Friday, February 1, 2019

Responding to 8 common pro-choice claims about late-term abortion.

In the wake of New York's Reproductive Health Act, I've seen a lot of pro-choice assertions about late-term abortion that I'd like to address here.

1. Pro-lifers actually think New York legalized abortion up until birth! It's ridiculous. No one is legalizing abortion into the ninth month.

The Reproductive Health Act allows abortion for any reason up until 24 weeks (~6 months) gestation. That's not new--New York already allowed that. The difference is their old laws restricted abortion after 24 weeks unless the woman's life was in danger, whereas the Reproductive Health Act allows abortions after 24 weeks if the woman's life or health is in danger. This is an important distinction because "health" isn't limited to physical health problems; it can include psychological and familial issues as well. The definition stems from Roe v. Wade's sister case, Doe v. Bolton, which defined health as:
...the medical judgment may be exercised in the light of all factors - physical, emotional, psychological, familial, and the woman's age - relevant to the well-being of the patient. All these factors may relate to health. This allows the attending physician the room he needs....
So if a healthcare practitioner determines that a woman's emotional or psychological well being is threatened or her familial situation is at risk, that practitioner can legally perform an abortion at any stage in the pregnancy. This is why pro-lifers assert New York's law effectively allows abortion at any stage for a wide variety of reasons.

But at least New York pretends to have gestational limits on abortion. There are currently seven states that make no pretense: in Alaska, Colorado, New Hampshire, New Jersey, New Mexico, Oregon, and Vermont it's actually legal (not just effectively legal) to get an abortion at any stage for any reason. It's not a coincidence that the abortion providers who have openly discussed aborting healthy, viable third trimester fetuses all operate out of these states.

Now Virginia has been considering a bill that would also allow abortion at any stage if the woman's life or health were impaired. Here is video footage of the bill's sponsor, Delegate Kathy Tran, agreeing her bill would legalize abortion even moments before birth.

Partial transcript:
(Chairman) Gilbert: How late in the third trimester could a physician perform an abortion if he indicated it would impair the mental health of the woman?
Tran: Or physical health.
Gilbert: Okay. I'm talking about the mental health.
Tran: So, I mean, through the third trimester. The third trimester goes all the way up to 40 weeks.
Gilbert. Okay, but to the end of the third trimester?
Tran: Yep. I don't think we have a limit in the bill.
Gilbert: So where it's obvious that a woman is about to give birth. She has physical signs that she is about to give birth. Would that still be a point at which she could request an abortion if she was so certified? She's dilating.
Tran: Mr. Chairman, that would be a decision that the doctor, the physician and the woman would make at that point.
Gilbert: I understand that. I'm asking if your bill allows that?
Tran: My bill would allow that, yes.

2. Just because it's legal to abort at any stage doesn't mean it's actually happening. Late-term abortions are extremely rare. 

Depends on how you define "rare," I guess. It's true that only 1.3% of all abortions take place after 21 weeks gestation. I would call that relatively rare because abortion is so incredibly common. There were an estimated 926,200 abortions in 2014; that amounts to 12,040 21+ week abortions, or about 33 per day.

And no honest and informed person can revert to the "clumps of cells" euphemisms here. The fetuses we're talking about are an average of 10.5 inches long, organ systems developed, flirting with viability.

Here's a premature girl at 24 weeks (though born at 21 weeks). Source.

I believe people dismiss late-term abortion as "extremely rare" largely because even at this late stage, they don't internalize fetal development or assign any real moral worth to the fetus. But try to remember that pro-life people tend to think of ^these kiddos as morally equivalent to newborns or toddlers. If we had a structure to legally kill three dozen 2-year-olds every day, would you call that "extremely rare"?

Or consider, for example, if, in the wake of yet another absurd and heartbreaking school shooting, you pointed out that dozens of children are killed (not only injured, but killed) in school shootings in this country every year (numbers here). Imagine if the people you bring this up to responded "Statistically that is an almost nonexistent number. Stop pretending this is such a huge deal. What's your real motivation here?"

3. But that picture is misleading because it's a healthy preterm baby. Late-term abortions are done for medical reasons, like major fetal anomalies or if the woman's life is in danger.

Sadly, no. Secular Pro-Life has discussed this misconception extensively. It would be a lot more comfortable to believe that we legally poison and dismember late-term fetuses only in the most dire of medical tragedies, but that's just a reassuring fiction. There's quite a lot of evidence to suggest that many or even most late-term abortions are not done for physical health reasons at all. Here's a quick list:

[Edit 2/26/19: We have since consolidated most of the links below, plus more information, here: Master post: 21+ week abortions usually aren't medically necessary.]
  1. No, most late-term abortions are not medically necessary (SPL blog post about abortions after 13 weeks and after 16 weeks, with links to all the original data)
  2. More evidence that most late-term abortions are elective (SPL blog post about abortions in the 2nd trimester and abortions 21 weeks or later)
  3. Even third trimester abortions are done for non-medical reasons| (SPL blog post with links to interviews of third trimester abortion providers)
  4. Clinton Off on Late-Term Abortions (FactCheck.Org calls out HRC for suggesting late-term abortions are all for medical reasons.)
  5. Who seeks abortions at or after 20 weeks? (Guttmacher research listing primary reasons for non-medical abortions at 20 weeks or later)
  6. The truth about later abortions, according to someone who actually had one (ThinkProgress interview of a woman who got an abortion 5.5-6 months into her pregnancy for reasons unrelated to serious health issues.)

4. Well a nine month abortion never actually happens. Anti-choice activists try to act like women are getting abortions right before birth, but abortion in the ninth month does not exist.

Women have gotten abortions in the ninth month (see Kate Carson's story here), but I agree that it's probably incredibly rare (both relatively and actually rare). Even Dr. Susan Robinson, one of the abortion providers who openly discusses performing non-medical third trimester abortions, has also discussed how she will refuse to do an abortion that's near the very end of pregnancy because it would be unsafe to the mother.
I had a patient from France and she just desperately did not want to be pregnant — but she was 35 weeks, and gestational age is plus or minus three weeks, so she could’ve been at 38 weeks, and that’s just too far along. It wouldn’t be safe.
However further answers in this interview and elsewhere suggest that as long as an abortion is safe for the mother, Dr. Robinson is open to performing it even if it's very late-term and even if there are no serious health problems. Here's a quote from the same interview above:
So how do you draw the line in the case of a healthy fetus? It’s hard. Essentially I have to say to myself, “Is this a very compelling story?” And I feel very bad about that because who am I to say, “Well, it’s compelling because you’re 11,” and then I see a similar case when the girl’s 14 and I think, okay… but then, what if you’re 15, what if you’re 16? How do we draw these lines? What is the ethical difference between doing an abortion at 29 and 32 weeks? Is there a meaningful ethical difference? Can I justify it? Will I have to justify it, and to whom?
Here's a quote from a different interview:
I have to admit, you know, when I started doing this, I thought, "Well, if someone came in to me at 38 weeks, could I do an abortion on a 38-week pregnancy? You know, it'd have to be a pretty good story." And then I started thinking, "What do ya mean a pretty good story? Is this how you earn your abortion? By telling good stories?"
So while I agree that a nine month non-medical abortion probably almost never happens, I don't think it's clear that it literally never happens. More to the point, if it literally never happens, why would it need to be a legal option? Can you imagine if we were having this conversation about anyone other than full-term fetuses?

Side A: We should legalize killing toddlers under these very niche, never-gonna-happen situations even though it would still be totally unnecessary.
Side B: What? That's horrifying. Why would we do that?
Side A: Wow, stop being so dramatic. It's never going to come up anyway!
Side B: In which case, again, why would we legalize it?

5. It needs to be a legal option because a woman could have an emergency medical situation in the ninth month that requires a life-saving abortion!

First of all, all gestational limits on abortion include an exception if the mother's life is at risk (see the "Exceptions" columns of the table at the bottom of this Guttmacher link). If the concern is to make sure that even in the ninth month she can get an abortion to save her life, that's already covered. Concerns about life-of-the-mother situations don't explain why abortion should be legal through the end of pregnancy for a much wider variety of reasons.

But that aside, what situations, exactly, would risk a woman's life if she could not get a 24+ week abortion?

Some OBGYNs have asserted no such situation exists. In fact usually when asked for specifics, the pro-choice side offers many stories about threats to fetal health, but so far none (that we're aware of) that established the woman's life was threatened in a way that abortion would save her but delivering a live child would not. That last point is key here, because very late-term abortions are just as--if not more--complicated than giving birth itself (see this interview with a late-term abortion provider which describes abortion after 25 weeks as "an agonising four day-trial" that still involves labor "as arduous as with a live baby.") So while there can definitely be emergency medical situations in the ninth month of pregnancy, we are aware of none that would be better resolved by an extremely late-term abortion than by giving birth.

Neither Virginia bill-sponsor Tran nor the NARAL lobbyist alongside her were able to describe a single instance where such an abortion would be medically necessary. Here's more partial transcript from the same video above:
Gilbert: Delegate Tran, what are some of the conditions that a woman could be experiencing in a third trimester late-term pregnancy for which an abortion and not delivery would be the optimal result to protect either her life or health or that of the child, if that's even an interest? What would be the--is there any commonly accepted medical decision to terminate the pregnancy in the late-term? Other than deliver the child? If the mother's health or life is actually in danger?
Tran: I'm aware that there are certain medical conditions where that might be an option for the mother, and I would actually turn over to Galina (sp) from NARAL to see if she has those specific medical examples.
NARAL lobbyist: So hi. I don't have a lot of specific examples because I'm not a physician, I'm an attorney, so we unfortunately do not have, the physicians could not be here today because they are seeing patients at the moment. I know that there are certain central nervous system anomalies that cannot be determined until later stages in the pregnancy. I also know that certain anomalies like the absence of certain organs…
Gilbert: Okay, so you're talking about the child. Let me just leave that out of the equation then. In terms of the health or life of the mother, what conditions are there that can't be resolved by delivering the child rather than undergoing an abortion?
NARAL lobbyist: Again, I am not a physician. I can point to a case that happened in Ireland. That's the first one that comes to my mind that I'd be happy to find for you and send you the article about. I can send you that article, and if you'll give me some time I can ask our physicians to provide you with a list of maladies that can lead to a woman having to have an abortion at the late stage of pregnancy. I do know that those cases exist.
Gilbert: But you don't know what they are?
NARAL lobbyist: Like I said, not a physician. I do not have those specifics about the woman. I have some specifics about the fetus. I do not have specifics about the woman.
Gilbert: And again since you yielded, you don't have any specifics on that, obviously.
Tran: No, I don't.

6. Pro-lifers act like women just wake up one morning and casually decide they no longer want to be mothers. Late-term abortion is not that simple.

I actually agree with this one. It's irritating how pro-choice people insist that late-term abortions are only done for severe medical reasons when that is clearly not the case, but that doesn't mean the non-medical reasons are casual reasons. The options aren't limited to:
  1. Women only ever seek late-term abortion because their child is going to suffer terribly or they themselves are going to die, or
  2. Women casually and cheerfully decide very late in a pregnancy they just don't want to be moms after all.
The reality is more like (3) a higher proportion of late-term abortions are due to physical health problems, most late-term abortions aren't for physical health reasons, but they are often for other very serious reasons. In her interview with The Irish Times, late-term abortion provider Dr. Shelly Sella describes some of the circumstances of women who go to her for third trimester abortions:
In the past few weeks Sella has cared for a nine-year-old impregnated by rape. Because she had never had a period, and because the rapist threatened to hurt her if she said anything, the pregnancy went unnoticed.

In another recent case, a teenager pregnant by rape and too traumatised to tell anyone was brought in by her mother, who was highly religious and anti-abortion – but not in the case of her daughter. “The mother feared coming home to find her daughter hanging dead in the closet,” says Sella.

A mother of three came to the clinic because, at 26 weeks, her husband was killed in a car crash, destroying her family emotionally and financially, so she felt she could not cope with a new baby.
I don't think pro-lifers always internalize the hardships that lead some women to seek late-term abortion.

But on the other hand, I don't think pro-choicers are willing to face the reality that women also seek late-term abortion not because of any horrifying physical health issues or personal circumstances, but because either (a) they simply didn't realize they were pregnant earlier or (b) they struggled to decide whether they wanted an abortion (or both).

Dr. Robinson describes women who come to her for third trimester abortions because they didn't realize they were pregnant until near the end of the 2nd trimester. Guttmacher research from 2013 lists "not knowing about the pregnancy" and "trouble deciding about abortion" as two of the most common reasons women sought abortions at 20 weeks or later. And Slate's Will Saletan outlines quite a bit of research suggesting unawareness of pregnancy and ambivalence to abortion are major reasons women abort later:
In the 2004 Guttmacher survey, nearly all second trimester patients said they wished they’d had their abortions earlier. Of these women, 67 percent said it had taken a long time to arrange the procedure. But 50 percent said (in addition or instead of that answer) that they’d taken a long time to decide. A 2002 study in Northern California found a narrower gap: 63 percent of second-trimester patients cited logistical factors, while 51 percent cited emotional factors such as changing their minds or difficulty making the decision. And in a third study, conducted in England and Wales in 2005, the most common reason cited by second-trimester patients for the lateness of their abortions was that “it took me a while to make my mind up and ask for one.”

The next most common reasons cited in the English study were 2) “I didn’t realize I was pregnant earlier because my periods are irregular,” 3) “I thought the pregnancy was much less advanced than it was,” 4) “I wasn’t sure what I would do if I were pregnant,” 5) “I didn’t realize I was pregnant earlier because I was using contraception,” and 6) “I suspected I was pregnant but I didn’t do anything about it until the weeks had gone by.” The most common logistical factor—”I had to wait more than 5 days before I could get a consultation appointment”—was eighth on the list. Abortion Review, a news update service produced by the British Pregnancy Advisory Service, concluded: “Perhaps the most striking finding of this study is the extent to [which] the delay in obtaining an abortion arose, not from factors within the abortion service such as lack of appointments, but from women’s delay in seeking an abortion in the first place.”

7. Well even if women abort very late-term healthy fetuses for non-medical reasons, it's none of your business. It's her body and her decision.

I'm glad to say that most Americans really don't agree with this, including even most of the people who describe themselves as pro-choice. And why should they? We're talking about killing healthy viable humans for no medical reason. Many people would consider that a human rights violation, and most people don't find "mind your own business" very persuasive in response to human rights violations.

I've always thought bodily rights arguments are the stronger pro-choice arguments (though not airtight), but they make a whole lot less sense when we're talking about late-term abortion. The idea behind bodily rights arguments is that no one can use your body against your will. Even if we accepted that this generally applies to pregnancy and abortion, it ceases to make sense once the fetus is viable. In that case the woman can restore her bodily autonomy by giving birth, so what justification is there for restoring her autonomy only by killing another human? As mentioned above (see #5), late-term abortions are not easier or less complicated than giving birth; in fact in the latest stages the woman still has to endure equivalent labor and delivery. So the distinction here is not what her body goes through; it's only whether she delivers a live child or a dead one. What do bodily rights have to do with it?

Most late-term abortions aren't about restoring a woman's bodily autonomy; they are about ensuring she doesn't birth a live baby.

8. Women who want late-term abortions will get them whether it's legal or not. Legal restrictions just make it more dangerous for the woman.

This is another misconception. While it's undoubtedly true that some nonzero amount of women will seek abortion even when it's illegal, it's also true that laws against abortion decrease abortion rates. Here's another quick list:

  1. Myth #3: Abortion restrictions don't stop abortion. (SPL video presentation explaining the flaws in the international Guttmacher data which suggests there's no relationship between abortion law and abortion rates.)
  2. International "unsafe abortion" studies are highly flawed. (SPL post outlining more issues with international Guttmacher data.)
  3. Pro-life laws stop abortions. Here's the evidence. (SPL blog post with links to original data, including some international data.)
  4. More evidence that abortion restrictions decrease abortions. (SPL blog post linking to studies for the United States specifically.)
  5. Evidence that pro-life laws mean fewer unplanned pregnancies. (SPL post linking to studies in the United States that find correlations--and sometimes causal relationships--between abortion law and a population's sexual behavior, including contraception use, STD spread, and pregnancy rates.)
  6. Stop saying that making abortion illegal won't stop people from having them. (Rewire article [pro-choice author] explaining how abortion laws do affect abortion rates.)
  7. I Got An Abortion In One Of The Most Restrictive States - This Is What I Went Through. (Example anecdote in which a woman explains if Ohio had already passed its 'heartbeat bill,' she would have ended up carrying her pregnancy to term rather than aborting.)
Note that the above information is for abortion at any stage in pregnancy, but it's likely the law's effects will be even more profound at the later stages. 

First, later abortion procedures are more expensive, time-consuming, complicated, and risky than earlier procedures. Few people are willing to legally provide late-term, especially third trimester, abortions in the first place. Few if any would be willing to chance trying to secretly and illegally provide one. 

Second, there are very few women desperate enough to try to get an illegal late-term abortion. There are relatively few women interested in late-term abortion in the first place (see #2). A higher proportion of those women seek such abortions due to severe medical issues (see #6), but nearly all state gestational limits make exceptions for maternal health issues (see #5), and many also make exceptions for severe fetal health problems. Late-term abortion restrictions are less likely to affect the women in the worst situations and more likely to apply to women without any serious maternal or fetal health conditions.

Abortion laws do decrease abortion, and that's especially likely to apply to (relatively) rarely sought difficult complicated procedures which are still legal for the absolute worst situations anyway.

In summary:

  1. Plenty of states effectively legalize abortion at any gestational age for a wide variety of reasons; seven states have no gestational limits on abortion in the first place.
  2. 21+ week abortions occur roughly 33 times per day in the United States. They aren't that rare.
  3. Most late-term abortions are not done because of significant physical health problems; most aren't done for medical reasons at all. Even in the third trimester, women seek abortions for non-medical reasons.
  4. Abortions in the ninth month are probably incredibly rare, but there's reason to believe that, yes, even those do happen.
  5. All gestational limits on abortion in the United States include an exception if the woman's life is in danger, so pointing to life-threatening situations to justify broad late-term abortion laws doesn't make much sense. Also, we don't know of any circumstance where a woman's health is better preserved by a very late-term abortion than by giving birth.
  6. Some women seek late-term abortions for very serious reasons, even if they aren't medical reasons. However other women seek late-term abortion simply because they didn't realize they were pregnant earlier and/or they couldn't decide if they really wanted an abortion.
  7. Bodily rights arguments don't justify aborting healthy viable fetuses that could simply be delivered live instead.
  8. Abortion restrictions significantly decrease abortion, and this is likely even more effective for later abortions than earlier ones.

If you read this far, wow--good dedication.

Further Reading: Are Women "Forced to Carry a Dead Baby" Due to Anti-Abortion Laws?

(While I personally haven't seen this claim, others have said they talk to many pro-choice people who believe late-term abortion laws need to be relaxed because otherwise women are forced to carry their dead fetuses. One of our followers, JoAnna Wahlund, wrote an extensive blog post explaining that even states with the most restrictive abortion laws specifically state their restrictions don't apply to removing a dead fetus.)

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