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Abortion, Partial-Birth Abortion, and
Adolescent Access to Abortion: An
Overview for Social Workers
Brooke Bernadi
a
, Deana Boughter
a
, Samantha Brown
a
, Andrea
Dunham
a
, Erica Galietta
a
, Lindsey Keiper
a
& Darrel Montero
a
a
School of Social Work, Arizona State University, Phoenix, Arizona,
USA
Version of record first published: 06 Nov 2012.
To cite this article: Brooke Bernadi , Deana Boughter , Samantha Brown , Andrea Dunham , Erica
Galietta , Lindsey Keiper & Darrel Montero (2012): Abortion, Partial-Birth Abortion, and Adolescent
Access to Abortion: An Overview for Social Workers, Journal of Human Behavior in the Social
Environment, 22:8, 947-959
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Journal of Human Behavior in the Social Environment, 22:947959, 2012
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ISSN: 1091-1359 print/1540-3556 online
DOI: 10.1080/10911359.2012.664504
Abortion, Partial-Birth Abortion, and
Adolescent Access to Abortion:
An Overview for Social Workers
BROOKE BERNADI, DEANA BOUGHTER, SAMANTHA BROWN,
ANDREA DUNHAM, ERICA GALIETTA, LINDSEY KEIPER, and
DARREL MONTERO
School of Social Work, Arizona State University, Phoenix, Arizona, USA
Although the U.S Supreme Court Roe v. Wade decision legalized
abortion in 1973, intense controversy over access, legality, and
morality has persisted ever since that landmark decision. National
opinion data collected from 1975 to 2007 show that a majority
of Americans support a womans right to an abortion, but this
right is increasingly under attack, and recent proposed changes
to abortion access are not in line with how most Americans feel.
This paper considers public opinion trends in the sharply divided
arenas of abortion, partial-birth abortion, and adolescents rights
to access abortion with a critical eye to social work practice. We
explore several opportunities for social workers to advocate for
clients, including legislative advocacy, reform through litigation,
social action, and social policy analysis.
KEYWORDS Abortion, pro-life, pro-choice, partial-birth abortion,
adolescent abortion
In 1989, the Supreme Court decision that allowed women the right to an
abortion narrowly escaped a reversal, prompting Justice Harry A. Blackmun
to argue that although women still retain control of their own destinies, signs
are evident and very ominous of the erosion of abortion rights (Webster v.
Reproductive Health Services, 1989).
Justice Blackmuns fears were realized when in February 2006, South
Dakota lawmakers enacted a statewide ban on abortion that did not allow
Address correspondence to Darrel Montero, School of Social Work, Arizona State
University, MC 3920, 411 North Central Avenue, Suite 800, Phoenix, AZ 85004-0689, USA.
E-mail: darrel.montero@asu.edu
947
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for exceptions in case of rape or incest. Furthermore, it made it a felony for
a doctor to perform an abortion (Nieves, 2006). At the same time, eight other
states were considering legislation that would create a similar ban if Roe v.
Wade were overturned.
Abortion rights are more contested now than ever before the nations
courts and legislatures continue to undermind womens access to abortion
services (Finer & Henshaw, 2003). As social workers, we have unique in-
sight into the factors that contribute to a womans decision to terminate
a pregnancy and the effects teenage parenthood, single parenthood, and
unplanned pregnancies have on families.
This article considers new challenges to abortion rights alongside public
opinion data, with an eye to how social workers can most successfully
reconcile mainstream opinions about abortion with a social climate that is
increasingly hostile to abortion and family planning. Although a majority of
Americans are pro-choice, this article will look at American attitudes toward
more controversial abortion issues including underage womens right to
abortion services and the procedure known as partial-birth abortion. This
paper seeks to provide social workers with greater knowledge of the issues
they face when helping their clients navigate the decision to terminate a
pregnancy.
PARTIAL-BIRTH ABORTION
In an era of ongoing public debate on abortion, what has come to be known
as partial-birth abortions have become particularly polarizing. According to
Heffernan (2001), a partial-birth abortion is a popular term for a medical
procedure known as an intact dilation and extraction (IDX). The IDX proce-
dure was referenced in a paper by Haskell (1992); its more controversial
monikerpartial-birth abortiondid not come into common usage until
1995, when Congressman and pro-life activist Charles Canady named it as
such, and the term became commonly used in political debate (Gordon,
2004).
Although slightly more than 25% of women ages 15 and older in the
United States have undergone an abortion (Vandegaer, 2007), the number
of IDX procedures performed annually is estimated to be as high as 5,000
(Heffernan, 2001). According to a study conducted by the Alan Guttmacher
Institute, IDX abortions made up only 0.17% of all abortions performed in
2000a relatively small number given widespread attention to this particular
procedure (Finer & Henshaw, 2003).
Beginning in 1995, a total of 30 states created legislation banning partial-
birth abortions, and similar attempts were also made on the federal level.
Although these attempts were ultimately vetoed by then-President Clinton,
partial-birth abortion continues to serve as a rallying cry in the pro-life move-
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Abortion, Partial-Birth, and Adolescent Access 949
ment, which considers the procedure tantamount to infanticide or murder
(Heffernan, 2001).
The specter of partial-birth abortions exerts an undue influence over
Americans relatively progressive attitude toward reproductive choices given
the extremely small number of these abortions that are actually performed.
The attention that the partial-birth abortion debate receives in the media and
in political discourse threatens to limit womens access to abortion. Given
that the partial-birth abortion debate is arguably based more in emotion
than empirical fact, social workers would benefit their clients and society
at large by recognizing how this paradigm skews the abortion debate and
has the potential to transform the reproductive landscape of the country into
something inconsistent with what a majority of Americans believe.
ADOLESCENTS AND ACCESS TO ABORTION SERVICES
The right of girls younger than age 18 to access abortion services is another
arena currently at odds with American public opinion. Americans who are
unflagging in their support of womens right to have an abortion think
twice when the same question is posed regarding women who are under
age (Benson, Parker, Habben, & Huebner, 2003; Benson, 2004; Resnick,
Bearinger, Stark, & Blum, 1994; Franz & Reardon, 1992; Ambuel, 1995; Trad,
1993).
Within the medical community, widespread support exists for underage
access to abortion services. A poll conducted among U.S. physicians who are
members of the Society for Adolescent Medicine revealed that pediatricians
overwhelmingly supported (96%) adolescent access to abortion under some
circumstances (Miller, Miller, & Pinkston Koenigs, 1998). In fact, 61% support
access to abortions under any circumstance.
Legally regulating access to abortion varies from state to state. In fact,
some states have defined any pregnant teenager as an adult for abortion
decisions (Lerner & Steinberg, 2004). Currently, 35 states require parental
consent or notification for an adolescent abortion, and an additional 9 states
have laws limiting an underage womans right to a legal abortion. Further-
more, only 6 of the 50 states and Washington, DC grant minor women free
and unhindered access to abortion services (Klassel, 2007).
The moral dilemma these data create for social workers is twofold.
First, social workers should realize that a majority of parents are likely to
want teenagers to obtain some form of notification or consent in order to
access abortion services, and social workers must be conscious of this fact
and are obligated to adhere to state and federal guidelines (Benson, 2004).
Interestingly, while a majority of Americans support notification or consent,
a majority of pediatricians and other health care providers do not (Fleming
& OConnor, 1993).
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Further, research by Tomal (1999) indicates that notification and con-
sent laws are not effective in preventing or reducing adolescent birth or
abortion rates. The NASW Code of Ethics (1996) states that social workers
pursue change, particularly with and on behalf of vulnerable and oppressed
individuals and groups of people.
THE DEBATE CONTINUES
The moral and legal questions raised by the abortion debate are exceed-
ingly complex and not resolved by either the pro-life or pro-choice camps.
Although religion, political affiliation, age, and gender influence personal
opinions about abortion, the data presented here report that Americans atti-
tudes toward abortion vary widely in relationship to the rights of minors and
the ethics of the partial-birth abortion procedure. Social workers encounter
these issues on a daily basis through their interactions with teenage parents
who struggle with the challenges of parenthood. Similarly, pregnant women
also must reconcile pressure to bring their children to term with greater social
and economic stigmas for being single mothers, for being poor, or for being
both.
METHODS
The findings of this study are based on published opinion polls from the
Gallup Organization (2003a, 2003c, 2005, 2006a, 2006b, 2007). The design
of the sample (Gallup, 1996) for personal (face-to-face) surveys is that of
a replicated area probability sample down to the block level, in the case
of urban areas, and down to segments of townships, in the case of rural
areas. After stratifying the nation geographically and by size of community
according to information derived from the most recent census, more than
350 different sampling locations were selected on a mathematically random
basis from within cities, towns, and counties that have, in turn, been selected
on a mathematically random basis.
The procedures just described are designed to produce samples that
approximate the adult civilian population (age 18 and older) living in private
households (that is, excluding those in prisons, hospitals, hotels, and reli-
gious and educational institutions and those living on reservations or military
bases) and, in the case of telephone surveys, households with access to a
telephone. Survey percentages may be applied to census estimates of the
size of these populations to project percentages. The manner in which the
sample is drawn also produces a sample that approximates the distribution
of private households in the United States; therefore, survey results can also
be projected onto the number of households.
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Abortion, Partial-Birth, and Adolescent Access 951
THE STUDY
Questions
This article considers Americans attitudes toward abortion by exploring
responses to the following questions: (1) How have attitudes toward abor-
tions legality changed over time; (2) do Americans support or oppose a
partial-birth abortion ban; (3) what are the publics views regarding requiring
parental consent for minors to obtain an abortion; and (4) how do gender,
age, region, education, and political affiliation influence a respondents view
of abortion? These questions sample public opinion toward abortion over the
last several decades, and the findings are drawn from opinion polls compiled
by the Gallup Organization.
Findings
VIEWS ABOUT THE LEGALITY OF ABORTION
In 1975, the Gallup Organization began polling Americans regarding their
perceptions of whether abortion should be legal, asking a cross-section of
Americans whether they thought abortion should be legal under any circum-
stances, legal under certain circumstances, or illegal under all circumstances?
(Table 1).
Since 1975, the results reveal very little change in Americans attitudes
regarding abortion. The percentage of Americans who support this position
range from 50% to 59%. The percentage of Americans who support abortions
legality (unconditionally) in the same time period ranged from 21% to 33%.
VIEWS TOWARD A PARTIAL-BIRTH ABORTION BAN
From 1996 to 2007, a cross-section of Americans were asked whether they
favored or opposed a law that would make it illegal to perform a spe-
cific abortion procedure conducted in the last six months of pregnancy
known as partial-birth abortion, except in cases necessary to save the life
of the mother. The question was worded slightly differently in 2007, asking
whether partial-birth abortion should be legal or illegal (Table 2).
The results reveal an upward trend for banning partial-birth procedures,
with the percentage supporting this position ranging from 55% to 72%. A
majority of Americans consistently support a partial-birth abortion ban in all
sampling periods. Between 1996 and 2007, the number of Americans who
opposed banning partial-birth abortions fell from 39% to only 22%.
VIEWS REGARDING PARENTAL CONSENT LAWS
The abortion debate in the United States is perhaps no more complex than
when considering a minor womans right to an abortion. From 1992 to 2005,
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TABLE 1 Views toward the Legality of Abortion, 19752006
Year
Legal only
under certain
circumstances
%
Legal under any
circumstances
%
Illegal in all
circumstances
%
1975 54 21 22
1977 55 22 19
1979 54 22 19
1980 53 25 18
1981 52 23 21
1983 58 23 16
1985 55 21 21
1988 57 24 17
1989 51 28 17
1990 53 31 12
1991 50 33 16
1992 50 33 14
1993 51 32 13
1994 52 32 14
1995 52 32 14
1996 55 25 16
1997 58 24 16
1998 59 23 17
1999 55 27 16
2000 54 27 17
2001 55 26 17
2002 53 26 20
2003 56 24 18
2004 56 24 19
2005 56 25 18
2006 53 30 15
Note. Question: Do you think abortion should be legal under any cir-
cumstances, legal only under certain circumstances, or illegal in all circum-
stances?
Figures may not total 100% because of rounding.
For each table, the authors have reported all data which were collected by
the Gallup Organization. However, it is important to note that the Gallup
Organization did not conduct the same survey every year, which explains
the occasional gaps in data reported from year to year.
Source: Poll data compiled by the Gallup Organization (2006a).
a cross-section of Americans were asked whether they favored or opposed a
proposed law that would require women under 18 to get parental consent
for any abortion (Table 3).
The results revealed a consistent level of support for a law requiring a
minor woman to acquire parental consent prior to receiving an abortion. The
percentage of Americans supporting such a law ranged from 69% to 74%.
VIEWS ON ABORTION BY SUBGROUPS
Beliefs regarding the legality of abortion vary greatly between individuals.
Support for abortion is often related to such factors as education, age, gender,
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Abortion, Partial-Birth, and Adolescent Access 953
TABLE 2 Views toward Partial-Birth Abortion Ban, 19962007
Year
Favor a ban
%
Oppose a ban
%
1996 57 39
1997 55 40
1998 61 36
1999 61 34
2000 64 31
2000 66 29
2000 63 35
2003 70 25
2003 68 25
2007 72 22
Note. Question: If you could vote on this issue directly, a law that would
make it illegal to perform a specific abortion procedure conducted in the
last six months of pregnancy known as a partial-birth abortion, except
in cases necessary to save the life of the mother. Favor or oppose?
In 2007, Gallupbrain asked a similar question with different wording: : : :
opinion about : : : partial-birth abortion. Do you think that this procedure
should be legal or illegal?
Data reported three times in 1 year indicate that the question was asked
multiple times during the same year.
Figures may not total 100% because of rounding.
For each table, the authors have reported all data which were collected
by the Gallup Organization. However, it is important to note that the
Gallup Organization did not conduct the same survey every year, which
explains the occasional gaps in data reported from year to year. Source:
Poll data compiled by the Gallup Organization (2003c, 2005, 2007).
TABLE 3 Views Regarding a Law That Would Require Women
Younger Than 18 to Receive Parental Consent for Any Abortion,
19922005
Year
Favor
%
Oppose
%
No opinion
%
1992 70 23 7
1996 74 23 3
2003 73 24 3
2005 69 28 3
Note. Question: Do you favor or oppose each of the following proposals
: : : a law requiring women under 18 to get parental consent for any
abortion.
For each table, the authors have reported all data that were collected by
the Gallup Organization. However, it is important to note that the Gallup
Organization did not conduct the same survey every year, which explains
the occasional gaps in data reported from year to year.
Source: Poll data compiled by the Gallup Organization (2006b).
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TABLE 4 Views on Abortion by Subgroups, 2003
Group
Legal in all/
most cases
%
Illegal in all/
most cases
%
Nations adults 38 60
Men 39 58
Women 37 60
1829 37 63
3049 42 55
5064 45 54
65C 22 72
East 42 56
Midwest 35 63
South 35 63
West 41 55
Postgrad. education 58 40
College grad. only 54 43
Some college 41 58
High school grad. or less 24 73
Republican 27 70
Independent 41 57
Democrat 46 50
Note. Question: Do you think abortion should be legal in all or most
cases or illegal in all or most cases?
Figures may not total 100% because of rounding.
Source: Poll data compiled by the Gallup Organization (2003a).
region, and political affiliation. Table 4 reports Americans response to the
following question: Do you think abortion should be legal in all or most
cases or illegal in all or most cases? In January 2003, when the poll was
conducted, the responses were divided into two categories: legal in all or
most circumstances and illegal in all or most circumstances.
The data reveal a few notable trends. Americans with a college degree
or higher support abortion rights more than those with less education, while
Americans living in the South and Midwest tend to be more conservative
than those in the East and West. Fully 4 in 10 Americans living in the East
or West believed abortions should be legal compared to only one-third of
Americans living in the South or Midwest. Fully 45% of Americans between
ages 50 and 64 believed abortion should be legal, whereas only 22% of those
65 and older indicated a similar response.
These responses are consistent with those found by Hess and Rueb
(2005), who also correlated pro-choice or pro-life identification with Amer-
icans political party affiliation. Carlton, Nelson, and Coleman (2000) de-
scribed gender differences on abortion views as minimal, and our findings
seem to bear that conclusion out.
Wang and Buffalo (2004) suggested that an increase in education leads
to an increase in sexual tolerance, which translates to more accepting at-
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Abortion, Partial-Birth, and Adolescent Access 955
titudes toward abortion. According to Wang and Buffalo, regional differ-
ences can be attributed to social and political conservativism, including
higher church and religious involvement in areas such as the South and
Midwest.
Implications
Figueira-McDonough (1993) presents four activist approaches available to
social workers. Specific ways in which social workers could serve as ad-
vocates for a more informed and progressive discussion about abortion for
minor women include legislative advocacy, reform through litigation, social
action, and social policy analysis.
LEGISLATIVE ADVOCACY
Most American women do not have full access to abortion services even
under the protections of Roe v. Wade, as local, state, and federal restraints
have combined to make abortion only partially or selectively available (Finer
& Henshaw, 2003). An underlying goal of social work practice is to foster self-
determination by providing thorough and objective information. Effective
social workers often balance advocating for social justice, promoting well-
being, and empowering their clients while engaging in policy practice. A
number of factorsfederal funding and the availability of services among
otherscontribute to reduced access to abortion services among women
from lower socioeconomic backgrounds. Social workers would best serve
as advocates against such discrimination by ensuring equal access to family
planning for all women, not just nationally but globally as well.
Medicaid is one of the largest health care provider in the United States,
and it provides health care to low-income individuals who would otherwise
not be covered by insurance. As a federally funded program, Medicaid is
subject to the provisions of the 1976 Hyde Amendment, which prohibits
Medicaid from covering the costs of abortions. Although states are free to
use their own funds to provide abortion services for women on Medicaid,
only 17 of 50 states actually do (National Network of Abortion Funds, 2012).
Under the Hyde Amendment, the federal government has essentially
legalized discrimination against poor women nationwide. The Hyde Amend-
ment has been a point of contention for social workers since its inception,
and effective advocacy and lobbying against the Hyde Amendment would
benefit not only poor women but women in general. Advocacy should raise
awareness and influence legislation that is beneficial to the populations
represented by social workers. Nowhere do vulnerable women and families
need social workers activism more than in pressuring officials on the local,
state, and federal level to reform legislation such as the Hyde Amendment
that limits access to abortion services based on womens socioeconomic
status.
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REFORM THROUGH LITIGATION
Although this approach requires an understanding of current laws and the
patience to see test cases through to their conclusion, reform through litiga-
tion is nevertheless a viable option for social workers interested in advocating
for their clients right to equal access to abortion services.
Social workers should make their clients aware that The Child Custody
Protection Act places liability (punishable by imprisonment or fines) on any
provider or person who assists a minor with a medical abortion if the minor
does not meet the criteria mandated for parental involvement (Center for
Reproductive Rights, 2006). Social workers are well aware that this act has
often confused the process and delayed an abortion through written consents
and required waiting periods.
One very significant way in which social workers could advance the
rights of women and follow the NASW Code of Ethics is to pursue social
change, particularly with and on behalf of vulnerable and oppressed indi-
viduals and groups of people (NASW, 1996). It would be important to use
reform through litigation to seek out test cases with the potential to expand
adolescents access to abortion services. This approach seems particularly
urgent, given the data presented here that suggest a majority of Americans
favor parental consent in order for a minor woman to obtain an abortion.
Social workers could advocate on behalf of minor women who do not yet
have the right to vote.
SOCIAL ACTION
Although each approach has the possibility to dramatically improve womens
choices and family-planning options, social actionwhich is community-
based and grassrootsmay be more immediately accessible to more social
workers than reform through litigation. Social workers could employ this
approach on a local level by establishing ongoing dialogue within their
community about reproductive options and by mobilizing key community
players for change. Additionally, social action relies on support from outside
groups and from general public opinion. Knowledge of public opinion data
could significantly aid social workers in influencing abortion availability on
a local level.
With such a socially divisive issue, knowledge of current and histor-
ical attitudes toward abortion helps to inform and prepare social work-
ers to navigate the range of emotions, beliefs, and opinions their clients
and their clients families may have. The data presented here uphold the
findings of previous polls on Americans attitudes about abortion: Despite
South Dakotas 2006 ban on abortion and the pro-life movements strong na-
tional presence, a majority of Americans remains pro-choice. Given this well-
substantiated fact, social workers should feel both justified and compelled
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Abortion, Partial-Birth, and Adolescent Access 957
to advocate for their clients ability to access abortion and family-planning
services as their clients deem necessary.
SOCIAL POLICY ANALYSIS
The fourth and final venue for activism by social workers in regard to greater
reproductive choices is social policy analysis, which provides social workers
with the tools to closely read and understand social policy. By applying
analytical lenses such as self-determination and equity, social workers are
better equipped to propose change to legislation that directly affects their
clients.
As an impartial social worker, our beliefs are secondary to the needs of
the client. It is our responsibility to provide accurate and concise abortion
counseling or referral information. As social workers, it is our duty to ensure
that a woman has comprehensive reproductive choices by advocating for
legislation and policy that will reinstate the health and privacy of the birth
mother as a primary human right.
There are many ways in which womens reproductive rights are under
attack: through legislation, through an increasingly hostile political climate,
and through issues such as partial-birth abortion procedures that skew the
publics perception of the abortion debate. The social policy analysis ap-
proach is an invaluable tool for social workers interested in advocating for
increased and equitable reproductive rights in that it prepares social workers
to critically address this issue on a number of fronts. In an era in which the
government increasingly encroaches upon womens reproductive rights and
privacy, social workers have the potential to be effective and much-needed
advocates for their clients in this arena.
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