The abortion debate is at the center of U.S. political dialogue. Voices from both sides flood social media feeds, newspapers, radio and television programs.

In the last year, attacks on reproductive rights sharply increased. In 2019, Georgia, Missouri, Ohio, Kentucky and Mississippi successfully passed so-called “heartbeat” bans to prohibit abortion as early as 6 to 8 weeks. Alabama is the first state to pass a complete abortion ban without exceptions for rape or incest. Due to ongoing legal challenges, these bans have yet to go into effect.

One important group’s voice is often absent in this heated debate: the women who choose abortion. While 1 in 4 women will undergo abortion in her lifetime, stigma keeps their stories untold. As an obstetrician/gynecologist who provides full spectrum reproductive health care, I hear these stories daily.

Unintended pregnancy

In 2011, nearly half of pregnancies in the U.S. were unintended. This reflects a 6% drop in unintended pregnancies since 2008, largely due to Title X family planning programs and easier access to birth control.

Unintended pregnancy remains most common among poor women, women of color and women without a high school education. Women living in poverty have a rate of unintended pregnancy five times higher than those with middle or high incomes. Black women are twice as likely to have an unintended pregnancy as white women.

Barriers to contraception play a major role. Among women with unintended pregnancies, 54% were using no birth control. Another 41% were inconsistently using birth control at the time of conception.

Forty-two percent of women with unintended pregnancy choose to end their pregnancies.

The women who choose abortion

Abortion is a routine part of reproductive health care. Approximately 25% of women in the U.S. will undergo an abortion before the age of 45. The Guttmacher Institute, a research and policy institute in New York City, has been tracking these data for the last 50 years.

American women have abortions with similar frequency to women living in other developed nations. The bulk of abortion patients are in their 20s.

Women of all races and ethnicities choose abortion. In 2014, 39% of abortion patients were white, 28% were black and 25% were Latinx. Similarly, women of all religious affiliations choose to end their pregnancies at similar frequencies.

Most of these women understand what it means to parent a child. More than half of abortion patients in 2014 were already mothers.

Poor women account for the majority of abortion patients. Fifty-three percent of women pay out-of-pocket for their abortion. The rest use private or state-funded insurance plans.

Women choose abortion for multiple reasons. The most common reason cited is that pregnancy would interfere with education, work or ability to care for dependents.

Financial stress also plays a major role in women’s decision-making. Seventy-three percent of women reported that they could not afford a baby at the time. Nearly half cited relationship difficulties or wanting to avoid single motherhood. More than a third of women felt their families were complete.

Twelve percent chose abortion due to their own health problems. For example, one of my patients and her husband were thrilled to find out she was pregnant for the first time. Then she received the diagnosis of metastatic breast cancer. She had to choose between lifesaving chemotherapy and radiation or her pregnancy.

Safety of abortion

Nine in 10 women who receive abortions undergo abortion in the first trimester. Only 1.3% of abortions happen with pregnancies past 20 weeks of gestation.

When performed legally by skilled practitioners, abortion is a safe medical procedure with a low complication rate. The risk of major complications – such as hospitalization, infection, blood transfusion or surgery – in first-trimester procedures is less than 0.5%. The risk of dying in childbirth is 14 times higher than the risk of dying from safe abortion.

Studies show that abortion is not linked to long-term health complications, including breast cancer, infertility, miscarriage or psychiatric disorders. The American College of Obstetricians and Gynecologists, the nation’s leading professional organization of obstetricians and gynecologists, has reaffirmed the safety of abortion.

Conversely, the negative impacts from abortion restrictions are well-documented. Women unable to obtain abortions are more likely live in poverty or depend on cash assistance, and less likely to work full-time.

Since 2011, politicians have enacted over 400 pieces of legislation restricting this medical procedure.

Access to safe and legal abortion is an essential part of health care. Most Americans agree. Sixty-four percent of Americans, regardless of pro-choice or pro-life status, would like to see the 1973 Roe v. Wade decision upheld. Another 79% want abortion to remain legal. As a physician, the health and livelihood of my patients depend on it.

This is an updated version of an article originally published on July 27, 2018.

Luu D Ireland is affiliated with Physicians for Reproductive Health.