BACKGROUND

State legislatures have adopted abortion restrictions that target specific populations of women and pregnancy conditions by banning abortion on the basis of sex selection, race selection or genetic anomaly. These bans stigmatize pregnant people of color who seek abortions by questioning the motivation behind their abortion decision. In recent years, members of Congress have introduced federal legislation that would prohibit abortion based on the sex or race of the fetus.

Historically, sex selection has occurred most frequently in countries where there is a strong gender bias that manifests in a preference for sons. Evidence from the global context indicates that sex-selective abortion bans do not work to prevent sex selection, because these bans do nothing to challenge the phenomenon of son preference or its underlying causes and they are difficult to enforce. Also, sex-selective abortion is only one of several medical methods of choosing the sex of a fetus; others, such as sperm sorting and preimplantation genetic diagnostics, remain legal under state bans on sex-selective abortion. There is broad international consensus that the most effective way to combat sex selection is to implement policies that promote gender equity.

Race-selective abortion bans are based on the idea that women of color are coerced into abortions or are complicit in a “genocide” against their own community.1,2 There is no evidence that women of color seek abortions on the basis of race or that a ban on race-selective abortions would decrease abortions among this group.

While nominally aimed at combating gender and racial discrimination, U.S. 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.3 They place women’s motivations for having an abortion under suspicion, thereby opening the door to discrimination toward and racial profiling of women of color and immigrant women. In particular, proponents of sex-selective abortion bans cite limited and inconclusive evidence that sex selection is practiced among some Asian communities in the United States, and proponents of race-selection bans erroneously claim that black women are targeted by abortion providers. Rather than protecting these communities, the laws perpetuate harmful stereotypes and put women at risk by making abortion less accessible. By forcing providers to scrutinize and second-guess women’s reasons for seeking an abortion, the bans discourage honest, confidential conversations and interfere in the provider-patient relationship. As a result, patients may withhold information or be dissuaded from seeking care from providers altogether.4

Similarly, laws that prohibit abortions or provision of information on abortion services 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 abortion in cases of fetal anomaly, including in cases where the fetus has a condition that is incompatible with life and will die before or soon after birth. In 2014, Louisiana enacted a law prohibiting health care providers from providing information on abortion as a “neutral or acceptable option” after a diagnosis or potential diagnosis of a fetal anomaly or genetic condition.

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 to Support Bans on Sex-Selective Abortions

Data from the United States and other countries demonstrate that bans on sex-selective abortion do not work. Banning the practice does nothing to confront the underlying causes of gender bias in society nor does it advance efforts to promote gender equity. There is international consensus that action to address the underlying reasons for son preference is necessary.5,6

  • Denying access to prenatal technologies and abortion care has little effect on rates of sex-selective abortion.7 Instead, experts, such as those in United Nations agencies, recommend using a multifaceted approach that addresses the underlying cultural, social, economic, legal and other factors that promote gender discrimination.8
    • An examination of two U.S. states that enacted sex-selective abortion bans in the 1980s found no difference in sex ratios (the number of boys and girls born at a given time) among the total population or the Asian American population in each state from five years preceding the ban’s enactment to five years afterward.9
    • South Korea’s sex ratio, which had long been skewed in favor of boys, became more balanced in the mid-2000s. This improvement is attributed to changes in social norms due to increased urbanization, economic development and women’s employment.7
  • U.S. sex-selective abortion bans are based on misinformation and negative stereotypes about Asian communities and are meant to restrict access to abortion service.9,10
    • According to a study pooling data from 2007–2011, the U.S.-born white population has a male-to-female sex ratio at birth that is higher than that of the Asian American population overall and higher than sex ratios among populations of Chinese, Indian and Korean immigrants.9
    • A 2017 study using 2010 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 child fell within the standard range, as did the sex ratios for other children in families in which the oldest child was male. Among Chinese and Indian families that already had one girl, data suggest that the sex ratios leaned toward boys for additional children; for Koreans, additional births matched the sex ratio for white Americans.11
    • Most abortions in the United States (92%) take place in the first trimester of pregnancy, before fetal sex can be determined.12
    • Proponents of sex-selective abortion bans also champion broader abortion restrictions. Rather than reducing gender discrimination, sex-selection bans require health care providers to interrogate women about their reproductive choices and could result in denial of reproductive health care services in the Asian community.9
  • Laws that prohibit abortions for specific reasons, such as sex selection, make it more difficult to obtain abortion overall, especially for women of color and immigrant women, compounding 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 health care professionals must question their patients’ motivations for obtaining an abortion, patients may feel forced to withhold information or lie to their provider—or they may be dissuaded from seeking care from a provider at all. The American College of Obstetricians and Gynecologists strongly opposes laws that compromise the provider-patient relationship.4
    • Laws that force doctors to interrogate a patient’s reasons for having an abortion perpetuate stereotypes and imply that women, and especially women of color, cannot be trusted to make their own medical decisions.

Lack of Evidence to Support Bans on Race-Selective Abortions

Race-selective abortion bans are based on the idea that women of color are coerced into abortions or are complicit in a “genocide” against their own community.2 There is no evidence that women of color seek abortions 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 reproductive health needs, including family planning services and access to abortion care.

  • 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 another race or ethnicity that is not white; 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.13
  • The overall abortion rate has declined for three decades.14 However, due to systemic racism and sexism, women of color often face difficult socioeconomic conditions, which in turn affects their access to health care services, including access to contraceptives and other reproductive health care. Among abortion patients nationally in 2014, black women were substantially overrepresented, Hispanic women were slightly overrepresented and white women were slightly underrepresented.15
  • Racism, abuse and ongoing implicit bias in the medical profession has resulted in mistrust among the black community.16 This mistrust—coupled with lack of access to health care, including family planning resources and education—contributes to a wide range of health disparities, including in reproductive health care.17
    • Distrust of the medical community contributes to underutilization of health care.18,19
    • The lack of access to health care and higher rates of abortion among U.S. communities of color reflect the systemic inequality and discrimination they face. Race, socioeconomic status and education level are linked to disparities in use of contraception and barriers to receiving family planning services.17
    • Abortion bans based on race further stigmatize communities of color and abortion services. In order to provide women of color with the reproductive health care they deserve, the medical profession must make deliberate efforts to develop and improve trust. Other necessary actions include improvements to sex education and societal changes that eliminate barriers and increase access to health care information and services.
  • Laws that prohibit abortions obtained for specific reasons, such as race selection, make it more difficult to obtain 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 health care providers must question their patients’ motivations for obtaining an abortion, some patients may feel forced to withhold information or lie to their provider—or they may be dissuaded from seeking care from a provider altogether. The American College of Obstetricians and Gynecologists strongly opposes laws that compromise the provider-patient relationship.20
    • Laws that force doctors to interrogate patients’ reasons for seeking abortion perpetuate negative stereotypes about women of color, continue historical racial injustice in the provision of reproductive health care, and imply that women—and especially women of color—cannot be trusted to make their own medical decision.21

Decision Making in Cases of Genetic Anomaly

Several states have passed laws (North Dakota’s is the only one currently in effect) that proscribe abortion in cases of fetal genetic anomaly, including in circumstances where the fetus cannot survive outside the womb. Other laws prevent patients from receiving information about abortion as one of the options after receiving a prenatal diagnosis of Down syndrome or other genetic conditions or impairments. Both types of restrictions would prevent women from making informed decisions that they deem best for their family and circumstances.

  • Some states have adopted laws that require patients receiving a diagnosis of a fetal genetic condition be given information about the condition from a health care provider. This information—about the medical condition or disability, comprehensive pregnancy options, and resources for the child and family—is intended to counter implicit bias against a particular condition or disability that may cause providers not to offer complete information about living with certain conditions or to emphasize abortion as the best outcome. However, abortion opponents have used these bills to push their own agenda by labeling them as “pro-information” while preventing patients from receiving information about abortion as an option to consider in response to a diagnosis.22
  • The American College of Obstetricians and Gynecologists recommends offering screening tests for fetal anomalies to all pregnant women, including those in their second trimester.23 Studies show that 96–98% of amniocentesis results are negative for fetal problems.24,25,26,27 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.

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

Arkansas (2017)

E

Indiana (2016)

E

Missouri (2017)

A

States that prohibit abortion in cases of possible fetal anomaly

Indiana (2016)

E

Louisiana (2016)

E

Ohio (2017)

E

Oklahoma (2016, 2017)

A

Pennsylvania (2018)

A

Utah (2018)

A

States that prohibit medical providers from offering information on abortion to patients following diagnoses of fetal anomaly

Tennessee (2018)

E

 Texas (2017)

A

Utah (2018)

A

REFERENCES

1. NAPAWF, Race and Sex Selective Abortion Bans: Wolves in Sheep’s Clothing, 2013, https://www.napawf.org/uploads/1/1/4/9/114909119/prendaissuebrief_11.26-final.pdf.

2. Kathryn Joyce, Abortion as black genocide, Public Eye, Summer 2010, https://www.politicalresearch.org/2010/04/29/abortion-as-black-genocide-an-old-scare-tactic-re-emerges/.

3. Statement of Miriam Yeung, Executive Director, National Asian Pacific American Women’s Forum, U.S. House Committee on the Judiciary, H.R. 4924, the Prenatal Nondiscrimination Act (PRENDA) of 2016 hearing, Apr. 14, 2016, https://docs.house.gov/meetings/JU/JU10/20160414/104783/HHRG-114-JU10-Wstate-YeungM-20160414.pdf.

4. 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-on-Abortion-Reason-Bans.

5. United Nations Population Fund (UNFPA), Programme of Action of the International Conference on Population and Development, Cairo, 5–13 September 1994, New York: UNFPA, 2004, https://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf.

6. Fourth World Conference on Women, Beijing, China, Sept. 4−15, 1995, Report of the Fourth World Conference on Women, New York: United Nations, 1996, http://www.un.org/womenwatch/daw/beijing/official.htm.

7. 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-preference-and-sex-selective-abortion-bans.

8. World Health Organization (WHO), Preventing Gender-Biased Sex Selection: An Interagency Statement OHCHR, UNFPA, UNICEF, UN Women and WHO, 2011, http://www.who.int/reproductivehealth/publications/gender_rights/9789241501460/en/.

9. Citro B et al., Replacing Myths with Facts: Sex-Selective Abortion Laws in the United States, University of Chicago Law School International Human Rights Clinic, National Asian Pacific American Women’s Forum (NAPAWF) and Advancing New Standards in Reproductive Health, 2014, https://ihrclinic.uchicago.edu/sites/ihrclinic.uchicago.edu/files/uploads/Replacing%20Myths%20with%20Facts%20-%20Sex-Selective%20Abortion%20Laws%20in%20the%20United%20States.pdf.

10. Mohapatra S, False framings: the co-opting of sex-selection by the anti-abortion movement, Journal of Law, Medicine & Ethics, 2015, 43(2):270−274, https://www.ncbi.nlm.nih.gov/pubmed/26242948.

11. Almond D and Sun Y, Son-biased sex ratios in 2010 US Census and 2011–2013 US natality data, Social Science & Medicine, 2017, 176:21–24, https://doi.org/10.1016/j.socscimed.2016.12.038.

12. Jatlaoui TC et al., Abortion surveillance—United States, 2013, Morbidity and Mortality Weekly Report, 2016, Vol. 65, No. SS-12, https://www.cdc.gov/mmwr/volumes/65/ss/ss6512a1.htm.

13. Guttmacher Institute, Claim that most abortion clinics are located in black or Hispanic neighborhoods is false, News in Context, June 1, 2014, https://www.guttmacher.org/article/2014/06/claim-most-abortion-clinics-are-located-black-or-hispanic-neighborhoods-false.

14. Guttmacher Institute, Induced abortion in the United States, Fact Sheet, 2018, https://www.guttmacher.org/fact-sheet/induced-abortion-united-states.

15. Jerman J, Jones RK and Onda T, Characteristics of US Abortion Patients in 2014 and Changes Since 2008, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014.

16. Gamble VN, A legacy of distrust: African Americans and medical research, American Journal of Preventive Medicine, 1993, 9(Suppl. 6):35–38.

17. Dehlendorf C, Harris LH and Weitz TA, Disparities in abortion rates: a public health approach, American Journal of Public Health, 2013, 103(10):1772–1779.

18. Armstrong K et al., Prior experiences of racial discrimination and racial differences in health care system distrust, Med Care, 2013, 51(2):144–150.

19. Boulware LE et al., Race and trust in the health care system, Public Health Reports, 2003, 118(4):358–365.

20. ACOG, Legislative Interference with Patient Care, Medical Decisions, and the Patient-Physician Relationship, 2016, https://www.acog.org/Clinical-Guidance-and-Publications/Statements-of-Policy-List.

21. Brief of Black Women’s Health Imperative as Amicus Curiae in Support of Plaintiffs-Appellants, NAACP v. Horne, No. 13-17247, 9th Cir., 2014, https://www.aclu.org/legal-document/naacp-et-al-v-tom-horne-et-al-amicus-brief-black-womens-health-imperative-support-pts.

22. Center for Reproductive Rights (CRR), Shifting the Frame on Disability Rights for the U.S. Reproductive Rights Movement, New York: CRR, 2017, https://www.reproductiverights.org/document/shifting-the-frame-on-disability-rights-for-the-us-reproductive-rights-movement.

23. ACOG, Screening tests for birth defects, 2014, http://www.acog.org/Patients/FAQs/Screening-Tests-for-Birth-Defects.

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

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

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

27. 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.