Impact of the supreme court decisions on the performance of abortions in the United States

On April 21, 1971, The Supreme Court rendered a decision in which the practice of abortion in the District of Columbia was defined legally. Since the District of Columbia is the Capital, and the Supreme Court represents the highest legal authority, I explored the influence of this decision on the judicial and legislative systems and on the practice of medicine with regard to therapeutic abortions in the United States. I interviewed the following people involved with abortions: 31 obstetricians and gynecologists in the District of Columbia; the heads of the Department of Obstetrics and Gynecology at three medical schools and at 11 hospitals; the administrators of the free-standing clinics; an Assistant United States Attorney; an Assistant Corporation Counsel; General Counsel of the Police Department; a City Councilman; and an Assistant Health, Education and Welfare Secretary. Thereafter, in 1971, nearly 19 000 legal therapeutic abortions were performed in the District of Columbia. This has risen steadily and nearly 39000 were performed in 1972. This compares to 2500 each year previously. Incomplete abortions fell from 10000 to 100 per year. Abortions are performed in all equipped hospitals except in two Catholic hospitals. Preoperative consultations and committee review are no longer required. Several hospitals have set up outpatient clinics so that there are ten free-standing clinics, and nine hospital facilities. Abortions in the clinics are restricted to pregnancies of less than ten weeks; hospitals allow up to 20 weeks. District of Columbia residence is not required. The physicians indicated that hospital and clinic requirements of spousal and parental consent were unnecessary. Abortions in the office were unacceptable to all but one physician. Since the decision, criminal investigations and prosecutions of physicians for abortions have ceased. This decision has resulted in a revolution in the practice of abortion in the District of Columbia. Abortion is now essentially available on demand. On January 22, 1973, the Supreme Court rendered two additional decisions interpreting the abortion statutes of Georgia and Texas. In essence the Supreme Court held that, during the first trimester, a woman may secure an abortion from a willing physician or available facility without any restrictions by the state, facility or profesion. During the last six months, the state may, through its police powers, regulate abortions only as to protect the life of the mother. Without deciding when life begins, the Court held that the state may regulate abortions during the last ten weeks of pregnancy when the fetus is “viable”, and its life can be reasonably and successfully maintained outside the mother. The Court did not decide whether spousal or parental consent is required to secure an abortion. Recent cases have now placed these specific issues before the Court. Based on other Court decisions, it also seems reasonable to believe that a facility may not deny an abortion when it is the only facility available, even though it may be contrary to the facility's policy. Although the mandate of the Supreme Court in regard to abortions seems clear, there is still a great deal of diversity among the states as to how to bring their abortion statutes into conformity with the Supreme Court decisions. In those jurisdictions where the Supreme Court decisions have been implemented, the experience with reference to the practice of abortion is similar to that of the District of Columbia. Furthermore, the attitude, approach and management of abortion among physicians has been revolutionary. Although a majority of Americans agree with the liberalization of abortion, there remains a nationwide vocal minority and actual majorities in some states that oppose the new policy. The Supreme Court decisions have had an international impact in that in a number of countries around the world efforts to liberalize abortion laws are underway.