Early and Later Abortions: Ethics and Law





Early Abortions Are Not Wrong, Late Abortions Could Be Wrong,

but probably All Abortions Should Be Legal













Draft 7/31/18 ; Google doc; Also available at Academia.edu and Dropbox





Abstract





Most abortions occur early in pregnancy. I argue that these abortions, and so most abortions, are not morally wrong and that the best arguments given to think that these abortions are wrong are weak. I also argue that these abortions, and probably all abortions, should be legal.



I begin by observing that people sometimes respond to the issue by describing the circumstances of abortion, not offering reasons for their views about those circumstances; I then dismiss “question-begging” arguments about abortion that merely assume the conclusions they are given to support; most importantly, I evaluate many arguments: both common, often-heard arguments and arguments developed by philosophers.



My defense of abortion is based on facts about early fetuses’ not yet possessing consciousness or any mental life, awareness or feeling, as well as concerns about rights to one’s own body.

Introduction

1. Defining Abortion

2. Arguments, Not Circumstances

3. Question-Begging Arguments

4. Arguments Against Abortion

5. Why Early Abortions – & So Most Abortions – Are Not Wrong

5.1. Consciousness and Ethics

5.2. The Right to Life

5.3. Later-term Abortions

6. Conclusion

For Further Reading





“Liberals,” or people on or towards the “the Left”, tend to be pro-choice about abortion. They tend to believe that, legally, women should be at liberty to have abortions, if they want, and so abortions should be legal. Here I support this view.



My emphasis won’t be on the law, but on the ethics of abortion. [2] I argue that at least early abortions - affecting first trimester or earlier fetuses - are not wrong. Since most abortions are early abortions, I address the ethics of most abortions. Since morally permissible behavior should not be criminalized, at least most abortions should be legal. I do argue, however, that probably all abortions should be legal, even if any later abortions are wrong. [3]

1. Defining Abortion

I propose this initial definition of abortion:





An abortion is the intentional killing of an embryo or fetus to end a pregnancy.





Abortions are intentional. If a pregnancy ends because of an accident, the women did not “have an abortion.” Miscarriages are called “spontaneous abortions,” but these are not deliberate actions that can be morally evaluated.



Some object to the word ‘killing,’ thinking that ‘termination’ is better. But if we think through what this “termination” is, we see that it involves taking something biologically alive and making it not alive, or killing it.



Some people are uncomfortable with this: they react that “Killing is wrong!” and so wonder if abortion should be understood as involving killing. This reasoning overlooks, however, that killing isn’t always wrong: indeed, it is often completely permissible. It’s not wrong at all to kill mold, bacteria, vegetables or tumors. These aren’t even prima facie wrong to kill, meaning, no good reason at all is needed to justify this killing . This isn’t in any way to compare human fetuses to any of these things: it just makes the point that, since killing often isn’t wrong at all, defining abortion in terms of killing is not problematic.



Some understand abortion as the killing of an unborn baby or child . While people are free to use the words ‘baby’ and ‘child’ however they’d like, people can misuse words. And this seems to be a misuse of words. Early fetuses have none of the relevant, perhaps essential, characteristics of babies. We could ask, ‘What are babies like?’ and use people’s responses to make a list of core baby characteristics: cute, cuddly, soft, having a certain smell, can cry, can be happy, sad or angry, needy, and so on. Early fetuses aren’t like that. A visual helps show that it is a stretch to call an embryo or early fetus a ‘baby’ or ‘child’ [4] :





– all that we want a definition to be. In sum, defining abortion as the intentional killing of an embryo or fetus to end a pregnancy is accurate, informative, and morally neutralall that we want a definition to be.

2. Arguments, Not Circumstances

People sometimes begin discussing abortion by asking questions about abortion in particular circumstances: “What if it’s needed to save the mother’s life?” “What if the pregnancy is from rape?” “What if there are severe fetal abnormalities?” and so on. Or they begin by stating circumstances where they think abortion is wrong or not: “It’s wrong if used for ‘birth control’,” “It’s not wrong if the woman is too young to be an effective mother,” and so on.



These starting points are fine, if – but only if – these statements are supported, or questions answered, with reasons. Our concern is arguments , the reasons given for and against specific conclusions about abortion, such as that:





Abortion is:

● (nearly) always morally wrong.

● (nearly) always morally permissible, or not wrong.





● wrong, except in these circumstances: ____.

● permissible, except in these circumstances: ____.





● sometimes morally obligatory, or wrong to not have, such as in these circumstances: ____.





People sometimes offer moral claims about abortion “in general,” without being precise about which abortions they have in mind. But the details matter: depending on the stage of fetal development and the woman’s circumstances, different moral conclusions may be appropriate.



Some people also want to focus on important, but comparatively rare, abortions: for example, of pregnancies from rape (perhaps 1% of abortions) or incest. [5] Our initial focus will be on more common circumstances where for a variety of other reasons, a woman is pregnant but does not want to have a child (or another child, now). After this we will discuss other important, but less common, circumstances.



We can immediately set aside circumstances though where the woman would die if her pregnancy continues, and so the fetus will die also, or we must choose between the mother and fetus. Even people who generally oppose abortion typically argue that we should save one life instead of losing two lives and prioritize the mother, not the fetus. Their view then is not that abortion is always wrong, but that it is wrong in most circumstances , or prima facie wrong.



Whether this specific conclusion, and any other, can be supported with good arguments is our concern.

3. Question-Begging Arguments

Many arguments about abortion are bad. Sometimes this is because they “beg the question,” or assume the argument’s conclusion as a premise. Question-begging arguments against abortion assume that abortion is wrong or that fetuses are wrong to kill; question-begging arguments in favor of abortion assume that abortions are not wrong or that fetuses are not wrong to kill. This is circular reasoning and must always be dismissed.



Sometimes it’s obvious why an argument is question begging (“Abortion is wrong because abortion is not right”); other times reflection is needed. Here are some question-begging arguments for the permissibility of abortion:





“Abortion is not wrong because:





(1) a personal choice.” abortion is.”

(2) should be able to make that choice.” couplesmake that choice.”

(3) a (moral) right to have abortions.” women haveto have abortions.”

(4) like abortions, then don’t have one!” well, if you don’tabortions, then don’t have one!”





These all seem to assume that abortion is not wrong.



About (1), we would never say that choices to commit arson or kidnapping are “personal choices.” Dying your hair or quitting piano lessons, however, are “personal choices.” “Personal choices” are choices that are not wrong to make. Saying that abortion is a “personal choice” assumes that abortion is not wrong, as does claim (2).



Regarding (3), sometimes when people assert that they have a “right” to do something, they are merely saying that it’s not wrong to do that something. That assumption begs the question. (If they explain why women have such a right, the argument might not be question-begging).



Response (4) is a slogan, not an argument, that assumes that abortion is not wrong. Imagine someone said, “Don’t like vandalism ? Don’t vandalize !” “Don’t like stealing? Don’t steal !” This would be are absurd because these actions are wrong. (4) assumes abortion is not wrong.



Here are a few question-begging arguments against abortion:





“Abortion is wrong because:





(1) murder;” abortion is;”

(2) better options than abortion, like adoption; there are morallyoptions than abortion, like adoption;

(3) must have the baby;” if a woman gets pregnant, she justhave the baby;”

(4) irresponsible;” women who have abortions are;”

(5) good person wouldn’t have an abortion;” wouldn’t have an abortion;”

(6)

women who have abortions feel guilty.”

assume that abortion is wrong: These allthat abortion is wrong:





(1) killing fetuses is wrong because it’s wrongful killing; “murder” means “wrongful killing,” so (1) says thatbecause

(2) may be but we can’t just assume that; this assumes that abortion is a bad or undesirable option: itbut we can’t justthat;

(3) must not have abortions, which is to say that it’s wrong; this asserts that womenhave abortions, which is to say that it’s wrong;

(4) supposed to do, so (4) assumes that abortions are wrong; “irresponsible” people don’t do what they are, so (4)assumes that abortions are wrong;

(5) this assumes that abortion is wrong and so a good person wouldn’t do it;

(6) not feeling guilty does not show that they did not do anything wrong either!). It only shows that they believe they have done wrong, which doesn’t mean that they really have done wrong. (6) assumes abortions are wrong. some women feel guilty after abortions, but many do not. And just because someone feels guilty for doing something does not always mean they have done wrong: there is “false guilt.” (Someonefeeling guilty does not show that they did not do anything wrong either!). It only shows that theythey have done wrong, which doesn’t mean that they really have done wrong. (6) assumesabortions are wrong. [6]





reasons. We now turn to non-question-begging arguments. If any are bad, it’s for otherreasons.

4 . Arguments Against Abortion

A case for anything depends on the case against its being weak. Showing that there’s no good reason to think that most abortions are wrong is important for showing that most abortions are permissible.



We only have space to discuss some of the most important arguments against abortion. Each claim below is given as a reason to believe that that fetuses have the right to life, or have other characteristics that make them prima facie wrong to kill, and so abortion is prima facie wrong:





● “Fetuses are human, biologically.”





○ biologically human cells or tissues is not prima facie wrong to kill. A malignant tumor isn’t wrong to kill and i f there were somehow an independently beating human heart, it wouldn’t be wrong to stop that heart. Reply: Yes, but a random blob ofcells or tissues is notwrong to kill. Af there were somehow an independently beating human heart, it wouldn’t be wrong to stop that heart.





● continuous development from fetuses to us. Since we have rights now, we’ve had them at every stage of our existence.” “We were once fetuses; there isfrom fetuses to us. Since we have rights now, we’ve had them at every stage of our existence.”





○ now does not mean we had it then. Most of us can walk, talk, think, feel, and make decisions but fetuses cannot, even though we developed from them. Continuous development does not, in itself, support thinking that fetuses are prima facie wrong to kill. Reply: Our having some characteristic or rightdoes not mean we had it. Most of us can walk, talk, think, feel, and make decisions but fetuses cannot, even though we developed from them. Continuous development does not, in itself, support thinking that fetuses arewrong to kill.





● human beings or organisms.” “Fetuses areor organisms.”





This claim is that fetuses are not merely biologically human, but that they are whole beings or organisms. This is true, but why would this make them wrong to kill?



Some respond that this is obvious, since it’s just plain wrong to kill human beings . This is not obvious, however, since embryos and beginning fetuses are human beings that are quite different from most human beings like us: they lack consciousness, cannot feel, think, perceive or experience any of the types of things that typical born human beings can. Arguably these are important differences, since psychological or mental characteristics are what make us wrong to harm and kill, and early fetuses lack them.



In thinking about human beings, who likely comes to mind are human beings who we interact with on a daily basis. We don’t think about human beings who are born without most of their brains (anencephalic newborns, who die soon after birth) or human beings who have permanently lost all consciousness due to serious brain injury.



These human beings should be treated respectfully, but they can also be treated in ways that would be wrong to treat “normal” human beings: letting their bodies die and, perhaps, (actively) killing them. This is sometimes not wrong because their being alive is no value to them anymore : they permanently lack or have lost consciousness, awareness, and feeling.



Early fetuses are human beings but have not developed what makes life valuable: consciousness, awareness, feeling, and other features of a mental life that allow for relationships, activities, learning and everything else that makes life worthwhile. They lack this; they are merely biologically alive; and so it is arguably prima facie permissible to kill them.





● “Fetuses are persons.”





Everyone can agree that persons have the right to life, or are prima facie wrong to kill, but who or what is a person? What makes something, or someone, a person?



Some claim that fetuses are persons , from conception or soon after, and so they are prima facie wrong to kill. Others deny that fetuses are persons, especially early fetuses. These disputes sometime lead to shouting and violence, with different sides merely insisting on their definition. There are more rational ways to help determine the essence of personhood, however, by thinking about what makes us persons. Consider this:





cease to be persons, what can end our personhood? If we will always be persons, how could that be? We are persons now. Either we will always be persons or we will cease being persons. If we willto be persons, what can end our personhood? If we willbe persons, how could that be?





if they were to go into a permanent coma: their body is (biologically) alive but the person is gone.person (perhaps even without a body!). Both responses suggest that personhood is defined by a rough and vague set of psychological or mental, rational and emotional characteristics: consciousness, knowledge, memories, and ways of communicating, all psychologically unified by a unique personality. Both options give insights into personhood. Many people think that their personhood ends at death orif they were to go into a permanent coma: their body is (biologically) alive but theis gone. [7] And if we continue to exist after the death of our bodies, what continues to exist? The(perhaps even without a body!). Both responses suggest that personhood is defined by a rough and vague set of psychological or mental, rational and emotional characteristics: consciousness, knowledge, memories, and ways of communicating, all psychologically unified by a unique personality.



A second activity supports this understanding:





Make a list of things that are definitely not persons. Make a list of individuals who definitely are persons. Make a list of imaginary or fictional being which, if existed, would be persons: these beings that fit or display the concept of person, even if they don’t exist. What explains the lists?





We are persons. Science fiction gives us ideas of non-human persons. Even though non-human characters from, say, Star Wars, don’t exist, they fit the concept of person: we can befriend them, work with with them, and so on, and we could only do that with persons. A common idea of God is that of an immaterial person who has exceptional power, knowledge, and goodness. Are conscious and feeling animals, like chimpanzees, dolphins, cats, dogs, chickens, pigs, and cows more relevantly like us, as persons, or are they more like rocks and cabbages, non-persons? Sentient animals seem to be closer to persons than not. So, this classificatory activity further supports a psychological understanding of personhood. Rocks, carrots, cups and dead gnats are clearly not persons.are persons. Science fiction gives us ideas of non-human persons. Even though non-human characters from, say, Star Wars, don’t exist, they fitthe concept of person: we can befriend them, work with with them, and so on, and we could only do that with persons. A common idea of God is that of animmaterialperson who has exceptional power, knowledge, and goodness. Are conscious and feelinganimals, like chimpanzees, dolphins, cats, dogs, chickens, pigs, and cows more relevantly like us, as persons, or are they more like rocks and cabbages, non-persons? Sentient animals seem to be closer to persons than not. So, this classificatory activity further supports a psychological understanding of personhood. [8]



not be persons on this account: they are not yet conscious or aware since their brains and nervous systems are either non-existent or insufficiently developed. Consciousness emerges in fetuses much later in pregnancy, likely after the first trimester. This is after when most abortions occur (see below). Most abortions, then, do not involve killing a person, since the fetus has not developed the characteristics for personhood. Concerning abortion, early fetuses wouldbe persons on this account: they are not yet conscious or aware since their brains and nervous systems are either non-existent or insufficiently developed. Consciousness emerges in fetuses much later in pregnancy, likely after the first trimester. This is after when most abortions occur (see below). Most abortions, then, do not involve killing a, since the fetus has not developed the characteristics for personhood.





● “Fetuses are potential persons.”





persons: they could, and would, become persons (and so they’re not persons now). Abortion is wrong because of this, however, only if premises like these are true: If early fetuses are not persons, they are potentialpersons: they could, and would, become persons (and so they’re not persons now). Abortion is wrong because of this, however, only ifpremises like these are true:





● or Potential X’s have the rights of actual X’s,

● Potential X’s should be treated like actual X’s.





But potential doctors, spouses, adults, judges, criminals and so on never have the (moral or legal) rights of actual individuals of that kind, or should be treated like that. Arguments from potential are doubtful. [9]





● “Fetuses have valuable futures; they lose those valuable futures when aborted.” [10]





Don Marquis argues that in thinking about abortion, we should begin by understanding why it is typically wrong to kill “normal” human beings, and then attempt to apply our findings to abortion.



He argues that the best explanation why it is typically wrong to kill us is that killing deprives us of our future good experiences, our valuable futures: if we are killed, we lose out on all the positive experiences, relationships, and accomplishments that we would have experienced. Inflicting this loss is profoundly wrong, unless done for an serious, justifying reason. Marquis thinks this explanation applies to fetuses: they have futures that they would experience, and abortion prevents them from experiencing those futures, so abortion is prima facie wrong.



While insightful, there is room for doubt. First, Marquis’s explanation for the wrongfulness of killing is developed from examples where there is a psychological connection from the murder victim to her future: she is aware of her future and has hopes and plans for it. Fetuses don’t have this at all. That’s a potentially relevant difference and so Marquis’s explanation might not extend to fetuses.



Second, Marquis’s argument might imply that contraception, even abstinence (!), is prima facie wrong. This objection begins with an abstract observation that there are single objects with multiple parts that do not touch: there is space between the parts. A dinette set is an example, but many physical items will do, since there are parts and there is some space between the parts, if we look closely enough. From here, we observe that there are eggs and sperms-that-could-and-would -fertilize-those-eggs all around us; some combinations of these are indeed single things , given the metaphysics above; some of these have valuable futures; and so contraception and abstinence are prima facie wrong, since they too prevent these (abstract) entities from experiencing their valuable futures. But since refraining from bringing these (abstract) individuals into actual existence is not wrong, something has gone wrong with Marquis’s argument.





may be able to reasonably reach some tentative conclusions about the case in favor of thinking that abortion is typically wrong. In sum, these are some of the most important arguments given against abortion. [11] More research and reflection is needed, but webe able to reasonably reach some tentative conclusions about the case in favor of thinking that abortion is typically wrong.

5.1. Consciousness and Ethics



If the arguments against abortion do not succeed, should we think that abortion is prima facie permissible? Almost. To fully reach that conclusion, we need some positive arguments in its favor.



Abortion debates often proceed with little factual information about fetuses or abortions. This is problematic: for any real-world ethical issue, we need to know the facts. Here is some relevant information:





● Fetal consciousness and pain:





Most medical and scientific research finds that, at the earliest, fetuses likely become conscious and develop an ability to feel pain around the end of the second or beginning of the third trimester of pregnancy (24 weeks). [12]





● When abortions occur:





The CDC reports that, “ in 2014, the majority (67.0%) of abortions were performed at ≤8 weeks’ gestation, and nearly all (91.5%) were performed at ≤13 weeks’ gestation. Few abortions were performed between 14 and 20 weeks’ gestation (7.2%) or at ≥21 weeks’ gestation (1.3%).” [13]





The Guttmacher Institute reports that two-thirds of abortions occur at eight weeks of pregnancy or earlier; 89% occur in the first 12 weeks [14]













Figures in other countries should be investigated. But, at least in the United States, most abortions are done early in pregnancy, far before consciousness develops in the fetus.



This information is morally relevant because consciousness, or awareness, is the basis for all that is valuable and important for us. Death or a permanent coma is typically bad for us because our consciousness ends: we cease to be and nothing can go worse, or better, for us. Consider whether, when someone has permanently lost consciousness, there is any value to that individual in keeping his or her body alive: there is not. Pre-conscious, early fetuses are at the other end of this cycle. It’s not that they haven’t experienced what’s of value: there is no experiencer of value: there is no one who is there, since a conscious individual does not yet exist.



Given these facts and quick philosophical thinking, here are three arguments in positive defense of abortion. First, a general argument from the absence of consciousness:





1. prima facie permissible to kill that thing. If something is not conscious and has never been conscious, then it ispermissible to kill that thing.

2. that are not conscious and have never been conscious. Early abortions kill early fetusesthat are not conscious and have never been conscious.

3. prima facie permissible. Therefore, abortions of early fetuses arepermissible.





harm: This general argument can be supported by more specific concerns. First, from concerns about





1. were. To harm someone is to make them worse off, compared to how they

2. Early fetuses aren’t made worse off by death: for a never-been-conscious being, non-existence doesn’t make it worse off, since it lacks a conscious perspective that can take a turn for the worse. [15]

3. So, killing does not make non-conscious beings worse-off, or harm them.

4. prima facie permissible. Actions that don’t harm anyone (or have a high risk of harm) arepermissible.

5. prima facie permissible. So abortion ispermissible.





Second, from the lack of personhood:





1. some of the following: consciousness, awareness, thoughts, feelings, memories, anticipations and so on: a mental life or mind. A person is a being who has at leastof the following: consciousness, awareness, thoughts, feelings, memories, anticipations and so on: a mental life or mind.

2. If something is not conscious or sentient and has never been conscious or sentient, then it is definitely not a person.

3. Early fetuses are not conscious or sentient and have never been conscious or sentient.

4. So, early fetuses are definitely not persons.

5. prima facie permissible to kill things that are definitely not persons. It ispermissible to kill things that are definitely not persons.

6. So, abortions of early fetuses are not wrong.





These arguments should be explained in greater detail, but the preceding discussion should help anyone understand why they might be considered sound. Let’s quickly consider some questions about these consciousness-based arguments:





● “Does this mean that it’s OK to kill sleeping people or comatose people?”





○ the coma patient will too. Reply: No, these individuals were conscious: the sleeper will regain consciousness and we hopethe coma patient will too.





● “Does that mean ‘more’ conscious human beings have more rights or greater value than those with less, if that makes sense?”





○ all conscious human beings have basic rights and equal value. Reply: No: why would anyone think that? We should think thatconscious human beings have basic rights and equal value.





● “Does that mean it’d be OK to kill someone who goes into a coma and awakens with a complete loss of all of her knowledge, memories, and personality?”





○ prima facie wrong to kill. This would, however, be the start of a new person (in the same body!) if there is no psychological connection to the earlier person. Reply: No. If they awaken, they are conscious, and sowrong to kill. This would, however, be the start of a new person(in the same body!) if there is no psychological connection to the earlier person.





prima facie permissible. This is true when abortions are sought for pregnancies resulting from rape or incest. It’s also true when a woman seeks an early abortion for nearly any reason. be criminalized, women should have the legal right to have abortions. What this all suggests is that abortions, if done early in pregnancy, arepermissible. This is true when abortions are sought for pregnancies resulting from rape or incest. It’s also true when a woman seeks an early abortion for nearly any reason. [16] And since actions that are not wrong should notbe criminalized, women should have the legal right to have abortions. [17]



5.2. The Right to Life





Some of the earlier arguments above can be seen as attempts to show that early fetuses have a right to life. They don’t appear to succeed. Nevertheless, it’s often assumed that if fetuses have the right to life, or are persons, abortion would be typically wrong. Judith Thomson has argued, however, that this common reasoning involves a false assumption about the right to life. Cases illustrate this:





● “You wake up in a hospital ‘plugged into’ a violinist, who is using your kidneys to filter his blood. You were kidnapped and put into this role. He will die without your assistance.”





○ right to use your kidneys? No. Does the violinist have ato use your kidneys? No.





● “Your death will be prevented by the touch of your favorite celebrity on your forehead.”





○ right to that touch? No. Do you have ato that touch? No.





● you donate your kidney to her.” “Your twin sibling will die unlessdonate your kidney to her.”





○ right to your kidney? No. Does she have ato your kidney? No.





not a right to another person’s body, even if that body is necessary to save one’s life. what the fetus needs to continue living: that means that abortion, at least, does not violate rights and so may be not wrong. This insight augments the arguments above, and suggests an alternative definition of abortion: These cases suggest that the (moral or legal) right to life isa right to another person’s body, even if that body is necessary to save one’s life. [18] So, fetuses do not have the right to their mother’s bodies, even if they are persons with the right to life. So it is permissible for a pregnant woman to withholdwhat the fetus needs to continue living: that means that abortion, at least, does not violate rights and so may be not wrong. This insight augments the arguments above, and suggests an alternative definition of abortion:





An abortion is the ending of a pregnancy by withholding the resources needed for the fetus to develop and be born.





5.3. Later-term Abortions





Fortunately, abortions far later in pregnancy are rare. But when they occur, they might kill conscious beings. Should later abortions be illegal?



No. According to information available on these types of abortions, they are nearly always done for very good medical reasons. Moreover, we don’t want the (slow) courts interfering in these time-sensitive, complex medical decisions. So probably all abortions should be legal, even if any are morally wrong. [19]

6. Conclusion

for thinking in calm, cool, careful and critical manners. This passion for fact-finding, conceptual analysis and argument evaluation should positively influence our other passions, as individuals and as a society. Whatever one’s politics, abortion is a momentous decision that determines, at least, whether a woman will continue a pregnancy and give birth and, usually, whether two people will be parents (or parents again). And there are, of course, the effects on the fetus. These are life-changing decisions that involve profound and intense emotions. These feelings seep into politics, but our task, as philosophical thinkers, is to examine passionate issues with a passionfor thinking in calm, cool, careful and critical manners. This passion for fact-finding, conceptual analysis and argument evaluation shouldpositively influence our other passions, as individuals and as a society. [20]





For Further Reading





A short, introductory reading on abortion:









A Defense of Abortion provides a comprehensive and systematic critical overview of many arguments about abortion, as well as argues in defense of abortion: David Boonin’sprovides a comprehensive and systematic critical overview of many arguments about abortion, as well as argues in defense of abortion:









the seminal philosophical writings on abortion: These three widely reprinted articles areseminal philosophical writings on abortion:

















For factual information concerning abortion, see the ( https://www.guttmacher.org ), the CDC’s Abortion Survellience System ( https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm ) and/or any other country’s national public health departments and organizations. Guttmacher Institute







