Late Term Abortions

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, 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.

Decades from now, what will the historians say about the morality crusade? How will the movement, led by religiously hysterical conservatives be recorded? The movement of a minority, intending to pass laws impacting the majority population, certainly will be evaluated for its intended and unintended consequences. I’m arguing that the scribes of cultural movements will note, no doubt with regret, that the oppressive laws stimulated the growth of illegal activities. And in the footnotes, some historians will wryly add that many of those who championed the draconian laws were privately against them. I’m not talking about abortion (yet). I am talking about the campaign that was the essence of the mostly failed alcohol prohibition here in the United States. But the similarities between prohibition and the current morality movement against abortion are disconcertingly similar. While there are many to consider, here are just a few.


Prohibition was fueled by the grim reality that people were dying from extreme forms of alcoholism. The move from drinking beer and wine to guzzling distilled spirits created a nation of drunkards. Those who called for temperance believed it would reduce illness, absenteeism at work, accidents in cities and on farms and, generally, improve the moral character of our nation.

Abortions were available prior to Roe for women of means. For other women, abortions were illegal, unsafe and often deadly. Curiously, there was little to no concern about abortion until Roe. Once it passed, anti abortion sentiment was fueled by images of fetal remains that scavengers collected out of garbage bins and out of clinic freezers. This sentiment was furthered with the misnamed partial birth abortion frenzy debated by hysterical and uninformed legislators. Current anti abortion turmoil has extended to legislation impacting clinic facilities. It’s really a bit of irony to think how similar this is to what finally nailed the coffin on alcohol. Rather than anti drinking campaigns, the anti saloon league worked better by closing all the saloons. It’s conceivable that current legislation might be headed in the same direction to not make abortion inconvenient but to make access impossible by closing clinics.

And when the cultural history of celebrities in the United States is written, the books will note the prohibition stars like Al Capone and Lucky Luciano, and the abortion celebrities like Abby Johnson and Troy Newman. They will be featured as single-issue stars who rose to fame then burned out.


Women were central figures in public protests against drinking alcohol. While the initial movement urged a form of moderation that came from a sincere desire within, rather than a forced decision, the women’s temperance groups eventually urged absolute abstinence.

Women continue to be central figures in public praying and protests outside abortion clinics. Being faithful heterosexuals, they also urge abstinence from sex until marriage.

Prohibition lobbying attracted single-issue voters like abortion attracts single-issue voters. Like Prohibition, the movement toward the repeal of Roe v Wade was started by Republicans and joined, later, by a few conservative Democrats.


Prohibition was energized by religious fervor, especially Protestants. Abortion is both a Protestant and Catholic issue in general. In the minority, Evangelicals and Fundamentalist Protestants and conservative Catholics have been vocal opponents of Roe.


Prohibition gave our nation new terms like bootlegger, scofflaw, teetotaler, the drys and the wets, and rum running. Legal abortion has provided new vocabulary terms like anti, choice, prolife, and partial birth.

The above are just a few of the similarities between prohibition and abortion. The people who believed in prohibition thought that government could make life better. It’s no different than those who believe the government should overturn Roe to make our nation a more moral nation. But, like those who thought the government had no right to interfere with alcohol consumption, there are those, a majority, who believe that government has no place in legislating morality, including abortion. Prohibition was a failed social experiment that ignited organized crime, killed thousands of innocent citizens in the name of morality and law, and during the period leading to WWI, linked booze with anti-German war propaganda.

It stands to reason that if abortion is outlawed, there will be similar unintended consequences, some quite deadly. Banned!

People who work in abortion clinics know what it’s like to be discriminated against.  Oh, I’m not talking about discrimination in the legal sense.  I’m just talking general “discrimination.”

For example, it is not unusual for a local business to refuse to serve the local abortion clinic.  It may be a cleaning service that does not want to clean the clinic at night.  It might take a long time for the director of the abortion clinic to find someone who would be willing to construct a website for them.  In some more extreme cases, the local police might not react as quickly as they normally do when called to control an unwieldy group of protestors.  It’s just all part of being in the abortion business.

Now, I am hearing of another form of possible “discrimination” against abortion providers – by Facebook.

Let me explain.

This blog is associated with the website,  That site is a directory of abortion clinics across the country.  The clinics pay a fee to be placed on the site, much like they pay the Yellow Pages to be listed in their books.  A while ago, the manager of the website decided to create a Facebook page.  As of two weeks ago, that Facebook page had over 100,000 “friends,” an incredible amount of people.

On a regular basis, the manager of the site (or one of the “friends”) would post a comment in an effort to generate a conversation.  For example, he might post something like “how do you feel about late term abortions?”   In response, dozens upon dozens of people would comment.  Many of them were anti-abortion, which was perfectly okay because it engendered some very lively debates.

Indeed, at times it would get downright hot and heavy.  Unfortunately, some people used foul language but if they did, they were immediately warned by the manager and removed if they ignored the warnings.   Then, a number of anti-abortion nut balls would flood the site with inane comments, repeating them over and over again.  I think the word is “trolling.”   The manager spent an inordinate amount of time deleting the troll’s comments.  In addition to all of this activity, the Facebook page was used to advertise for in the hopes of directing women to reputable abortion clinics.

Then, suddenly, about a week ago the Facebook page disappeared.


Just like that.

The manager and his staff immediately tried contacting Facebook to find out why the site was taken down.  It was puzzling.  After all, there are a number of other abortion related Facebook pages out there.  Indeed, some of the anti-abortion pages are incredibly gross.  So, it was very hard to figure out why they were shut down without notice.

Compounding the problem is that it is virtually impossible to talk to anyone at Facebook because they are so insulated.  There may be some bullshit “contact us” button but you know that your message will wind up on the computer of some teenager in some Third World country who is getting paid $5 an hour.  Go ahead, try it yourself.  Try contacting Facebook.

So, where does that leave us?

I cannot imagine why Facebook took down this page.  But, no matter what the reason, it is incredibly arrogant to close down a page with that many fans without even notifying the manager.  Who are these anonymous people who make these decisions willy-nilly?   Or sure, I understand it’s their company but, c’mon folks, where are your manners?

I can only conclude that Facebook was getting somewhat uncomfortable with the page for some reason.  The cynic in me would say that the powers that be are anti-abortion and were concerned that an abortion rights page was getting so much visibility.  And, if I can prove that is the case, then I am ready to lead a pro-choice revolt against this company whose owner recently named “Person of the Year” by Time Magazine.

My antennae is up – is it possible that, once again, abortion providers are being discriminated against?

Doctor Tiller

The other night I watched a documentary entitled “The Assassination of Doctor Tiller.”   The film followed the events leading up to the brutal murder of Doctor Tiller, a physician in Wichita who performed late term abortions.

I hated the film.

No, let me clarify that.  I think it was dangerous and irresponsible.

Let me remind everyone that I knew George Tiller very well.  We were good friends, spent a lot of time together.  We had informative conversations about his controversial work.  He was an amazing, dedicated man.  And while I appreciated how this documentary discussed to some extent his life and his work, I am very concerned that the film could incite more violence.

Of course, the mainstream pro-choice groups all think it was a wonderful film in that it documented how abortion providers have been stalked, bombed, threatened and, yes, killed.  They say it’s important for the public to know about the “domestic terrorism” that took place or is still taking place around the country.

Now, I am not naïve.  I understand there are anti-abortion protestors who continue to stand in front of clinics and harass women.  I know that some of the more unstable ones call clinics and threaten the staff.  Those with too much time on their hands will follow the doctors to and from the clinic.  Basically, a lot of stuff is still going on and abortion providers cannot let their guard down.

But the fact is that, compared to the 1980’s and 1990’s, when anti-abortion groups like Operation Rescue could get hundreds of people to block the front door of an abortion clinic at a moment’s notice,  these days things are relatively quiet.  There are a few reasons for this trend.  Years ago, the pro-choice movement (with my assistance) passed federal laws that protected clinics and women entering clinics.  Meanwhile, the number of protestors on a general scale is smaller as the anti-abortion leadership has become older and has moved on to other issues (issues that might be able to raise them more money).  Then there is a very cooperative Administration that is making sure the FBI and BATF do their jobs.  Surely, things are not perfect by any means.  For example, there are still people like Bill O’Reilly who continue to preach hatred (and who was particularly focused on “Tiller the Killer.”)  But my point is that things are much quieter compared to a decade or two ago when the shit was hitting the fan everywhere.

The film, meanwhile, focused on the heyday of Operation Rescue, particularly that time when they surrounded George’s clinic for a whole month as part of their “Summer of Mercy.”  And I guess it’s good to have a history lesson lest we forget.  But what really bothered me – and concerns me – is that the film spent a lot of time focusing on Scott Roeder, the man who assassinated Doctor Tiller.   In my opinion, that was totally irresponsible.

I am not a criminologist but I do know that history is replete with cases where someone killed

Scott Roeder

someone after being “inspired” by some other violent event.  There’s always a copy-cat killing after a sensational murder.  Just remember the rash of school shootings that occurred after Columbine.  The fact is that there are idiots out there, total losers, who are looking to depart from this world with a large bang.  They’re thinking how they’ve got nothing to lose so they decide they might as well take out 20 people at a local McDonalds and get their name on the front page of all the newspapers in the country.  These people are violent extensions of all of those folks who feel a need to go on Doctor Phil or Oprah and talk about their sex change operation or their fight against obesity.  We are a nation of narcissists and sometimes those narcissists take their need for attention a little too far.

So, imagine there is this guy sitting in his dark bedroom, which is located in the basement of his parent’s house.  He is 30 years old, he just lost his job and his wife and two kids are living in another state.  He spends all day playing video games or watching reruns of “Cops.”  He’s got nothing to look forward to.  And he’s got several guns in the closet.

Then, while channel surfing, he runs across “The Assassination of Doctor Tiller.”  He is mesmerized at the films of Scott Roeder, the confessed killer of Doctor Tiller.  He watches his wedding ceremony films and learns how Roeder lost his job soon thereafter and his wife threatened to leave him.  He listens to the ominous background music while he watches grainy films of Roeder standing quietly in front of an abortion clinic.  The film then jumps to Roeder testifying during his trial about how he started thinking of killing Doctor Tiller.  He is impressed with Roeder’s cool demeanor on the witness stand, how he admitted right up front that he did it, that he put the gun to Tiller’s head and fired.  He finds himself getting excited at all of the attention Roeder is getting and how Roeder is cool, even relieved, as he testifies.  He does not sweat a lick, even though he is going to jail for the rest of his life.  Fucking A  – he is the man!

Then maybe this guy in this dark basement starts to get his own ideas…


It happens every day.  It’s the same pattern.  And that’s what concerns me about this documentary.  The pro-choice movement has basically done all it can to protect themselves.  They have passed every law imaginable.  But they cannot stop a lone madman from taking the law into his own hands.  If a person wants to kill and give up his own life, you’re not going to stop him.

And what bothered me about this film is that it may have given some wacko out there another idea.

On January 22, 1973 the U.S. Supreme Court handed down the Roe v Wade decision which declared that the constitutional right to privacy extended to abortion.  Supporters of legal abortion rejoiced, although some did object to the fact that the decision allowed some restrictions on the procedure.  At the same time, the pro-life movement declared it as a dark day in history.

Over the next few years, however, the pro-life movement actually took “possession” of January 22.  They started organizing large rallies on that day across the country and ultimately launched the annual “March for Life” where hundreds of thousands of pro-lifers came to Washington, D.C. to express their opposition to legal abortion.  The pro-choice movement could only watch feebly from the sidelines.


In late 1997, as a staff person for the National Coalition of Abortion Providers, it dawned on me that the next January 22nd would be the 25th anniversary of Roe v Wade.  I started to think about how we could “take back” that day.  Remember that this was a time when abortion providers were under attack.  The bullets were flying, clinics were being bombed, every day was another battle in the constant war.  Ironically, I came up with the idea of actually having a party, a celebration commemorating the work of the doctors and staff at the abortion clinics.  Indeed, for years at the annual NCAP conference, we always had a dinner dance to help us wind down after a full day of seminars and lectures.

But I started wondering why we shouldn’t go a step further?  I had been in Washington, D.C. long enough to know that other organizations, from the realtors to the bankers, regularly had formal, black tie parties.  Why couldn’t we do the same thing?  Why not have a real “grown up” party?

At first, some of our members were reluctant.  It was almost as if it would be a sacrilege for the doctors and staff to “dress up.”  But within a few weeks, the idea spread like wildfire.   On email and over the telephone, people started talking about what they were going to wear, how they needed to rent a tuxedo and other logistical issues.  While they were still nervous opening up their car doors, I could tell they were even more nervous about how they were going to do their hair that night.

To make the evening extra special, I booked the main ballroom at the famous Mayflower Hotel in Washington, D.C.  I then spent weeks looking for a live band and finally found one that I liked.   Everything was in place.

Since they were in town anyway, we offered our members a series of lectures during the day.  They sat through speeches on “head and heart” counseling and how to advertise on the Internet, but it was clear that no one was concentrating.   They were thinking of their “coming out” party.  Finally, the time arrived.  My staff and I got there early and stood at the door greeting folks as they shuffled in.  I was literally taken aback.  I had gotten to know these folks intimately, had talked to them for years about the protestors and the murders, was accustomed to seeing them in their scrubs or casual “clinic wear,” but now they were coming into the room with flowing gowns and jewelry that had been in storage for years.  Instead of bullet proof vests, the male doctors now had shiny tuxedos.  They were different people.  They were finally having fun, getting all “gussied up” as one person put it.  The music, the food and, yes, the booze flowed all night.

A few weeks earlier, I had spoken with a writer for the “Style” section of the Washington Post and she thought it was fascinating that abortion providers would even consider having a party.  I invited her to come and she readily accepted.  The next morning, after a very long night of revelry, our conference attendees had copies of the Post delivered to their hotel rooms and there on the front page was an article entitled “Dinner Break From a Hot Issue.”   The joy of those interviewed jumped from the pages.  Doctors who drove to


their clinics with blankets over their heads for security purposes openly talked to the reporter about the great time they were having for that one evening.   Clinic owners spoke candidly about how proud they were of the work they performed.  Directors of clinics talked about the women they served and about whose gown they were wearing.   We had created an alternate world for one magical evening.

Within a few days, everyone was back at their clinics.  Waiting for them were the local protestors, the anonymous phone calls, the nasty unsigned letters and the myriad of issues that come up daily in a medical facility.  But for weeks, they just talked about “the party.”

On that night, we had taken back Roe v Wade.

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