- D. Lynn JacksonD. Lynn JacksonUniversity of North Texas
Until the 19th century, abortion law was nonexistent and abortion was not seen as a moral issue. However, by the turn of the 20th century, abortion was legally defined and controlled in most states. The landmark Supreme Court case, Roe v. Wade (1973), marked the legalization of abortion but did not end the controversy that existed. Legislation at both the federal and state levels has added restrictions on abortion, making it difficult for women to exercise their reproductive rights. Social work's commitment to promote the human rights of women compels social workers to be aware of and involved in this issue.
- Ethics and Values
- Health Care and Illness
- Social Justice and Human Rights
The Supreme Court legalized abortion in 1973 Roe v. Wade (1973) but this pivotal decision has not prevented the federal or state governments from adding restrictions to abortion, that is, parental involvement or the so-called partial birth abortion ban. Social work is a value-based profession (Pardeck, 2003) that has a longstanding commitment to making resources available and accessible to all women. This is supported by the National Association of Social Work (NASW) through policy statements aimed at providing comprehensive sex education, dissemination of information on safe contraception, and access to information on abortion (Haslet, 1997).
Examining the history of abortion-related social policy provides knowledge as to how people have come to think and act about abortion (Ginsburg, 1989). From the 12th to 19th centuries, it was not difficult for a woman to end a pregnancy well into her fifth month because it was believed that pregnancy did not begin until there was quickening (that is, independent movement) by a fetus and as a result, abortion was not seen as a moral issue (Nossiff, 2001).
Legislation to restrict access to abortion services in the United States began to emerge in the 1800s, when physicians became concerned about protecting their professional status, perhaps to try and discourage female midwives and other nontrained physicians from medical practice in this area (Petchesky, 1990). By the turn of the 20th century the United States transformed from a nation with no abortion laws to one where abortion was legally defined and controlled by the states (Mohr, 1978).
The lack of consensus among physicians regarding abortion, the growing movement toward abortion law reform, and an emerging women's movement provided an opportunity to explore changing existing abortion legislation. Griswold v. Connecticut (1965) enabled the Supreme Court to rule that that there were areas of privacy or protected freedoms, which permitted married couples the right to decide whether or not to use birth control (Tribe, 1992). Feminists used this decision to provide a context for the abortion issue by framing the relevant issues in terms of gender and to define access to contraception and abortion as a reproductive right.
By the 1970s, abortion laws varied within the United States, and in 1971, a case from Texas challenged the existing abortion law. It resulted in the landmark Supreme Court case Roe v. Wade (1973), which established the legal right to have an abortion, and extended the Constitution's guarantee of privacy to abortion. Just 3 years later, legislators, including Henry Hyde (R-Illinois), brought attention to the fact that 33% of abortions were paid for by Medicaid funds and sought to ban all federal funding for abortions by introducing an amendment to a Department of Health and Human Services appropriations bill (later known as the Hyde Amendment). Passage of the amendment was an effective method in reducing the number of abortions despite the Roe v. Wade (1973) decision because it limited federal Medicaid reimbursement for abortion.
On July 3, 1989, the Supreme Court upheld restrictions on abortion in the case of Webster v. Reproductive Health Services (1989). This Missouri law prohibited public employees from performing abortions in public facilities, prohibited the use of public facilities to perform abortions, and required doctors to test to see if a fetus was viable (Craig & O'Brien, 1993). It was a turning point in abortion policy, because although Roe v. Wade (1973) outlined the role of the states primarily within the second and third trimester, the Supreme Court's decision in Webster v. Reproductive Health Services (1989) provided states with the necessary authority to impose restrictions as long as it appeared that the restrictions would not place an undue burden on women seeking abortions (Tribe, 1992).
Following Webster v. Reproductive Health Services in 1989, Pennsylvania passed legislation that imposed a variety of restrictions on abortion access, including waiting periods, parental consent, and viability tests. Upon appeal, the Supreme Court in Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) upheld the Pennsylvania provisions, severely limiting access to abortion services, but reiterated their commitment to Roe v. Wade (1973) upholding a woman's right to have an abortion. The Court stated that waiting periods and delays were constitutional unless proven to be an “undue burden” and affirmed the right of states to impose further restrictions on abortion access (Wilcox, 1996).
Supreme Court decisions in 2000 and 2007 were both directed at federal legislation called the Federal Abortion ban or partial birth abortion ban. Ruling first in 2000, Stenberg v. Carhart (2000) struck down the ban because it permitted for no health exception to the woman, but by 2007, with two new justices on the Court, Gonzales v. Carhart (2007) upheld the ban, paving the way for states to enact additional restriction.
There are scholars who argue that statutory or court restrictions alone do not account for the difficulty in obtaining an abortion and attribute a decrease in the abortion rate to reasons such as the dwindling number of abortion clinics and physicians, political issues or policy ideology, and demographic factors such as race and socioeconomic status (Berkman & O'Connor, 1993; Haas-Wilson, 1993; Henshaw & Van Vort, 1994; Meier & McFarlane, 1993; Tatalovich & Daynes, 1988).
Social work has a long history of commitment and obligation to make resources available and accessible for clients. When social workers do not recognize clients' differences in values and the diversity of their lives, it is incongruent with social work values (Haynes & Mickelson, 1997).
At the micro level, social workers provide information and educate individuals about reproductive health issues, including birth control and abortion, sexually transmitted diseases, and HIV. Social workers may also help clients locate and utilize resources, including finding abortion clinics (particularly problematic in rural areas, where there are fewer abortion providers), and will help women to access financial resources to pay for services (through organizations such as the National Network of Abortion Funds [Jackson, 2007]).
At the macro level, in promoting social justice, the Code of Ethics requires social workers to uphold the human rights of women (George, 1999), including reproductive rights. It necessitates that social workers permit clients to determine their own course of action (self-determination) and to assist them with the information and resources needed to make decisions about their own lives. The expectation is that clients are permitted every opportunity to obtain needed information, services, and resources and that equality of opportunity which defines the value of social justice be made available to all clients despite race, age, or level of income (National Association of Social Workers [NASW], 1999).
Social workers whose religious ideology is in conflict with a pro-choice stance may be faced with a client seeking information or assistance in obtaining an abortion. Those individuals will have to decide whether they can work with the client despite a personal values conflict or whether they would do better to refer that client out to another social worker or agency, if that is possible.
Further, the NASW policy statement on Family Planning and Reproductive Choice takes a proactive stance in terms of a woman's right to choose and maintains that women's reproductive rights are protected through fewer restrictions on state and federal policies regarding abortion, including policies that restrict financing abortion services through health insurance and foreign aid programs (NASW, 2006).
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