The Science is In: Abortion Bans Are a Public Health Emergency

Last month, the World Health Organization (WHO) published new guidelines on abortion care, developed through years of consultations with providers, researchers, and human rights experts. The release of this groundbreaking healthcare manual is timely for people in the United States, who are bracing for the end of Roe v. Wade and ensuing crackdowns on abortion access. It’s also a test for the Biden administration, who has made women’s healthcare a major talking point in its campaign to re-assert US leadership on human rights globally.

Most importantly, however, the guidelines can serve as an authoritative confirmation for what American reproductive rights activists have always known: abortion is essential healthcare.

The WHO’s guidelines take a radically simple approach to laws and policies on abortion, recommending both full decriminalization and that abortions be made available on request, without any grounds-based or gestational restrictions.

Decriminalization includes not just removing abortion from all criminal and/or penal codes, but also ensuring that no criminal penalties exist for “having, assisting with, providing information about, or providing abortion.” Full decriminalization also applies to people who experience pregnancy loss, making sure that they aren’t investigated or prosecuted when they seek medical care.

Obviously, decriminalization alone is not enough to create an enabling environment for abortion access. Grounds-based restrictions, which only allow abortions in certain circumstances, are detrimental to the health and well-being of people seeking abortions. The guidelines specifically note the disproportionately negative impact of grounds-based restrictions on people seeking abortions following rape, who are often “subjected to questioning, protracted delay, and bureaucratic processes due to requirements such as reporting the crime to the police or need for a court order, even though it is not human rights compliant to make such reporting or processes a prerequisite for accessing abortion.” In the interest of public health and human rights, the WHO recommends that abortion be made available on request.

This edition of the WHO guidelines is the first to recommend telemedicine as an option for self-managed abortions. This is also the first time that the guidelines acknowledge that it’s not just cisgender women and girls who have abortions. It makes it clear that trans men, non-binary and gender-diverse people, and intersex individuals also have the right to comprehensive abortion care, free from discrimination based on their gender identity or expression.

Contrast this evidence-based public health guidance with the state of abortion care in the United States. In 2021 alone, states passed 108 abortion restrictions, the most in a single year since the Roe decision in 1973. Opponents of abortion have long justified their actions using the ruse of concerns about women’s health and wellbeing, employing junk science and scare tactics to enact oppressive restrictions. Texas’ SB8 law, which went into effect last September, is an especially draconian ban not just on people seeking abortions but also on anyone who supports them in doing so.

This June, the Supreme Court is expected to issue a ruling on the constitutionality of Mississippi’s law, which bans abortions after 15 weeks. The Mississippi law is less extreme than laws like Texas’ SB8 but no less harmful to the health of pregnant people. Still, some nominally pro-choice people have fallen into the trap of legitimizing abortion restrictions based on gestational age. The WHO guidelines disavow such limits for a reason, saying they “have been found to be associated with increased rates of maternal mortality and poor health outcomes.”

It’s important to point out that the WHO guidelines also reject the restrictions that don’t grab headlines, such as mandatory waiting periods, targeted regulation of abortion providers (“TRAP”) laws, and parental consent and/or notification requirements. These restrictions are commonplace across the US, even in “blue” states, where abortion will remain legal if Roe is overturned. Take Minnesota, which protects the right to abortion in its state constitution but still has a number of medically-unnecessary restrictions in place, including mandatory state-directed counseling, a 24-hour waiting period, requirements that only physicians be allowed to perform abortions, and parental notification for minors. All of these laws run contrary to the WHO’s guidance, increasing personal costs to abortion seekers and creating logistical and policy hurdles for providers. Rights mean little without the ability to exercise them freely. Enshrining legal protections for abortion is certainly important, but states must also do the work to put those protections into practice so that abortions are accessible to all.

Internationally, this powerful directive from the WHO presents a challenge to the Biden administration. In speeches to the UN and other major international forums, the president and his team have pointed to US re-engagement with the WHO after the Trump years as evidence of its commitment to global health and multilateralism. Yet, American abortion rights advocates have regularly criticized the president for failing to take measures that would conform to WHO guidelines on abortion. This includes a refusal to act on the Helms Amendment, which has prohibited any US foreign aid from funding abortion as a method of family planning since 1973. If the US is to be an international leader on human rights, its renewed engagement with the WHO should include a comprehensive effort to follow its healthcare protocols.

The reality is that public health experts agree: narrow standards for abortion access are not justifiable. Abortion is healthcare, and healthcare is a human right. We must make abortion access a reality for all. The health and well-being of millions is at stake.