Tuesday, February 26, 2019

Master post: 21+ week abortions usually aren't medically necessary

Despite conventional wisdom, there's zero quantifiable data to support the idea that all or even most late-term abortions are medically necessary.

Defining our terms.

First, the phrase "late-term abortion" is ill-defined. We've had past posts where we were including anything after the first trimester, but to be more conservative, this post is only for abortions performed at 21 weeks or later. [Update 2/8/20: some complain the term "late-term abortion" is not a medical term and/or is made up by pro-lifers. See this thread for examples of abortion providers, Guttmacher, and the media using the phrase "late-term abortion" over the years.]

Second, when we say "medically necessary" we're referring to abortions where the reasons cited were risk to the woman's life, risk to the woman's health, or fetal abnormalities.

Objections to the "medically necessary" definition.

We understand that many pro-life people object to characterizing some or all of these situations as "medically necessary abortions." Some people don't consider a procedure that destroys a fetus an "abortion" if the procedure is done to save the woman's life. Some don't believe there are any scenarios where a woman's life or health is better protected by late-term abortion than by induction of labor or c-section. Some view abortion due to fetal abnormalities as a type of involuntary euthanasia, not medically necessary to the woman and not clearly in the best interest of the fetus. Some especially object to calling abortions "medically necessary" for fetal abnormalities because not all such fetal abnormalities are life-threatening to the fetus (possibly the most controversial example being the very high rate of abortion when the fetus has Down syndrome).

SPL recognizes some relevant points here (scroll down to "Further Reading" for more thoughts on these subjects). But for this blog post, we leave all that aside. Here we're not debating whether and when abortion is justified for maternal health and life or for fetal abnormalities. We're demonstrating that even if you believe all of these reasons constitute medically necessary abortions, most late-term abortions are still not medically necessary.

In reality, most women seek 21+ week abortions for non-medical reasons, such as:
  • Not realizing sooner that they were pregnant, 
  • Struggling to find the time and money for later abortion procedures (which are more complicated and expensive than earlier procedures), and 
  • Difficulty deciding whether they wanted to continue carrying the pregnancy.
Here is a list of further resources, including data and studies, interviews of abortion providers and other pro-choice sources, and interviews of women who obtained non-medical late-term abortions.

Data and studies:

1. More evidence that most late-term abortions are elective - Arizona state data over several years showed ~80% of 21+ week abortions were not for maternal or fetal health issues.

[The above link summarizes the AZ data, but go here to see exactly which Arizona reports and which tables in those reports we referenced to get this info.]

2. Clinton Off on Late-Term Abortions FactCheck.Org, September 29, 2015.
"A spokesman for Clinton’s campaign told us that she meant that many late-term abortions — not all or even most — are because of medical reasons. But that’s not what she said. Her statement left the impression that the majority, if not all, late-term abortions are medically necessary. The available evidence does not support that assertion."
3. Who seeks abortions at or after 20 weeks? Perspectives on Sexual and Reproductive Health, 2013.
"Data suggest that most women seeking later terminations are not doing so for reasons of fetal anomaly or life endangerment."
4. An answer to pro-choicers on Kermit Gosnell. Slate, January 24, 2011. Pro-choice author Will Saletan outlines quite a bit of research suggesting late-term abortions are often not for medical reasons (see parts 8 and 9 of his piece).

[All emphasis added.]

1. Fake News About Abortion in Virginia. The New York Times, February 1, 2019. Frances Kissling, president of the Center for Health, Ethics and Social Policy:
“Our talking point is, most of these procedures are on women who discover abnormalities late in the pregnancy,” Kissling said. “We don’t know if that is true.
5. An Abortion Rights Advocate Says He Lied About the Procedure. New York Times, February 26, 1997.
In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along, Mr. Fitzsimmons [Executive Director of the National Coalition of Abortion Providers] said. ''The abortion-rights folks know it, the anti-abortion folks know it, and so, probably, does everyone else." 
3. Interview with Dr. Susan Robinson, One of the Last Four Doctors in America to Openly Provide Third-Trimester Abortions, The Hairpin, September 20, 2013. Dr. Robinson explains the women who seek third trimester abortions not for medical reasons, but because they didn't realize they were pregnant earlier:
They think they just got pregnant. They have no idea they’re in their 24th week. So they make an appointment for an abortion, and it takes a few weeks, and they have their ultrasound and find out that they’re at 27 weeks, which is too far for an abortion anywhere. So then what happens? They either give up or have a baby, or they go on the Internet and they find us.
4. Abortion is 'never, ever a casual decision,' The Irish Times, September 21, 2013. Dr. Shelly Sella explains why women come to her for third trimester abortions:
The women Sella treats fall into two categories: those who discover foetal abnormalities; and those with healthy, viable babies whose maternal circumstances mean they could not cope with the baby.
He doesn't share his clinic's statistics and rarely speaks of individual cases, but Hern has said he also performs late abortions for women who are not facing any grave medical outcome.
6. The truth about later abortions, according to someone who actually had one. ThinkProgress, February 2, 2019. A woman obtained a $12,000 non-medical abortion around the 5.5-6 month:
I wanted an abortion because my partner wasn’t supportive and I wanted to finish my studies. And if I didn’t have enough money for me or a place, how could I have a baby, you know? So sometimes it is for our future. It’s not the right time.
7. What It Was Like To Get A Later Abortion Teen Vogue, February 8, 2019. A woman obtained a non-medical third trimester abortion because she didn't learn she was pregnant until late in the second trimester and then struggled to find both a clinic that would perform such a late abortion and the $12,000 to cover the cost.
Despite living in Oregon, a state with one of the most progressive abortion laws in the nation, I encountered so many obstacles to accessing abortion just because of my situation [how far the pregnancy had already progressed].
8. What to Know About So-Called "Late-Term Abortion" Teen Vogue, February 12, 2019. A woman obtained a non-medical late second trimester abortion because she didn't find out she was pregnant until she was already in her second trimester.
“Ultimately I knew I just would have no financial stability, and I also knew, too, if I were to have a child I didn’t want, I would definitely drop out of college.”

Further Reading:

Reasons for abortion after the first trimester.
These resources relate to women seeking abortions after the first trimester, but the information is not limited to only 21+ week abortions.
  1. Responding to 8 common pro-choice claims about late-term abortion. Secular Pro-Life Perspectives, February 1, 2019
  2. Timing of Pregnancy Discovery Among Women Seeking Abortion, Contraception, August 2021. More than 1 in 5 women seeking second trimester abortion didn't realize they were pregnant until after 20 weeks gestation.
  3. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination - Prenatal Diagnosis, January 2014 (Dr. Warren Hern, who operates a clinic that performs 21+ week abortions, explains that at most 30% of his patients seek 2nd and 3rd trimester abortions for reasons of fetal abnormality.)
  4. Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions. PLoS One, January 2017 (Study found "Timing of pregnancy recognition was the factor most strongly associated with obtaining a very early or second trimester abortion.")
  5. No, most late-term abortions are not medically necessary Secular Pro-Life Perspectives, October 20, 2016 (Links to data for proportion of 13+ and 16+ week abortions done for medical reasons.)
  6. Attitudes and decision making among women seeking abortions at one U.S. clinic. Perspectives on Sexual and Reproductive Health, June 2012. (In this study, 81% of abortions were sought in the first trimester and 1% of abortions were sought for fetal anomaly. Even assuming all of the fetal anomaly abortions were in the second trimester, it would still mean only ~5% of second trimester abortions were sought for fetal anomaly.)
  7. Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions--A Critical Review of Research, Women's Health Issues, February 2011. ("Research suggests that the overwhelming majority of women having later abortions do so for reasons other than fetal anomaly.")
  8. Predictors of delay in each step leading to an abortion. Contraception, April 2008. (Study found that regardless of the gestational age at the time of the abortion, women were delayed more often by not taking a pregnancy test sooner than by delays in contacting a clinic or obtaining an abortion. "Our findings suggest that interventions which are aimed at improving women's ability to identify a pregnancy at an earlier gestation could be helpful in facilitating women obtaining abortions earlier in their pregnancy.")
  9. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception, April 2006 (Study of women obtaining second trimester abortions found the top reasons for delay were the time it took to learn they were pregnant/how far along they were, the time it took to raise money for the abortion, and the difficulty of making the decision to abort. See Table 1.)
  10. Risk Factors Associated With Presenting for Abortion in the Second Trimester Obstetrics & Gynecology, January 2006 (Study finding that later suspicion of pregnancy and delaying factors such as difficulty obtaining state insurance were major influences on obtaining second rather than first trimester abortions.)

Unsubstantiated claims about medical necessity.
Note none of these articles includes links or even citations to any quantifiable evidence.
  1. Later Abortion: A Love Story. Jezebel, February 21, 2019: "Few people get [later abortions] (only one percent of abortions happen after 21 weeks), and nearly all of the parents who do are grappling with devastating diagnoses like mine."
  2. Hillary Clinton tweet, February 12, 2019: "Only about 1% of abortions happen later in pregnancy—almost always because a woman’s health or life is at risk, or the pregnancy is no longer viable."
  3. Before judging 'late-term abortion,' understand what it means, doctors say, CNN, February 6, 2019, Dr. Barbara Levy of American Congress of Obstetrics and Gynecologists: "Abortions later in pregnancy typically occur because of two general indications: lethal fetal anomalies or threats to the health of the mother."
  4. What Is Late-Term Abortion? Trump Got It Wrong, New York Times, February 6, 2019. "When they occur, it is usually because the fetus has been found to have a fatal condition that could not be detected earlier, such as a severe malformation of the brain, or because the mother’s life or health is at serious risk."
  5. What Doctors Want Politicians To Know About Abortion. Huffington Post, October 21, 2016. "Only 1.3 percent of abortions take place at or after 21 weeks, pointed out [Dr. Sarah] Horvath, and the majority are conducted because the fetus has severe birth defects."
  6. Donald Trump confuses birth with abortion. And no, there are no ninth month abortions. Huffington Post, October 20, 2016. Dr. Jennifer Gunter: "1.3 percent of abortions happen at or after 21 weeks and 80 percent are for birth defects."
  7. Face The Nation, CBS, September 20, 2015. Hillary Clinton: "I think that the kind of late-term abortions that take place are because of medical necessity."
  8. Congress introduced 6 anti-abortion bills in its first 7 days, Yahoo Health, January 16, 2015. "Again, the majority of late-term abortions are performed because of tremendous dangers posed to the health of the mother."
  9. Anti-abortionists on Trial, New York Times, July 25, 2012. "Later abortions mostly often involve severely troubled pregnancies that pose risks to a woman’s health or life."

Objections to the "medically necessary" definition.
Late-term abortion to save a woman's life or protect her health.

Late-term abortion for fetal abnormalities.
Late-term abortion as euthanasia.

Late-term abortion and ableism.

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