The United States is one of only four countries since 1994 to roll back abortion rights — alongside El Salvador, Nicaragua, and Poland. Over 60 countries liberalized in the same period. Canada has operated with zero abortion law for 36 years and has lower abortion rates, lower late-term rates, and lower maternal mortality than the US. The evidence is not ambiguous. The question is whether we follow it.
The government has no place in this decision. Religion has no place in this decision. The empirical record is clear: reproductive autonomy produces better outcomes on every measurable metric — lower abortion rates, lower maternal mortality, lower teen pregnancy, higher workforce participation, and lower poverty.
Ten pillars — one framework: Codify abortion in federal law with no government-imposed gestational limit. Repeal the Hyde Amendment. Make all contraception free. Protect medication abortion and codify FDA authority. Ban fetal personhood laws. Mandate federal IVF coverage at 3 cycles minimum. Require evidence-based sex education in all federally funded schools. Strengthen emergency maternal care through EMTALA enforcement. Close the Black maternal mortality gap. Permanently fund Title X at $500 million per year.
Voters have been clear: abortion rights have prevailed in 11 of 14 state ballot measures since Dobbs — including Kansas (59%), Ohio (57%), Missouri (51.6%), and Montana (57.8%). France constitutionalized abortion 780–72. Texas maternal mortality rose 56% in the first year of its ban. Abortion restrictions cost the economy $105–$133 billion per year in lost productivity. The political and moral case are the same: this is between a woman and her doctor.
As of early 2026, the United States has the most fragmented reproductive rights landscape of any democracy. Approximately 62.7 million women and girls live under state abortion bans. Roughly 1 in 3 women of childbearing age live in states that ban abortion before most women even know they are pregnant.
| Restriction Type | States | Count |
|---|---|---|
| Total ban | AL, AR, ID, IN, KY, LA, MS, ND, OK, SD, TN, TX, WV | 13 |
| 6-week ban (before most know they're pregnant) | FL, GA, IA, SC, WY | 5 |
| 12-week ban | NE, NC | 2 |
| 15–18 week ban | UT (18 weeks) | 1 |
| Viability or no government-imposed limit | Remaining states | ~29 |
Source: Guttmacher Institute — guttmacher.org
These are not abstractions. They are named women, documented cases, confirmed preventable by the same state review committees operating under the laws that killed them.
At least 12 preventable deaths have been documented nationwide — almost certainly an undercount, as maternal mortality review committees are underfunded, understaffed, and subject to political pressure in the states most affected.
| Country | Maternal Mortality (per 100K) | Abortion Access |
|---|---|---|
| Norway | 0 (zero reported, 2022) | Up to 18 weeks self-determined (expanded 2024) |
| Switzerland | 1.2 | Up to 12 weeks on request |
| Netherlands | ≤3 | Up to 24 weeks |
| Sweden | ~3 | Up to 18 weeks |
| Germany | ~4 | Up to 12 weeks |
| France | ~7 | Constitutionalized in 2024; up to 14 weeks |
| Canada | ~12 | No gestational limit — zero abortion law since 1988 |
| United States | 18.6 (2023) | 13 states: total ban; 5 states: 6-week ban |
Black women die in childbirth at 3.5 times the rate of white women — 50.3 vs. 14.5 per 100,000. The racial gap is widening: it was 2.6× in 2022. Over 80% of all US maternal deaths are preventable. Texas maternal mortality rose 56% in the first year of its ban; among white women in Texas it rose 95%. In states with protected abortion access, maternal mortality fell 21% over the same period.
OB/GYN residency applications to ban states dropped 6.7% in a single year. Texas fell 16%. Texas is projected to be 15% short of needed OB/GYNs by 2030, and over 40% of Texas counties are already classified as maternity care deserts. 60% of OB/GYNs in ban states fear legal retaliation; 40% say they actively limit emergency care to avoid prosecution. The bans are creating a self-reinforcing crisis: women die, doctors leave, more women die.
Sources: GEPI — thegepi.org · CDC — cdc.gov · NPR — npr.org
Roe v. Wade (1973) established the constitutional right to abortion. For 49 years, state legislatures systematically chipped away at it: mandatory waiting periods, parental consent requirements, TRAP laws targeting clinic construction, ultrasound mandates, counseling scripts containing medically inaccurate information, and funding prohibitions. Planned Parenthood v. Casey (1992) replaced Roe's trimester framework with the "undue burden" standard, opening the door to restrictions previously impossible. By 2021, states had enacted over 1,300 abortion restrictions since Roe.
On June 24, 2022, the Supreme Court overturned Roe and Casey, holding there is no constitutional right to abortion. Thirteen states had trigger laws that took effect immediately or within 30 days. The decision placed the US alongside El Salvador, Nicaragua, and Poland as the only countries to roll back abortion rights since 1994. Every subsequent ballot measure has confirmed majority support for reproductive freedom in states that had restricted it.
Since 1976, the Hyde Amendment has prohibited federal Medicaid funds from covering abortion — creating a two-tiered system where reproductive rights depend entirely on income. The fiscal inversion is stark: the government refuses to pay $568–$625 for an abortion while paying $9,131–$13,590 for a Medicaid birth. One in four Medicaid women seeking abortion are forced to carry because they cannot pay out of pocket. Hyde falls disproportionately on women of color — 62% of Black women below the poverty line are insured through Medicaid.
In February 2024, the Alabama Supreme Court ruled frozen IVF embryos are "extrauterine children," immediately shutting down three IVF clinics. Nineteen states already have broad personhood provisions in law. In 2024, lawmakers in 16 states introduced over 40 fetal personhood bills. In 2025, 11 states introduced legislation to classify abortion as homicide. In the first two years after Dobbs, prosecutors initiated at least 412 criminal cases related to pregnancy, pregnancy loss, or birth outcomes. Personhood laws do not stop at abortion — they criminalize IUDs, Plan B, IVF, and every miscarriage that might look like something else to a prosecutor.
Sources: Center for Reproductive Rights — reproductiverights.org · Pregnancy Justice — pregnancyjusticeus.org · Guttmacher — guttmacher.org
| Metric | Canada | United States |
|---|---|---|
| Abortion rate (per 1,000 women) | ~10.1 | ~11.6 |
| Abortions at or before 12 weeks | ~87% | 92.8% |
| Abortions at or after 21 weeks | ~1.3% | 1.1% |
| Maternal mortality (per 100K) | ~12 | 18.6 |
| Criminal abortion law in force | None since 1988 | 13 states: total ban |
Canada has one-third fewer abortions relative to population than the US. There was no surge in abortions after decriminalization. Late-term rates are essentially identical. The 36-year natural experiment is definitive: removing criminal law from abortion does not increase abortion rates or late-term procedures. It does reduce maternal mortality.
France constitutionalized abortion in March 2024, 780 votes to 72. Norway extended self-determined abortion from 12 to 18 weeks in December 2024. Denmark did the same in 2024. Iceland expanded to 22 weeks in 2019. Ireland overturned a constitutional ban by popular referendum in 2018 with 66% in favor. Argentina legalized abortion to 14 weeks in 2020. Colombia to 24 weeks in 2022. Mexico's Supreme Court decriminalized nationally in 2023. These are not fringe positions — they are where the world's democracies have arrived after looking at the evidence.
| Country | Funded Cycles | Patient Out-of-Pocket Cost |
|---|---|---|
| France | 4 per child attempt | Effectively €0 |
| Denmark | 6 (first child) | Medications only |
| Belgium | 6 full cycles | Fully covered |
| Sweden | 3 cycles | ~$250 total |
| United States | 0 federal mandate | $12,000–$25,000+ per cycle |
Countries that combine easy abortion access with easy contraception access produce the lowest abortion rates. Broadly legal countries average 34 abortions per 1,000 women. Restricted countries average 37. Latin America — one of the most restrictive regions — has the highest regional rate at 44. Bans do not reduce abortions. They make them more dangerous, more expensive, and more traumatic while producing no improvement in the metric used to justify them.
Sources: Canada.ca — canada.ca · CFR — cfr.org · Guttmacher — guttmacher.org · Euronews — euronews.com
Ten pillars, each addressing a distinct failure of the current system. The foundation is federal codification. Everything else builds on the principle that medical decisions belong to patients and their physicians — not legislators, prosecutors, or courts.
92.8% of abortions occur in the first trimester. Only 1.1% occur after 21 weeks — overwhelmingly for severe fetal anomalies or life-threatening conditions. Canada has operated without any gestational limit for 36 years; its late-term rate is 1.3%, effectively identical to the US. No gestational limit does not mean unlimited late-term abortion. It means trusting doctors to make medical decisions.
The Hyde Amendment forces the government to pay up to $13,590 for a Medicaid birth while prohibiting it from paying $625 for an abortion. This is not fiscal conservatism — it is ideological punishment of the poorest women in the country.
Every $1 spent on family planning saves $7.09 in government costs. Colorado's free long-acting reversible contraception program cut teen births 57% and teen abortions 42%. The UK provides all contraception free through the NHS. Countries with easy access to both contraception and abortion produce the lowest abortion rates in the world.
Medication abortion represents 63% of all US abortions as of 2023, up from 53% in 2020. Mifepristone has a 25-year safety record that independent research has found superior to Tylenol and penicillin on standard risk metrics. Attempts to restrict it are not medical — they are political.
Alabama's 2024 ruling that frozen IVF embryos are "children" immediately shut down three IVF clinics. 412 women faced criminal charges related to pregnancy outcomes in just the first two years after Dobbs. Personhood laws don't stop at abortion — they criminalize IUDs, emergency contraception, IVF, and miscarriage.
The US charges $12,000–$25,000 per IVF cycle with no federal mandate — 271% above the 25-country average. France covers 4 cycles free. Denmark covers 6. Belgium covers 6. Only 15 states mandate any coverage, most riddled with exemptions that make them effectively meaningless.
Abstinence-only programs show no statistically significant reduction in teen pregnancy rates. Comprehensive sex education reduces teen births by 3%+ at the county level (PNAS causal evidence). Combined with universal free contraception, this is the most effective abortion-reduction framework available.
Amber Thurman, Candi Miller, Nevaeh Crain, Porsha Ngumezi — documented, named, confirmed preventable. They died because physicians feared prosecution more than they feared their patients dying. No woman should die because a politician overruled her doctor.
The US has the worst maternal mortality of any wealthy nation at 18.6 per 100,000. Norway: zero. Over 80% of US maternal deaths are preventable. Black women die at 3.5× the rate of white women — a gap that is widening, not closing.
Title X serves 2.8 million patients annually, 83% below 250% of the poverty line. Planned Parenthood provides cancer screenings to over 1 million people per year — only 3% of its services are abortion-related. Defunding these programs does not reduce abortions; it increases unintended pregnancies, which increases abortions.
Reproductive healthcare is among the most cost-effective investments in public health. Most of these policies save money rather than cost it. The framework is fiscally positive — it redirects spending from more expensive outcomes to less expensive ones, and unlocks economic participation that restrictions suppress.
Cost summary: Contraception expansion costs an estimated $2–3 billion per year — but every $1 invested in publicly funded family planning saves $7.09 in Medicaid and other government costs (Guttmacher Institute). IVF coverage mandates add an estimated $1–2 billion per year in insurance costs. Clinic protection and Title X expansion: $500 million per year. Unintended pregnancies currently cost the US an estimated $21 billion per year in public expenditures (Brookings Institution). The offsets dwarf the outlays.
| Policy | Fiscal Position | Mechanism |
|---|---|---|
| Repeal Hyde Amendment | Net savings | Medicaid abortion ($568–$625) costs ~96% less than a Medicaid birth ($9,131–$13,590) |
| Universal free contraception | ~$2–3B/yr; $7.09 saved per $1 spent | Prevents 2.2 million unintended pregnancies per year, including 760,000 abortions. Every $1 in family planning saves $7 (Guttmacher Institute) |
| Title X at $500M/year | $214M annual increase | Offset by savings from prevented unintended pregnancies and reduced emergency care costs |
| IVF coverage mandate | ~$1–2B/yr insurance cost | Net lifetime tax contribution of ~$606,200 per IVF-conceived child — economically positive |
| Comprehensive sex education | Minimal federal cost | Redirect existing abstinence-only funding; reduces teen births 3%+ at county level |
| Maternal mortality programs | ~$2–3B/year | Midwifery expansion, doula programs, postpartum home visits, Maternal Health Equity Fund |
| Clinic protection & Title X | ~$500M/year | Physical security, legal defense, and full Title X authorization — offset by unintended pregnancy prevention |
| EMTALA enforcement | Regulatory cost | Strengthens existing federal obligation; penalty revenue from non-compliant hospitals offsets enforcement cost |
The net fiscal position is strongly positive. Unintended pregnancies cost the US $21 billion per year in public expenditures (Brookings). Abortion restrictions cost the economy $105–$133 billion per year in lost productivity, reduced labor force participation, and lower lifetime earnings. Lifting restrictions would add approximately 505,000 women to the labor force and boost GDP by 0.5%. The maternal mortality crisis costs billions in preventable deaths, litigation, and lost economic output. Prevention is not just the right thing to do — it is the less expensive thing to do.
Sources: Milbank Quarterly — pmc.ncbi.nlm.nih.gov · Third Way — thirdway.org · IWPR — iwpr.org
Sources: CDC — cdc.gov · ANSIRH Turnaway Study — ansirh.org · Guttmacher — guttmacher.org
| Statistic | Figure | Source |
|---|---|---|
| Abortions in first trimester | 92.8% | CDC Abortion Surveillance |
| Abortions at or after 21 weeks | 1.1% (fetal anomaly / emergencies) | CDC |
| Women who say it was the right decision (5 years later) | 95% | ANSIRH Turnaway Study |
| Increased poverty risk for women denied abortions | 4× more likely | AJPH / Turnaway Study |
| Medicaid women forced to carry due to Hyde | 1 in 4 | Guttmacher Institute |
| Return on family planning investment | $7.09 saved per $1 spent | Milbank Quarterly |
| US maternal mortality (2023) | 18.6 per 100,000 | CDC |
| Black maternal mortality vs. white | 50.3 vs. 14.5 per 100K (3.5×) | CDC |
| US maternal deaths that are preventable | 80%+ | Commonwealth Fund |
| Texas maternal mortality increase (year 1 of ban) | +56% | GEPI |
| Criminal pregnancy cases in 2 years post-Dobbs | 412 | Pregnancy Justice |
| Economic cost of abortion restrictions (annual) | $105–$133 billion | Third Way / IWPR |
| Women added to labor force if restrictions lifted | 505,000 | Third Way |
| Countries that liberalized since 1994 | 60+ | Center for Reproductive Rights |
| Countries that rolled back since 1994 | 4 (incl. US) | Center for Reproductive Rights |
Reproductive autonomy does not exist in isolation. Economic security, healthcare access, educational opportunity, and racial justice all shape when and whether a pregnancy is sustainable — and what options a woman has when it is not.
"This is between a woman and her doctor. The government has no place here. Religion has no place here. Politicians have no place here. The evidence has spoken in 60 countries, in 11 ballot measures, in the names of the women we have already lost. We know what works. We choose to do it."— The Common Good Party