Recently, Pat said that pro-choice folks have to face the fact that late term abortions are very difficult.  I would agree. A late-term abortion raises many issues for the general public, the doctor, the woman and the opponents of these procedures. As such, I’d like to address some of these issues.

To begin, let me dispel the general myth perpetuated by mainstream journalists (such as TIME magazine and the Washington Post) and by antiabortion activists that late term abortions are widely available. First, the reality is such that access to first term abortions, up to and including 12 weeks gestation, is difficult because of geographical hardships, arrangements for childcare and time off from work, finances and, for some younger women, parental support. The Guttmacher Institute provides further data about availability citing “Some 87% of U.S. counties do not have an abortion provider and 35% of women aged 15–44 live in those counties. The proportions are lower in the Northeast (53% and 18%) and the West (74% and 13%). In 2005, nonhospital providers estimated that while more than seven in 10 women traveled less than 50 miles to access abortion services, nearly two in 10 traveled 50–100 miles and almost one in 10 traveled more than 100 miles.”

Second, access to abortions in the second trimester, defined as 13 to 27 weeks, grows increasingly difficult beginning at 21 weeks. There are very few physicians in the United States who are skilled enough and willing to provide abortions services past 22-24 weeks. While, attempting to corral definitions of “widely available” and “late term” is like trying to herd cats, the facts are easier to grasp. According to the CDC’s latest surveillance (2007) from reporting agencies, of all 877, 609 abortions performed, only 1.3% were performed at ≥21 weeks’ gestation. To further illustrate other aspects of the late term abortions, consider that among the clinics listing themselves as late term abortion providers on Abortion.com, three provide services up to 21 weeks (Atlanta, sister sites in Philadelphia and NJ, and Hartford), four provide services up to 24 weeks (Dallas, and multiple sister clinics in NY and FL), and two provide services up to 26 weeks (D.C. and four locations in Maryland). These listings hardly exemplify widespread access.

For the general antiabortion population, late term abortion providers are vilified as heinous murderers who have no moral compass, who kill unborn children capable of feeling excruciating pain.  On the other hand, for women who need later abortions, these providers are compassionate and highly skilled angels in their darkest hour. Overall, first or mid-trimester termination of pregnancy for fetal anomalies is legally and morally accepted amongst the majority of the population. Over the past decades screening and diagnostic methods have improved noticeably and, as a result, increasingly more anomalies are being detected at an early stage in pregnancy. Research on late termination of pregnancy finds that, “When a severe congenital anomaly is diagnosed, the majority of couples opt for termination of pregnancy . . . Termination of pregnancy in case of a fetal anomaly is a complex and conflicting life-event” (Prenatal Diagnosis 2005) especially because it is a voluntary act and because it may interfere with loss and grieving. In an especially touching case study, Kersting and colleagues found that an induced abortion due to fetal malformation is a traumatic loss which may entail a complicated grieving process with needs to be detected and treated at an early stage. Their advice for clinical staff is such that the affected parents not to be subjected to pressures of time when making the decision to terminate the pregnancy, but that the individual options and their consequences should be carefully considered, especially in light of the extent of fetal anomalies. So, let’s take a look at a few fetal malformations.

To begin, a diagnosis of Meckel Gruber at 20 weeks means the pregnancy becomes high-risk. The condition, characterized by the triad of encephalocele, bilateral polycystic kidneys and polydactyly, occurs in 0.7 per 10,000 births. Women and their families have the option to terminate the pregnancy or wait and deliver a child who will live only a few hours. Either choice is heartbreaking.

 

Hydranencephaly, encephalocele, Down syndrome, microcephaly, to list a few more, are anomalies that can lead to fetal demise, early death after birth or life long health issues with poor prognoses. For some women, the choice to terminate, while excruciating, is made on the basis of avoiding fetal suffering or simply wanting the dead fetus removed. In the rare case of severe twin-to-twin fetal transfusion syndrome, unless one twin is terminated, both will die in utero. For some women, the diagnosis of Down syndrome is a justifiable reason for terminating a pregnancy. For example, a thirty-seven year old married woman with two children and with an unplanned pregnancy has a fetal diagnosis of D.S. at 30 weeks. She may determine that her duty is to her born children. She may want to protect them from the adverse effects of having a needy sibling with D.S. while also wanting to execute her duty of beneficence to a fetus with a future negative net quality of life. She may also want to protect her family’s resources as a child born with Down syndrome often consumes excessive amounts of finances, emotional resources and healthcare resources. Despite amazing progress in quality of life issues for those born with D.S., not every woman, not every family, is willing to assume the responsibility for a child with Down syndrome.

For the overwhelming majority of women who choose later abortions, their pregnancies were wanted (or accepted), often loved from the beginning, and greatly mourned after the loss. Late abortions are difficult emotionally, financially and physically. Those who glibly chirp about selfish women or greedy doctors, demonstrate their inability to fully grasp the gravity of these cases, however, repellant they may be to outsiders. These folks fail to feel the devastation these women and their families feel. They are simply unwilling or unable to show compassion for the woman who learns that her fetus with no brain will live no more than a few seconds after birth, that her dead and decomposing fetus is infecting her, or that her fetus has a high level myelomeningocele that will mean, if it survives, will lead a life of absolute dependence. From listening to those who claim to be life advocates, it’s clear to me that they believe a woman should deliver the brainless fetus rather than terminate it early with an abortion. They believe that no woman carrying a fetus with a positive diagnosis of Down syndrome should abort. The reality is that some women and their loved ones DO choose to carry the pregnancy to term, knowing that they will have precious little time to with their child, knowing that death is imminent or knowing that their child has DS and accept the challenges of parenting. Others want to terminate their pregnancy because they do not feel capable of caring for a handicapped child or because they cannot bear to continue the pregnancy knowing they are carrying around a dead or deformed fetus.

Regardless of the reason, the choice should always remain with the woman and her family and her physician whether she terminates a fetus with a fetal anomaly or continues the pregnancy to deliver the fetus. The discovery of a pregnancy with fetal malformation is a traumatic event that any woman finds hard to withstand and which entails the potential risk of severe and complicated grieving. This is an event that demands expertise from the medical community, for certain, and understanding and compassion from us all.

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