Legal abortion is one of the safest procedures in modern medicine, with a mortality rate of roughly 0.5 deaths per 100,000 cases. Restricting it doesn’t stop abortions from happening. It makes them dangerous, deepens poverty, widens racial health gaps, and drives doctors out of the states that need them most. The case for legal abortion rests on overlapping evidence from public health data, economics, and basic patient safety.
Legal Abortion Is Extremely Safe
Medication abortion, which accounts for the majority of abortions in the United States, has a mortality rate of 0.54 deaths per 100,000 uses, based on FDA data covering 5.9 million patients through 2022. When only cases clearly related to the abortion itself are counted, the rate drops to 0.31 per 100,000. To put that in perspective, penicillin causes fatal allergic reactions at a rate of 2 per 100,000 patients. Erectile dysfunction drugs like Viagra carry a fatality rate of 4 per 100,000 users. Acetaminophen (Tylenol) overdose causes over 600 deaths per year in the U.S. alone.
Major complications from medication abortion, defined as hospitalization, blood transfusion, or surgery, occur in about 0.31% of cases. Carrying a pregnancy to term is far riskier: the mortality rate for people who deliver a live-born infant is 8.8 per 100,000, roughly 14 times higher than the mortality rate for medication abortion.
Restrictions Increase Maternal Deaths
When states ban or severely restrict abortion, the people living there die at higher rates during and after pregnancy. Data published in JAMA Network Open found that during the ban period following the Dobbs decision, pregnancy-associated mortality was 81.2 per 100,000 live births in states with bans (excluding Texas), compared with 49.2 per 100,000 in states without bans. That’s a 65% higher death rate.
The gap is even more staggering for Black women. In ban states, their pregnancy-associated mortality reached 165.2 per 100,000, compared with 106.2 per 100,000 in states without bans. These numbers reflect a pattern visible across the globe. The World Health Organization reports that in regions where unsafe abortions are common, death rates exceed 200 per 100,000 abortions. Where abortion is safe and legal, the death rate is less than 1 per 100,000. Globally, 8% of all maternal deaths are linked to abortion complications, and in developing countries alone, roughly 7 million women per year are hospitalized for complications from unsafe procedures.
Racial and Economic Disparities Widen
Abortion restrictions don’t affect everyone equally. More than half of the U.S. Black population, about 56.7%, lives in a state that has banned or is likely to ban abortion. Nearly 6.5 million Hispanic individuals are in the same position. These are communities that already face sharply worse maternal health outcomes regardless of income. Black women die from pregnancy-related causes at nearly three times the rate of white women (55.3 versus 19.1 per 100,000 births). They are 6.5 times more likely to die from an ectopic pregnancy. Black and American Indian individuals face roughly double the risk of severe, life-threatening pregnancy complications compared with white patients.
One particularly revealing statistic: Black women at the highest income levels experience pregnancy-related mortality rates comparable to white women at the lowest income levels. This means the disparity isn’t simply about poverty or insurance coverage. It’s baked into the healthcare system itself. Restricting abortion access in this context compounds an already dangerous inequity.
Denial of Abortion Drives Poverty
The Turnaway Study, conducted by researchers at the University of California, San Francisco, tracked nearly a thousand women over five years, comparing those who received a wanted abortion with those turned away because they were just past a clinic’s gestational limit. The findings were stark.
Half the women seeking abortions already had incomes below the federal poverty level, and three-quarters couldn’t cover basic living expenses. Being denied an abortion made things significantly worse. Six months later, women who were turned away had more than three times the odds of being unemployed. Over the longer term, being forced to carry an unwanted pregnancy to term produced an almost four-fold increase in the odds of living below the poverty line compared to women who received the abortion they sought. These women were also more likely to report being unable to afford food, housing, and transportation.
This isn’t a temporary setback. The economic consequences cascaded through years of the study and affected not just the women themselves but their existing children, who grew up in households with fewer resources.
The Mental Health Argument Doesn’t Hold Up
One common argument for restricting abortion is that it harms women’s mental health. A five-year longitudinal study published in JAMA Psychiatry tested this directly. In the first week after seeking an abortion, women who were denied reported more anxiety, lower self-esteem, and lower life satisfaction than those who received one. Depression levels were similar between the two groups.
Over the full five years of follow-up, psychological well-being improved for the denied group until both groups eventually converged. The researchers concluded that being denied an abortion may cause short-term psychological harm, but that no evidence supports restricting abortion access on the basis that the procedure itself damages mental health. In other words, the data points in the opposite direction from what restriction advocates claim.
Bans Threaten Medical Care for Everyone
Abortion restrictions are reshaping where doctors choose to train and practice, with consequences that extend well beyond reproductive healthcare. Data from the Association of American Medical Colleges shows that the number of U.S. medical school seniors applying to residencies in states with abortion bans fell by 4.2% in the 2023-2024 cycle, compared with just a 0.6% decrease in states where abortion remained legal. For OB/GYN specifically, applications to programs in states with complete bans dropped 6.7%, while states without restrictions saw a small increase.
The trend is accelerating. The gap between ban states and non-ban states grew larger in the second year after the Dobbs decision than in the first. This matters because residency training is a pipeline. Doctors tend to practice in the regions where they train. Fewer residents means fewer physicians in the long run, not just fewer OB/GYNs but fewer doctors across specialties, since applicants to other programs are declining in ban states too. Rural and underserved communities in these states, already short on providers, stand to lose the most.
Fetal Anomalies Require Medical Options
Some pregnancies involve fetal conditions that are incompatible with life outside the womb. A six-year case series from El Salvador, which has a total abortion ban, documented 239 pregnancies involving one of 18 congenital malformations considered lethal. In every one of those cases, the pregnancy could not result in a surviving infant, yet patients were forced to continue carrying to term.
These situations expose the cruelty of absolute bans. Conditions like anencephaly, where the brain fails to develop, are diagnosed during routine ultrasounds. Without legal access to abortion, patients must endure weeks or months of pregnancy knowing the outcome is predetermined, facing all the physical risks of continued pregnancy and delivery with no possibility of bringing home a living child. Legal abortion gives families the option to end that suffering on their own terms.
Legality Determines Safety, Not Frequency
Decades of global data show that abortion rates are similar in countries where the procedure is legal and countries where it is banned. What changes is safety. The WHO reports that nearly all unsafe abortions occur in countries with highly restrictive laws. Legality doesn’t create demand for abortion. Unintended pregnancies do. What legality determines is whether a person ends that pregnancy in a clinic with medical oversight or through dangerous, unregulated means.
Countries that combine legal abortion access with contraception coverage and comprehensive sex education consistently achieve both low abortion rates and low maternal mortality. Restriction without those supports simply forces people into riskier situations while doing little to reduce the number of abortions performed.