(RNN) - Forty years after the Roe v. Wade ruling made abortion legal in the U.S., the issue of abortion remains divisive and emotional as reproductive rights are under attack.
On Jan. 22, 1973, the U.S. Supreme Court announced its Roe v. Wade decision in a case that had been filed by "Jane Roe," an unmarried woman who wanted to legally end her pregnancy.
The decision, which pointed out that a woman's constitutional right to privacy included the right to terminate her pregnancy, has saved women's lives by making abortion safer and easier to obtain.
In 1965, 17 percent of all pregnancy and childbirth-related deaths resulted from illegal abortion, according to the Guttmacher Institute.
In 2007, the most recent year for which information is available, six women were reported to have died from complications from legal abortions, according to the CDC, with no reported deaths resulting from illegal abortions.
Abortion is now one of the most commonly performed clinical procedures in the United States. Since 1973, an estimated 54,559,615 abortions have been performed in the U.S., according to information from the Guttmacher Institute.
The Supreme Court noted in 1992, in its Planned Parenthood of Southeastern Pennsylvania v. Casey ruling, that "the ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives."
And 40 years later, the ruling still has popular support, according to a Pew Research Center poll, with 63 percent of Americans believing that Roe v. Wade should not be completely overturned, compared to 29 percent who believe it should be.
Pro-life lawmakers have worked to limit women's access to abortion by enacting a bevy of regulations and mandates on federal and state levels.
The Planned Parenthood v. Casey ruling, while reaffirming Roe v. Wade, also stated that abortion regulations could only be challenged if they placed substantial obstacles to women seeking abortions. Further Supreme Court actions have placed prohibitions on partial-birth abortions and some second-term abortion procedures.
The new millennium has been the era of red tape, with the largest number of abortion restrictions, 92, enacted in 2011, according to the Guttmacher Institute.
Some states mandate procedures that are not medically necessary, such as counseling, waiting periods and ultrasounds in an effort to discourage women who are seeking abortions.
"Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion," according to the Guttmacher Institute.
Mandated ultrasounds also penalize patients by increasing the cost of the procedure. Ultrasounds and waiting periods also cause delay and may cause women who travel long distances for an abortion to make repeat trips to the provider.
Depending on where women live, they may have difficulties getting to a facility that offers abortion. Across the U.S., 87 percent of U.S. counties, mostly in rural areas, have no abortion providers, according to NARAL Pro-Choice America.
In addition to the red tape, women have to deal with a ticking clock.
The time window for obtaining an abortion has shrunk for some, with seven states banning abortion after 20 weeks, the Guttmacher Institute stated. Arizona's ban of abortion after 18 weeks gestation has been blocked by an appeals court.
A couple of states have proposed banning abortion when a fetal heartbeat can be detected. The proposals, called heartbeat bills, have been pushed without success in Ohio in 2012 and has been put forward in Wyoming recently.
Some state regulations interfere with the doctor/patient relationship by restricting or distorting the information flow to patients. Laws in eighteen states now require providers to give women misleading information about the negative consequences of abortion, according to the National Abortion Federation.
Legislation has also complicated insurance coverage for abortion procedures.
The federal government has restricted abortion access under the Affordable Care Act because of the Stupak-Pitts Amendment, which restricts federal funding of abortion coverage with few exceptions, according to NARAL. While the ACA permits insurance coverage of abortion, plans with abortion care must segregate funds used for these services.
Women who depend on the federal government for their healthcare or health insurance - including military women, Native Americans, Peace Corps volunteers, prisoners and low-income women - also have limited access to abortions because of restrictions on the use of federal funds.
However, the 2013 National Defense Authorization Act included an expansion of abortion rights - the Shaheen amendment, sponsored by U.S. Senator Jeanne Shaheen of New Hampshire.
The amendment allows the Department of Defense to cover abortions for military women in cases of sexual assault or incest.
"Put simply, this is about equity. It's about doing what's right for our women in uniform and treating them fairly," Shaheen said.
Those who receive healthcare under private insurance plans are also subject to legal interference. Eight states restrict coverage of abortion in these plans, most often only allowing abortion if carrying the child to term would put the woman's life is in danger.
Because of a law passed soon after Roe v. Wade, the U.S. allows individuals or groups to refuse to provide women specific reproductive-health services, information or referrals, which includes abortion or sterilization services.
Healthcare groups can "refuse to train medical professionals to provide abortion services, require abortion training, or provide referrals for abortion training," according to the Guttmacher Institute.
In Mississippi, the state's only abortion clinic is currently in danger of being closed because of a law mandating that abortion providers have hospital privileges, something the local hospitals are unwilling to provide the clinic, according to a report by WDAM in Hattiesburg, MS.
Republican Gov. Phil Bryant said his goal is to shut down the clinic.
Americans United for Life, a pro-life group, point to Mississippi as an example of the effectiveness of incremental laws on the state's abortion rate.
"Over the past 15 years, Mississippi has adopted 15 pro-life laws," the group states. "As a result, abortions in the state have decreased by nearly 60 percent, and six out of seven abortion clinics have closed."
Though abortion remains legal, pro-life forces have been working on strategies to eliminate Roe v. Wade.
Pro-life legislators have brought forward personhood amendments, which define life as beginning at conception.
Sponsors of personhood legislation, including federal measures co-sponsored by unsuccessful vice-presidential candidate Paul Ryan, generate these proposals in hopes that they will circumvent Roe v. Wade or lead to a challenge that will serve as an impetus to strike down the ruling.
AUL envisions another way legislators could curtail abortion.
"For example, an alternate amendment could be one that establishes that 'no right to abortion is protected by the constitution,'" AUL stated.
Personhood efforts have thus far been largely unsuccessful. In October 2012, the U.S. Supreme Court refused to entertain Oklahoma's personhood amendment, struck down by the Oklahoma Supreme Court, according to the Christian Science Monitor.
Mississippi's personhood amendment came up for a statewide vote in 2001 and failed, not even winning the support of that state's pro-life governor, who cringed at the verbage.
"I believe life begins at conception. Unfortunately this personhood amendment doesn't say that," Gov. Haley Barbour said at the time, according to WDAM. "It says that life begins at fertilization or cloning or the functional thereof. That view is striking a lot of pro-life people as concerning."
Despite a lack of success in enacting personhood laws, AUL lauds some victories in laws protecting the unborn.
"The pro-life movement has already been successful in establishing legal personhood for the unborn in certain areas of the law, such as fetal homicide, wrongful death, and assault and battery laws," the group stated.
Nationally, the number of abortions has decreased. In 2009, the CDC reported 784,507, a rate of 15.1 abortions per 1,000 women aged 15 to 44, from a high of more than 1.6 million in 1990.
The National Right to Life Education Trust Fund credits the decline in abortions to a change in attitude, reflected in restrictive legislation.
"A large segment of the public … saw abortion for what it was – the destruction of innocent human life – and undertook legislative, educational, organizational and practical steps to protect the lives of unborn children and their mothers," the group stated.
However, across the globe, it seems abortions are more common in places where it is restricted.
Internationally, Europe, where abortions are widely available, has the lowest rate of abortions, below 10 per 1,000 women aged 15 to 44 years, according to the National Institutes of Health.
In contrast, Africa, Latin America and the Caribbean have rates "from the mid-20s to 39 per 1,000 women" despite more restrictive laws.
The World Health Organization says in countries where abortion is unsafe or illegal, it is a leading cause of maternal death.
Whether they categorize abortion as a women's rights issue or an unborn child issue, people on both sides feel strongly, leading to protests and counterprotests, with abortion clinics often the collision point.
In March 2012, a controversial transvaginal ultrasound measure in Virginia spurred protests at the state capital, leading to the arrest of 30 protesters, according to WWBT.
"We really, honestly, didn't think we were doing anything wrong," said Shelley Abrahms, one of the protesters charged with trespassing and unlawful assembly. "We're just sitting on the side of the steps."
Rocky Humphries, a pro-life protester, spoke to KCBD in October 2012 about abortion.
"We can't point our finger the Iraqis or the Muslims," he said. "The guilt is right here in our own country. ... We need to repent to God, and God will help us, and these clinics will be closed."
Abortion providers have been a target of violence. More than 4,000 acts of violence have been committed at abortion clinics nationwide since 1977, according to the National Abortion Federation. Eight people have died since 1993.
To remedy this, a 1994 law, the Freedom of Access to Clinic Entrances Act, "prohibits a range of violent, obstructive, and threatening activities intended to interfere with the provision of reproductive-health services."
That didn't stop a few South Dakota state legislators in 2011 from proposing provocative legislation, an act to expand the definition of justifiable homicide to provide for the protection of unborn children.
According to that state's legislative database, the act stated in part:
"Homicide is justifiable if committed by any person while resisting any attempt to murder such person, or to harm the unborn child of such person in a manner and to a degree likely to result in the death of the unborn child, or to commit any felony upon him or her, or upon or in any dwelling house in which such person is."
The act was tabled by that state's House of Representatives.
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