BACKGROUND

State legislatures have adopted numerous abortion restrictions targeting very specific populations of women and pregnancy conditions. In recent years, members of Congress have introduced federal legislation that would prohibit abortions based on the sex or race of the fetus.

Sex-selective abortions—abortions performed because of the sex of the fetus—occur most frequently where there is a strong gender bias that manifests in a preference for sons. It is only one of several medical sex-selection methods, including sperm sorting and preimplantation genetic diagnostics (both of which remain legal under state bans on sex-selective abortion). In some countries, such as those in Eastern and Southern Asia, the widespread practice of sex selection favoring male babies has resulted in skewed national sex ratios. In contrast, in the United States, there is limited and inconclusive evidence of the use of sex-selective abortions; likewise, there is no evidence pointing to race-selective abortions.

Bans on sex- and race-selective abortions send the message that women, and especially women of color, cannot be trusted to make their own medical decisions. They place a burden on providers to scrutinize a patient’s pregnancy choices and second-guess patients’ reasons for seeking an abortion, thus discouraging honest, confidential conversations and interfering in the provider-patient relationship.1

By placing women’s motivations for an abortion under suspicion, these bans open the door to discrimination toward and racial profiling of women of color and immigrant women. While nominally aimed at combatting gender and racial discrimination, these laws actually work to make abortion less accessible by causing some women to fear they will be suspected of seeking a sex- or race-selective abortion; as a result, these patients may withhold information from providers or not seek care at all.2

Similarly, laws that prohibit abortions in cases of fetal genetic anomaly restrict women’s ability to make decisions that are best for themselves and their families. In 2013, North Dakota was the first state to prohibit abortions in cases of fetal anomaly, even in cases where the fetus has a condition that is incompatible with life and will die before or soon after birth.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state related to abortion bans for specific purposes, see Abortion Bans in Cases of Sex or Race Selection or Genetic Anomaly.

For information on state laws and policies related to other sexual and reproductive health and rights issues, see State Law and Policies, issue-by-issue fact sheets updated monthly by the Guttmacher Institute’s policy analysts to reflect the most recent legislative, administrative and judicial actions.

RELEVANT DATA AND ANALYSIS

Lack of Evidence Supporting Bans on Sex-Selective Abortions

Data do not show that such bans work, nor is there evidence that legal action on sex-selective abortion is warranted in the United States.

  • Sex-selective abortions driven by son preference—and the skewed sex ratios that result—are a serious problem in certain countries around the world,3 but bans on sex-selective abortion have not been shown to successfully curb sex-selective abortion.
    • Experts agree that denying access to prenatal technologies and abortion care has little effect on rates of sex-selective abortion and that working to address son preference is a more effective method of preventing sex-selective abortion.3 Moreover, experts and a United Nations interagency report recommend using a multifaceted approach that addresses the underlying cultural, social, economic, legal and other factors that promote gender discrimination.4,5
    • South Korea’s skewed gender ratios at birth have narrowed in the last decade, due to changes in the social norms that led to son preference and increases in urbanization, economic development and women’s employment.3
  • Data indicate that sex-selective abortions are not prevalent in the United States.
    • Research using 2000 U.S. census data found that among Chinese, Korean and Indian families in the United States, the male-to-female sex ratio of their oldest children fell within the biologically normal range, as did the sex ratios among children in families in which the oldest child was male.6 For families in which the oldest child was female, data suggest son-biased sex selection may have occurred. However, the populations studied account for less than 2% of the total U.S. population.
    • Most abortions in the United States (91%) take place in the first trimester of pregnancy, before fetal sex can be determined.7
  • Laws that prohibit abortions obtained for specific reasons, such as sex selection, make it more difficult to access abortion overall, especially for women of color and immigrant women. They compound the issues these groups already face when attempting to access sexual and reproductive health care.
    • Prohibiting abortion for specific reasons discourages honest, confidential conversations between patients and providers. When doctors must question a patient’s motivations for obtaining care, patients may feel forced to withhold information or lie to their provider—or they may not seek care at all.8 The American College of Obstetricians and Gynecologists strongly opposes laws that compromise the provider-patient relationship.9
    • Requiring physicians to scrutinize a patient’s pregnancy choices sends the message that women, and especially women of color, cannot be trusted to make their own medical decisions. Laws that force doctors to interrogate patient’s reasons for abortion perpetuate existing stereotypes.1

Lack of Evidence Supporting Bans on Race-Selective Abortions

There is no evidence that abortions among women of color are sought on the basis of race or that a ban on race-selective abortions would decrease abortions among this group. Instead, there is a need to address elevated abortion rates among women of color by addressing their higher rates of unintended pregnancy.

  • Despite evidence to the contrary, abortion opponents continue to claim that abortion providers target women of color. 
    • In 2011, only 22% of abortion clinics were located in neighborhoods where a majority of residents were Hispanic, black or “non-Hispanic other;” 60% were located in neighborhoods that were majority white, and the remaining 18% were located in neighborhoods in which no racial group represented a majority of residents.10
    • In 2011, 42% of all unintended pregnancies ended in abortion, and unintended pregnancies were more common among Black and Hispanic women (who had 79 and 58 unintended pregnancies per 1,000 women aged 15−44, respectively) than among non-Hispanic white women (who had 33 unintended pregnancies per 1,000 women).11
  • Women of color are at heightened risk for unintended pregnancy because they have lower rates of contraceptive use and less access to contraception than white women do. Eighty-three percent of black women who are at risk for unintended pregnancy currently use a contraceptive method, compared with 90% of Hispanic and Asian women and 91% of white women.12 Likewise, their rates of abortion in 2008 were 40.2 per 1,000 for black women, 28.7 for Hispanic women and 11.5 for non-Hispanic white women.13
  • Laws that prohibit abortions obtained for specific reasons, such as race selection, make it more difficult to access abortion overall, especially for women of color. They compound the issues women of color already face when attempting to access sexual and reproductive health care.
    • Prohibiting abortion for specific reasons discourages honest, confidential conversations between patients and providers. When doctors must question a patient’s motivations for obtaining care, patients may feel forced to withhold information or lie to their provider—or they may not seek care at all.8 The American College of Obstetricians and Gynecologists strongly opposes laws that compromise the provider-patient relationship.9
    • Requiring physicians to scrutinize a patient’s pregnancy choices sends the message that women, and especially women of color, cannot be trusted to make their own medical decisions. Laws that force doctors to interrogate patient’s reasons for abortion perpetuate existing stereotypes of women of color and continue historical racial injustice in the provision of reproductive health care.1

Decision Making in Cases of Genetic Anomaly

Many proposed laws—and one that has been enacted in North Dakota—proscribe abortion in cases of fetal genetic anomaly, including in circumstances where the fetus cannot survive outside the womb. Bans on abortion in cases of genetic anomaly would prevent women from making informed decisions that they deem best for their family and circumstances.

  • The American College of Obstetricians and Gynecologists recommends offering screening tests for fetal anomalies to all pregnant women, including those in their second trimester.14 Studies show that 96–98% of amniocentesis results are negative for fetal problems.15-18
  • Some women who receive a diagnosis of fetal anomaly choose to carry the pregnancy to term. A positive diagnosis allows them to prepare for the birth of a child who may have disabilities. As former Alaska Gov. Sarah Palin (R) said of amniocentesis results diagnosing her son’s Down syndrome, “I was grateful to have all those months to prepare. I can’t imagine the moms that are surprised at the end. I think they have it a lot harder.”19

DATA CENTER

RECENT STATE ACTION ON THIS ISSUE

States that have addressed this issue in the past three years are listed below.

E: State enacted a relevant measure

V: State vetoed measure

A: State adopted measure in at least one chamber

 

States that prohibit abortion for purposes of race or sex selection

Indiana (2015, 2016)

E

Louisiana (2015)

A

South Dakota (2014)

E

States that prohibit abortion in cases of possible fetal anomaly

Indiana (2015, 2016)

E

Louisiana (2016)

E

Oklahoma (2016)

A

REFERENCES

1. Brief of Amicus Curiae Black Women’s Health Imperative in Support of Plaintiffs-Appellants, NAACP, et al., v. Tom Horne, et al, No. 2:13-cv-01079-PHX-DGC, 2014, https://www.aclu.org/legal-document/naacp-et-al-v-tom-horne-et-al-amicus....

2. American College of Obstetricians and Gynecologists, ACOG statement on abortion reason bans, 2016, http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-....

3. Barot S, A problem-and-solution mismatch: son preference and sex-selective abortion bans, Guttmacher Policy Review, 2012, 15(2):18−22, https://www.guttmacher.org/gpr/2012/05/problem-and-solution-mismatch-son....

4. United Nations (UN), Population and Development: Programme of Action Adopted at the International Conference on Population and Development, Cairo, Sept. 5–13, 1994, New York: Department for Economic and Social Information and Policy Analysis, UN, 1995.

5. UN, Declaration of the Fourth World Conference on Women, Beijing, September 4–15, 1995, New York: UN, 1995.

6. Almond D and Edlund L, Son-biased sex ratios in the 2000 United States Census, Proceedings of the National Academy of Sciences, 2008, 105(15):5681−5682, http://www.pnas.org/content/105/15/5681.full.

7. Guttmacher Institute, Induced abortion in the United States, Fact Sheet, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/fact-sheet/induced-abortion-united-states.

8. American College of Obstetricians and Gynecologists, Statement on Reason Bans, 2016, http://www.acog.org/About-ACOG/News-Room/Statements/2016/ACOG-Statement-...

9. American College of Obstetricians and Gynecologists, Statement of policy #89: Legislative Interference with Patient Care, Medical Decisions, and the Patient-Physician Relationship, 2016, http://www.acog.org/-/media/Statements-of-Policy/Public/89LegislativeInt...

10. Guttmacher Institute, Claim that most abortion clinics are located in black or Hispanic neighborhoods is false, 2014, https://www.guttmacher.org/claim-most-abortion-clinics-are-located-black....

11. Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, http://nejm.org/doi/full/10.1056/NEJMsa1506575.

12. Jones J, Mosher WD and Daniels K, Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995, National Health Statistics Reports, 2012, No. 60, http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf.

13. Jones RK and Kavanaugh ML, Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion, Obstetrics & Gynecology, 2011, 117(6):1358−1366.

14. American College of Obstetricians and Gynecologists, Screening tests for birth defects, 2014, http://www.acog.org/Patients/FAQs/Screening-Tests-for-Birth-Defects.

15. Crandall BF et al., Chromosome findings in 2,500 second-trimester amniocenteses, American Journal of Medical Genetics, 1980, 5(4):345−356.

16. Han SH et al., Clinical and cytogenetic findings on 31,615 mid-trimester amniocenteses, Korean Journal of Laboratory Medicine, 2008, 28(5):378−385.

17. Philip J et al., Fetal chromosome analysis: screening for chromosome disease? Prenatal Diagnosis, 1983, 3(3):209−218.

18. Lowe CU, The Safety and Accuracy of Mid-trimester Amniocentesis: The NICHD Amniocentesis Registry, Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Institute of Child Health and Human Development, 1978.

19. Westfall SS, John McCain and Sarah Palin on shattering the glass ceiling, People, Aug. 29, 2008, http://www.people.com/people/article/0,,20222685,00.html.