Late Term Abortion


Fetal parts are for sale. Yep, the terrible Planned Parenthood abortionists found and tapped into a profitable market for fetal parts, especially intact forms.

This is the basic narrative inserted into the talking points of anti-abortion politicians these days after edited videos between Planned Parenthood representatives and imposter biomedical tissue brokers surfaced. Ignored was the benefit fetal tissue provides to medical research. Disregarded was the selectivity used to decide what was fit for public consumption. Much has been made of interactions that might be suspicious to outsiders of medical and scientific research environments or appeal to the emotions of the uninformed.AR headline

Planned Parenthood can sufficiently respond to the “undercover sting videos” of its medical staff discussing fetal tissue donation. The rest of us need to respond to this attempt by anti-abortion dogmatists to impose their view of the world into public policy.  The states that have initiated investigations based on the videos found Planned Parenthood in compliance with regulations. Even if one state, or several states, unsuccessfully takes action for political value or reject continued contracts with Planned Parenthood for health services, it would be a measurement of success for this false narrative. Planned Parenthood will remain open to provide important health services, but there are other issues of which we should all have concern.

Deception and Ethics

The videos were created by the Center for Medical Progress (CMP), which claims to be “…citizen journalists dedicated to monitoring and reporting on medical ethics and advances.”  Their website appears to be focused only on promoting anti-abortion viewpoints, no other medical ethics issues. End-of-life treatment, organ donation processes, and equality in accessing medical care are among the top ethical issues one would expect to see mentioned.ethics

Why the deception when it would have been perfectly acceptable for CMP to identify itself as abortion opponents with specific, legitimate ethical questions pertaining to abortion and fetal tissue?

Honesty and integrity are critical to discussions about ethical issues.  Would abortion clinic representatives talk openly with abortion opponents? I and many others certainly have on many occasions in our roles as reproductive healthcare professionals. Did the CMP even attempt to arrange a discussion? If the intent of the “undercover” effort was to learn about the involvement of some Planned Parenthood affiliates with fetal tissue procurement, it was not necessary for CMP to engage people by misrepresenting themselves as biomedical professionals. Why just Planned Parenthood and no other providers of elective, therapeutic, and emergency abortions? Hospitals and other medical facilities play a significant role in tissue procurement, which can seem quite unsavory to outsiders.

abortion safeApparently deception and fabrication are a preferred method of operation within anti-abortion activism. Deception and fabrication are the hallmarks of Crisis Pregnancy Centers, also known as fake abortion clinics because of the their strategy to appear as if they are abortion clinics and use misinformation to dissuade women from abortion once they arrive for their “abortion appointment.”  Anti-abortion literature distributed to Congress, the media, and the public also contains incorrect, distorted, and often manufactured information. This is how the public at times believes that most abortions are late term. Or have murky ideas about parental consent for abortion in which it is compared to unrelated issues that are often guided by business policies, not laws.

It is no surprise that deceptive tactics were used to generate the storyline about fetal tissue procurement. It is nonetheless striking that there is not outrage about the deception, especially when ethics is the alleged target. Clearly, acquiring and providing information about fetal tissue procurement would not generate outrage if done without the theatrics of imposter biomedical professionals and video editing skills. Do we really want topics of importance to be introduced to public discourse in this manner? Of course not. The media would serve the public well to fully investigate the “investigators” and bring political balance to that part of the story. The notion that an organization like CMP, with a Postal Annex rented address no record of prior work as a nonprofit in the medical ethics arena, and leadership comprised of people connected to anti-abortion groups like Operation Rescue, can have traction in promoting political ideology as if it was credible news or journalism is frightening. The media failed by not scrutinizing the source before doing the reporting, especially since another group, Life Dynamics, attempted to do the same in the late nineties.

For the record, pro-choice people resorted to deception to “out” the Crisis Pregnancy Center’s fake abortion clinic charades. Why? Because CPCs claimed that they informed women that they did not perform abortions, provided factual information, and other practices did not square with what women had shared with actual medical professionals.  A hidden camera sent in by the media with a young woman proved that the experiences of other women were accurately presented.

Using the Mistruths as Truths to Further the Mistruths

Talk radio stars Laura Ingraham, Sean Hannity, and Rush Limbaugh all regularly speak of the CMP as if it is a credible nonprofit out there doing good work.  Politicians, including U.S. Speaker of the House John Boehner and those running for president, refer to the videos time and again as if they were part of a documentary. Absolutely nothing revealed in the videos is evidence of anything sinister. At worst, the videos illustrate the seeming insensitivities that can develop when people work in medical settings. wd

Right wing websites are having a great time exaggerating the video content and piling on more false or misleading information. Red State claims that Planned Parenthood was “…caught…appearing to haggle over the sale of aborted baby parts.” Haggling? Not hardly. The videos revealed explanations, in clinical and business tones, about how tissues and parts are procured. Bear in mind that CMP presented themselves as biomedical professionals interested in obtaining fetal tissue. Would it have somehow been acceptable for responses to exclude information about quality of parts and associated costs?

Comments made by elected officials can be perceived as the truth. Thus, when Senate newcomer Joni Ernst (R-Iowa) states, “Planned Parenthood is harvesting the body parts of unborn babies,” to explain her sponsorship of a bill to defund Planned Parenthood, perceptions are broadly formed and shared throughout every possible medium. The tone of Ernst’s statement can conjure so many images that only perpetuate incorrect information. When Breitbart News quotes a Ted Cruz comment that the videos show Planned Parenthood representatives “confessing to multiple felonies,” it misleads, misinforms, and further polarizes people on the basis of ideology as opposed to facts. Shame on all who have made, and are continuing to make, comments implying that the videos exposed evidence of crime. Shame on all who are giving the CMP credibility, so much credibility that there are threats to shut down the government if Planned Parenthood is not defunded.

Fetal Tissue Research is Ethical and Beneficial

There has always been a market for anatomical and biological goods, including human fetal tissue and parts.  Specific companies respond to the demand for human and animal parts. College psychology departments buy brains to teach students. Medical and scientific researchers need specimens in order to learn more about genetics or real and prospective treatment options for a range of diseases, for example. Fetal tissue/parts obtained from miscarriages and abortions have been used for decades and have led to a number of medical breakthroughs, including rubella and polio vaccines. Kimberly Leonard wrote an excellent article in the August 4, 2015 online issue of US News about the contributions of fetal tissue research. Many of us are grateful for those contributions. In the August 12, 2015 New England Journal of Medicine, lawyer R. Alta Charo stated, “A closer look at the ethics of fetal tissue research…reveals a duty to use this precious resource in the hope of finding new preventive and therapeutic interventions for devastating diseases. Virtually every person in the [United States} has benefited from research using fetal tissue.”  Quite simply, it would be unethical for medical researchers to suddenly discontinue use of fetal tissue due to politically extreme ideology.

research petri dishFetal parts are not allowed to be sold – they can only be donated with consent from pregnant women after they are removed.  If profit for fetal parts is the actual concern of CMP, their time would be better spent honestly working with regulatory agencies to determine with certainty if any inappropriate financial transactions between abortion providers and biomedical tissue businesses exist. It is certain that people of all political views on the issue would abhor such a practice.

As the dribble of videos continues, no evidence of illegal activities will be presented. Instead, ideology will be promoted with the intent to cause some to rethink their views about abortion and try to stop an organization that serves the healthcare needs of so many low-income women. The effort will fail, but in the meantime, we will all have to witness the nonsense and speak up about reality when we can.

Daily BeastNational Right to Life, Family Research Council, and other anti-abortion organizations have been enthusiastically spreading the word about a study published in the New England Medical Journal showing that a fetus can be viable if born at 22 weeks gestation with advanced medical intervention. A New York Times article about the study was very clear that survival was for a “tiny minority” and that 24 weeks remains the medically and scientifically accepted point of viability.  Nonetheless, as all sides in politically polarized issues tend to do, abortion opponents have focused on sharing the headline of the study and not the details. Although coincidental, the publication of the study is perfectly timed with the U.S. House of Representatives passing the 20-week abortion ban, which the Senate will now consider.

Predictably, those who oppose abortion see the study as the proof needed to ban late term abortions, also suggesting that viability age should be lowered. They are appealing to our hearts through survival babies, giving the false impression that at 22 weeks most fetuses can survive outside of the womb. Many who believe that late term abortions must be legally available might even agree with them if the study was conclusive. It is not.

There are important medical-scientific limitations to babies born before 24 weeks. When pregnant women either go into labor early or a medical complication otherwise comrpomises the pregnancy, doctors discuss available medical interventions and the prospective outcomes of each on the fetus. Not all hospitals have the technology or equipment most able to produce a live birth and not all parents choose to have those interventions. Indeed, it is those very women who may choose a late term abortion to save their own lives or spare their wanted child a life of poor health. Much as they felt joy at being pregnant, life offered them a heartbreaking complication. No one has the right to judge the decision they make, certainly not Congress or political opponents of abortion.22 week fetus

In a column for the Daily Beast, Cornell Professor of Pediatrics Jeffrey Perlman noted in more eloquent terms that the study had serious biases and design flaws and should not lead to lowering the age of viability. For that to make sense, a randomized study with and without medical intervention would be necessary. Perlman also pointed out that the research would have to account for  a range of factors, such as gender differences in fetal development and accurate estimates of the age of the fetus to name a couple.

I am personally very grateful for the medical advances that have made it possible for premature babies to survive and live healthy, productive lives. I have significant reservations about the use of technology to force life too early to ensure health and quality, just as I do with sustaining life too long when people are confined to a bed with no consciousness and only technology allowing them to breathe.  All of us know of children born with disabilities or conditions that require lifelong care. That happens and to full term as well as premature babies. Families accept and embrace the children, adjusting and growing with the child. The acceptance that society places on these children and the value they place on supporting them and their families is evident through public policies, including the Americans with Disabilities Act and various educational reforms.

If a 22-week-old fetus can receive medical assistance and survive, how should medical experts and ethicists respond in the future, if at all, to the prospect of lowering the stage of viability if technology continues to advance? Are we concerned about the financial and social/personal costs associated with using the technology? There are high costs for the medical technology and there are high costs to care for babies born so early that they must receive medical care throughout life however long or short. What about 22-week gestational stage babies born addicted to drugs? Are we going to complain about the public assistance their moms receive? Will Congress thwart programs that support the care for these babies?

Doctor with laptop and pregnant woman in doctor's officeFor pregnant women in the wrenching situation of unexpectedly delivering a 22-week-old fetus, this study might offer hope if they happen to be at a hospital with the technology and expertise to offer medical intervention that might allow survival of the fetus. For other pregnant women, if this study is improperly used for political gain, and it already is**, instead of hope, it will further erode their options to make decisions they consider best for them and the baby they wanted and may even allow a physician to place priority on the life of the fetus over the woman. Which life is more important?

Instead of having implications for late term abortions and viability, the real issues to come from the study involve ethics and social support. A 22-week-old fetus is not naturally viable. An abortion at 20-22 weeks gestation may well save a woman’s life or spare a baby a life of pain. Nothing has changed in that regard.

** 5/15-15 update: Political misuse of the study has begun. See http://black.house.gov/press-release/rep-black-lauds-upcoming-house-vote-pain-capable-unborn-child-protection-act and http://www.nytimes.com/2015/05/15/opinion/an-abortion-bans-bogus-arguments.html?_r=0

Let’s face it: most people view late term abortions as a pretty hideous thing, and that opinion is one of the few to cross the pro-choice/pro-life divide. The pro-life side is aware of this, which is why a substantial amount of propaganda focuses on the method of late term Dilation and Evacuation procedures and attempts to conflate it with earlier term abortions, to pair a false equivalence with emotional appeal. (I’ve seen the following picture—or one very much like it–shared from multiple conservative sites online, as well as handed out by abortion protesters at clinics or demonstrations.)

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What has been striking to me, however, is how prevalent the ignorance of issues relevant to late term abortion tends to be on both sides of the divide. On both sides, I often encounter ignorance as to why women might choose to seek late term abortions in the first place (although this is more prevalent among pro-lifers), and about the relevant physiological details in terms of fetal development near viability.

Is there a secular argument for late term abortion bans?

Actually—surprisingly—yes.  Essentially, the ethical considerations around abortion all center on the question of what defines a “person.” While it remains a hotly debated philosophical and religious question, it’s also one that we can attempt to answer scientifically. One answer is viability, and the landmark decision in Roe v. Wade adheres to this measurement. This in itself is a somewhat blurred line because each pregnancy is unique and the point at which different fetuses becomes viable is variable. Still, the court decision defined viability as between 24 and 28 weeks’ gestation. With new medical advances over time, the limit of viability (the gestational age that ensures a significant chance of survival outside the womb) has fallen to earlier in pregnancy, but a survey of just over 700 members of the American College of Obstetricians and Gynecologists (ACOG) showed that most would still not attempt to rescue fetuses younger than 24 weeks with a caesarian section if there were signs of fetal distress. Respondents who judged viability to be earlier than 24 weeks tended to have practiced for a shorter period of time and to be from southern or central states (I wonder what that could mean?).

There are other medically sound arguments that can be made, however, for abortion bans prior to viability. If we measure the beginning of meaningful life by the same benchmark we use to measure the end of meaningful life for comatose patients, a secular argument can be made that the beginning of brain function, which actually precedes viability, is more important in determining the beginning of meaningful personhood than likelihood of survival outside the mother’s body. Even here, however, the answer gets a little dicey: which benchmark is the most important to use?

From the review article “Pain and its Effects in the Human Neonate and Fetus,” we have the following description of the beginning of fetal brain function: “intermittent electroencephalograpic bursts in both cerebral hemispheres are first seen at 20 weeks gestation; they become sustained at 22 weeks and bilaterally synchronous at 26 to 27 weeks.”

Cortical functioning is crucial to higher order cognitive processes necessary to all attributes we associate with personhood (thought, memory, emotion, perception, reasoning, etc.), so using it as a measure for the beginning of meaningful personhood is sound logic, in theory. Philosopher Mary Anne Warren’s often-touted 5 criteria of personhood (consciousness, reasoning, self-motivated activity, capacity to communicate, and self-awareness), and other personhood definitions that require higher levels of cognitive or physical functioning, have troubled critics who point out that such a high bar may eliminate not only fetuses from “personhood,” but also many mentally or physically handicapped people and children up to several years of age. Lowering the bar instead to brain development necessary to support the most basic form of sentience is more inclusive: sentience is something of which all “people” are capable no matter how cognitively impaired, and in normal cases precedes other, higher forms of brain functioning. Below it, there is nothing indicative of personhood, and without it, all higher forms of awareness (such as self-awareness or the ability to reason) are impossible. This definition notably excludes those with brain death and early term fetuses.

What makes late term abortion bans a bad idea?

Despite their deep unpopularity that spans the abortion divide, and even despite a secular argument that could be used to support them, late term abortion bans are currently unfeasible, and likely a very bad idea. Why? There are several reasons:

1) Many severe fetal abnormalities can’t be caught until after the 20th week. Only about 1% of abortions are performed after the 20th week, according to the Guttmacher Institute, but many of those are due to severe developmental or genetic fetal abnormalities that are found by ultrasonography after 20 weeks.  Of these, many are unsalvageable pregnancies, in which the fetus will almost inevitably die close to birth or shortly after. Forcing women to carry wanted but doomed pregnancies to term is cruel and unnecessary.

Still, in the debate for late abortion bans, there remains huge controversy about the legality of abortion for less severe defects, such as Down Syndrome. This has led, on the pro-life side, to a sometimes prevalent impression that abortions for fetal defects are never necessary, but rather an excuse for “lazy” women to get rid of children that don’t meet their ideals. North Dakota recently became the first state in the country to pass a law banning abortions because of fetal defects, and dubbed the practice a form of “discrimination.” Meanwhile, in Texas, lawmakers who recently passed a 20 week abortion ban with no exception for severe but not definitively lethal fetal defects remained deaf to testimony from women who had received late term abortions for that reason.

There are multiple problems with this particular pro-life perspective.  First and foremost is the severity of the misperception of why women have abortions for non-lethal fetal defects. The blanket judgment that they are lazy or refuse to have imperfect children fails to acknowledge the very real psychological burden that mothers of impaired children bear. A study of mothers of disabled children of various types found they suffered from significantly higher psychological distress compared to other mothers, even after education, income, and race were controlled for. Many more studies of individual disorders among children (ADHD, asthma, cystic fibrosis, Duchenne muscular dystrophy—the list goes on, and yes, it includes Down Syndrome) consistently reveal poor mental health in their mothers compared to controls (depression and anxiety are most commonly studied). And while it is true that there appears to be gradation in the psychological effects on mothers concomitant with the severity of their children’s defects (for instance, one study showed Down Syndrome children’s mothers have better mental health than mothers of children with Fragile X syndrome or autism), this is no reason to discount the idea that not all women are psychologically or financially prepared to deal with raising a disabled child.  (It’s also worth noting that many women can receive earlier term abortions after discovering their child has Down Syndrome, since early tests are available that can screen for it in the first trimester, so it is much less relevant to the late term abortion debate than most pro-lifers imply.)

The second problem with the pro-life view that abortions are never necessary for fetal defects is that it heavily downplays the importance of abortions of wanted pregnancies performed for almost invariably fatal defects like anencephaly, a condition (seen below) in which much or all of the brain fails to form.

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Lastly, even when pro-lifers do recognize the importance of abortions for fatal disorders (instead of merely supporting perinatal hospice/palliative care instead), we run into another problem: the slippery slope. Where do fatal disorders fall that don’t cause death immediately, but invariably cause death over time? Cystic Fibrosis and Huntington Disease fall into this category, and prenatal testing options are available for both. If abortion bans are to be instated, and allow only some fetal defects to be used as an exception, who should draw the line in the sand, and where should that line be?

 2) Many abortion bans make exceptions for maternal life, but not maternal health. It’s difficult to overstate the severity of this oversight. The major problem with this kind of legislation is embodied by Savita Halappanavar, who recently began a firestorm in Ireland over women’s reproductive rights. Savita sought hospital care while undergoing a miscarriage, and though her physicians were well aware her pregnancy was doomed, their hands were tied by Irish law until the fetus’s heartbeat stopped, because Savita, despite being in extreme physical pain and distress, was not deemed to be in mortal danger. Unfortunately, when the heartbeat ended and Savita’s physicians were able to intervene, it was too late: Savita died of an entirely preventable case of septicemia. If you think the case will make a difference in Ireland’s laws, I’d urge you not to hold your breath: their new law doesn’t allow exceptions for rape, incest, or even lethal fetal abnormalities, but only for the life of the mother. Unfortunately, it doesn’t actually fix the problem that led to Savita’s death: as is, the legislation still requires doctors to wait for a preventable problem to become potentially lethal before they are legally allowed to intercede.

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Sadly, recent state level abortion bans in the US that make exceptions for the life but not the health of the mother suffer from the exact same problem. Addressing the Arkansas House about a recent proposed “fetal heartbeat bill,” the chairman of the Department of Gynecology and Obstetrics at the University of Arkansas for Medical Sciences (UAMS) pointed out that, under the law, doctors who perform abortions for women with congenital heart problems who have a 50% chance of surviving childbirth, or for women who suffer a rupture of the amniotic membrane surrounding the fetus (which inevitably causes miscarriage but may lead to severe infection while the fetus still lives) could be charged as felons.

3) Abortion bans are put in place without addressing the reasons women have abortions later in pregnancies besides fetal defects. A report by the Guttmacher Institute showed that black women, adolescents, women with lower levels of education, and women with insurance policies that covered abortion procedures were more likely to have second trimester abortions than other women. For the first three categories, the report may indicate significant issues in lack of access: “The overwhelming majority of second-trimester patients would have preferred to have had their abortion earlier, and our findings suggest that black women and those with less education would most benefit from increased access to early abortion services.”

Unfortunately, and ironically, anti-abortion legislation in multiple states aimed at reducing access by closing abortion clinics with unnecessary restrictions or requiring extra hurdles for women to obtain abortions (like mandatory delay, ultrasounds, and/or counseling), has a counterproductive effect. Most women affected by these laws still have abortions, but many seek them later due to their difficulty accessing services. This is further supported by a Guttmacher Institute report that studied the effects of a mandatory delay law in Mississippi on the timing of women’s abortions. It found that after the law was implemented, the rate of second-trimester abortions rose by 53% for all women who didn’t live close to an out-of-state provider! When coupled with laws aimed at eliminating early access to abortion, current late term abortion bans seem more about further preventing women from accessing abortion than a good-faith attempt at balancing women’s reproductive rights with bioethical concerns.

What does this mean for late term abortion bans?

While very strongly pro-choice, even I have serious moral qualms about the ethicality of very late term abortions in unexceptional cases, because of concerns that they may be performed after there is enough brain function to support a primitive form of sentience. Since I’m of the notion that “I think, therefore I am,” I feel there’s a serious case to be made that fetuses with intermittent or sustained cortical function (at 20 or 22 weeks’ gestation, 2-4 weeks prior to the current general bar for viability) are in fact “people.”  Still, I have to say that late term abortion bans are not currently feasible, because implementing them successfully would require the type of compromise between the pro-choice and pro-life community that neither side appears at all comfortable making.

For a late term abortion ban to be at all fairly implemented, it would require the pro-choice side to give up the notion that all elective abortions should be legal up to viability. In return, the pro-life side would have to concede several things: first, that exceptions should be made for rape, incest, maternal life and health, and all fetal defects discovered by ultrasonography or prenatal testing. Second, that early term abortion access should be encouraged and expanded, making it readily available for poor and minority women. This would, of course, require overturning the many, many laws passed in recent years by the GOP at the state-level aimed at doing the precise opposite, and may even require overturning the Hyde Amendment, which bars federal funding for abortion, thus preventing poor women from receiving elective abortions except in cases of rape, incest, and their lives.

As you can see, putting in place a late term abortion ban that could actually be considered a moderate proposal and which is supported by one secular argument for personhood is a near-impossibility, as it would require actual compromise between pro-choice and pro-life legislators and the willingness to lose ground on either side. In a political climate where ‘compromise’ is a dirty word, and one side refuses to even listen to opposing viewpoints, let alone negotiate, getting to a point where both sides meet in the center will be a long, uphill battle.

References:

1) Morgan, M.A., Goldenberg, R., Schulkin, J. 2008. Obstetrician-gynecologists’ practices regarding preterm birth at the limit of viability. Journal of Maternal-Fetal and Neonatal Medicine 21(2): 115-21. http://www.ncbi.nlm.nih.gov/pubmed/18240080

2) Anand, K.J.S., Hickey, P.R. 1987. Pain and its Effects in the Human Neonate and Fetus. The New England Journal of Medicine 317(21): 1321-29.

http://www.cirp.org/library/pain/anand/

3) Mary Anne Warren’s essay “On the Moral and Legal Status of Abortion”: http://instruct.westvalley.edu/lafave/warren_article.html

4) Guttmacher Institute’s “Facts on Induced Abortion in the United States,” including rates of early vs. late term abortion: http://www.guttmacher.org/pubs/fb_induced_abortion.html

5) For more on the extreme anti-abortion laws passed by North Dakota, including one barring abortion for gender preference or genetic defects (the first of its kind in the United States): http://www.nytimes.com/2013/03/27/us/north-dakota-governor-signs-strict-abortion-limits.html?pagewanted=all&_r=1&

6) Here are several papers on the psychological effects of raising disabled children:

–Breslau, N., Staruch, K.S., Mortimer, EA Jr. 1982. Psychological distress in mothers of disabled children. American Journal of Diseases of Children 136(8): 682-6. http://www.ncbi.nlm.nih.gov/pubmed/6213143

–Yilmaz, O., Sogut, A., Gulle, S., et al. 2008. Sleep quality and depression-anxiety in mothers of chidren with two chronic respiratory diseases: asthma and cystic fibrosis. http://www.ncbi.nlm.nih.gov/pubmed/18585104

–Bourke, J., Ricciardo, B., Leonard, Helen. 2008. Maternal physical and mental health in children with Down syndrome. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586647/

–Abi Daoud, M.S., Dooley, J.M., Gordon, K.E. 2004. Depression in parents of children with Duchenne muscular dystrophy. Pediatric Neurology 31(1): 16-19.

–Abbeduto, L., Seltzer, M.M., Shattuck, P., et al. 2004. Psychological well-being and coping in mothers of children with autism, Down syndrome, or fragile X syndrome. American Journal of Mental Retardation 109(3): 237-54. http://www.ncbi.nlm.nih.gov/pubmed/15072518

–Hobdell, E. 2004. Chronic sorrow and depression in parents of children with neural tube defects. Journal of Neuroscience Nursing 36(2). http://journals.lww.com/jnnonline/Abstract/2004/04000/Chronic_Sorrow_and_Depression_in_Parents_of.5.aspx

7) For information on prenatal testing for Huntington Disease (http://predictivetestingforhd.com/testing-for-hd/prenatal-testing/) and Down Syndrome (http://www.mayoclinic.com/health/down-syndrome/DS00182/DSECTION=tests-and-diagnosis)

8) For more information on Savita Halappanavar’s death: http://www.irishtimes.com/news/health/report-identifies-multiple-failures-in-treatment-of-savita-halappanavar-1.1427332

9) For more on the new Irish abortion bill: http://www.bbc.co.uk/news/world-europe-23507923

10) For more on Dr. Curtis Lowery’s testimony in opposition to Arkansas’ proposed fetal heartbeat bill in February: http://www.arktimes.com/ArkansasBlog/archives/2013/02/08/a-doctor-speaks-out-on-abortion-bills

11) Jones, R.K., Finer, L.B.. 2011. Who has second-trimester abortions in the United States? Contraception 85(6): 544-51. http://www.guttmacher.org/pubs/journals/j.contraception.2011.10.012.pdf

12) Joyce, T., Kaestner, R. 2000. The impact of Mississippi’s mandatory delay law on the timing of abortion. Family Planning Perspectives 32(1).  http://www.guttmacher.org/pubs/journals/3200400.html

13) For more on state-level abortion restrictions so far into 2013: http://www.guttmacher.org/media/inthenews/2013/07/08/

14) Last, but certainly not least, this website is dedicated to sharing the stories of women who received late term abortions for medical reasons: http://1in10blog.wordpress.com/

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.

Pro Life Violence

Pro Life Violence

I rarely read LIFENEWS, the on-line “newspaper” of the Right To Life movement, or at least the main one.  But I was recently trolling around the internet the other night when I came across this site and an article caught my eye.  The headline read:   “House Panel OKs Bill to Stop Unlimited Abortions in Nation’s Capital” and the first sentence informed us that this bill would stop the “policy of unlimited abortions throughout pregnancy for any reason in the nation’s capital.”

Abortion Washington DC

Abortion Washington DC

In the past, I’ve talked about how advocates on both sides of the abortion issue get so locked into their positions that they dare not consider that their opponents might have a point and they certainly do not question the stuff that comes down from their oh-so-sacred national organizations.  So, if Planned Parenthood announced tomorrow that they’ve learned that President Obama will soon convert to the pro-life position, their followers would take the announcement as gospel and start sending money to “help us convince the President is on the wrong track.”

Violence against Abortion Providers

Violence against Abortion Providers

So, this little nugget from LIFENEWS got my attention pretty quickly.

As my readers know, I’ve worked with abortion clinics for the last 20 years.  As such, I got to know just about every clinic, every owner and every doctor.  One thing that I paid particular attention to was how far a doctor would go in terms of weeks when terminating a pregnancy. That was important information because I would constantly get calls from women looking for an abortion and the first thing you needed to know was how many weeks pregnant they were because, if their pregnancy was rather advanced, the number of doctors who performed later abortions were few and far between.  So, I basically knew how far each clinic went.

So, when I read that there was a “policy of unlimited abortions” in the District of Columbia, I was caught short.  Unlimited?   As in, they perform abortions in our capital up to the point of birth?  Now, if there were clinics in D.C. that performed abortions up to the moment of birth, I would just say it.  Everyone knows I am unapologetic about what the clinics do and how far they go.  So, I gotta tell you that LIFENEWS and their advocates on Capitol Hill are full of it.

Violence against Abortion Providers

Violence against Abortion Providers

Years ago, there was a doctor who did third trimester abortions in D.C., but he has since cut back dramatically and is only offering the abortion pill.   Then, there is Doctor Lee Carhart, who recently relocated to Maryland where he is legally permitted to perform third trimester abortions.  Then, outside of the D.C. area, there’s a doc in Florida who performs third trimester abortions, Doctor Warren Hern in Colorado, a doctor in California then I understand there are two who do later abortions in New Mexico.  Meanwhile, I called the clinics in D.C. and found one that went to 22 weeks.

But, who cares about the facts?   Political advocates have to make their points regularly to keep the troops stirred up and, yes, to raise money.  And the troops will follow, like lemmings to the sea.

Abortion

Abortion

Late March, 1997.

A little over one hundred abortion clinic doctors, owners and staff people trekked to Washington, D.C. like battle-scarred soldiers returning from a great war.  For years, they had been under siege by pro-life terrorists who felt they had permission from their personal God to inject noxious butyric acid into clinic’s keyholes, bomb abortion facilities, make daily threatening phone calls and even kill abortion doctors.

Then, just a few weeks earlier, the national debate over the so-called “Partial Birth” abortion procedure blew wide open when a rift developed between abortion providers and pro-choice groups over how frequently the procedure had been used and in what circumstances.  Tensions between the groups were at an all time high.  And now, members of the National Coalition of Abortion Providers, whose Executive Director, Ron Fitzsimmons, in an attempt to tell the truth about that abortion procedure had precipitated the firestorm, were coming to Washington, D.C. for their annual national convention.

Christian Pro Life Terrorists

Christian Pro Life Terrorists

As they were setting the agenda for the meeting a few weeks earlier, NCAP staff came up with an idea to rally the beleaguered troops.  They suggested that, as the last item of business for the three day conference, the entire group go to the U.S. Supreme Court for a picture.

In retrospect, it may not have been the most original idea but it was new to this group who often worked in the shadows.  Normally, they were not prone to exposing themselves in a public way.  They rarely, if ever, congregated as a group in a spot that would make them a convenient target for would-be terrorists. But, with some of their colleagues bailing out because of an impending snowstorm, those that remained dressed for the occasion and cabbed up to Capitol Hill for their group shot.

Abortion Law

Abortion Law

As the professional photographer composed the shot, you could feel the excitement grow.  You got the sense that at least for those few moments they had nothing to hide and it was as if they could feel the presence of Justice Harry Blackmun, the author of Roe v. Wade, the decision that legalized abortion in 1973.  The photographer had to take a number of pictures, but you got the feeling that the group could have stood there for hours.

Over the next 6 years, as a member of the NCAP staff, I visited many abortion facilities and was continually greeted by a framed picture of the group in front of the Supreme Court hanging in the clinic waiting room or the administrator’s office.  Yes, over the years a number of those pictured have left us, like Doctor George Tiller and NCAP founder, Susan Hill.  But as I look at that picture, which is now hanging in my study, I remember that it was a great step forward, that it was a moment when this group of abortion providers were able to stand roudly in front of the building that had been the source of a legal decision that legitimized their work and proved to be a giant leap forward for women’s health.

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