and hypocrisy objections are not successful in showing inconsistency arguments “do not matter,” they threaten to undermine the discipline of ethics. No person has merely one moral belief, so if a diversity of beliefs invalidates moral analysis, ethics is impossible. In all cases in which a person acts morally responsibly (save maybe some interpretations of Frankfurt-style cases (Frankfurt 1969 ), agents have other possible actions, so if merely having other actions was sufficient to disregard moral analysis, ethics fails. Finally, if interpreting moral analysis as an ad hominem attack of hypocrisy was sufficient to rebuff criticism, one can shut down all moral debate merely by being thin-skinned. Here, I have argued that Blackshaw et al. ( 2021 ) fail to defend these objections, and fail to show that inconsistency arguments do not matter.

However, these are lofty claims about the discipline of ethics; let’s consider something a bit more down to Earth. Consider the following case:

Jacqueline is surprised to find herself pregnant, calling into question her school’s sexual education program. While discussing the matter with her physician, she learns that some people believe embryos are persons from conception! She finds this view intuitive and compelling, and outraged by her school’s poor sexual education program, she endeavors to work tirelessly to change the public perception of the status of embryos. Later, her physician expresses concern about her exertion, recommending that she puts her efforts to educate on hiatus during the pregnancy, fearing the worst. Jacqueline faces a choice — (i) continue with her pregnancy for the next 6 months, losing ground on her fight to change public perception of embryos or (ii) induce abortion (perhaps by hysterectomy) and continue the fight. When speaking with her physician, Jacqueline quotes an influential piece of literature (Colgrove et al. 2020 ), “It may be unclear, however, which option is superior. Many considerations apply to each, and they may be highly individualistic.” She continues “Objectively evaluating options to determine the most appropriate action for a particular belief held by a specific individual seems a very difficult task.” Upon careful and thoughtful reflection, she chooses (ii), judging that it will do the most good. After all, her embryo is but one embryo and while it is tragic to disconnect it from her body and let it die, her tireless efforts might do more good overall.

If the other actions objection shields OA from inconstancy arguments, it seems that it equally shields Jaqueline from restrictivist OA arguments that seek to restrict her freedom. Therefore, it seems that Blackshaw et al. face a dilemma — (i) reject the position that merely having other actions, beliefs, etc. is sufficient to shield a position from criticism, or (ii) abandon their opposition to induced abortion. If (i), then inconsistency arguments matter. Then again, if (ii), then it seems as though no ethical arguments matter.

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