Phoebe White
Late Term Abortion
April 2018
Gretchen Voss, a happily married, healthy, pregnant thirty-one-year-old, went into her checkup appointment for an ultrasound with excitement to find out the sex of her soon-to-be first-born child. Shortly into the visit, her dreams were crushed with the news that the child would lead a painful, surgery-filled life as he or she had an open neural tube defect. Gretchen was about four months along in her pregnancy when she and her husband decided to end the pregnancy of her sick baby. At the time, in 2002, she did not have any problems receiving the procedure that spared her unborn child’s life, but the story may now be changing. (Voss, 2011)
Background & Historical Context
Roe vs Wade
On January 22, 1973, an incredible stride in women’s reproductive rights would be made: the supreme court decision of Roe vs. Wade. Abortion would become legal in the United States, ending a long history of women trapped with unwanted pregnancies and complications due to black-market abortion procedure. (Planned Parenthood, 2018) Women gained the right to their own uterus. However incredible, the law drew a blurry line on when during the pregnancy is too late to be terminated. Roe vs. Wade states that the state may not prohibit abortion during the first trimester or at any time of the pregnancy if the mother’s health is in jeopardy, but it is up to the individual state to decide whether later term abortion of a healthy mother is lawful (US conference of Catholic Bishops, 2018). Currently, there are eight states with no abortion band of any kind, while every other state has some regulation on how late a woman can obtain an abortion. These laws have a great magnitude of varying determinates, which is completely state-decided, including fetal viability, fetal- pain, mother’s physical health, mother’s mental health and mother’s life. The individual states laws are outlined in figure 1 below. (Kaiser Family Foundation, 2018)
Figure 1: Abortion restrictions by state.
What is it?
A late term abortion and third trimester abortion are often used interchangeably but actually mean quite different things. The third trimester begins in the 28th week of pregnancy while late term is a nonmedical term that often means after the 20th week but has no actual set parameters and may refer to abortion as early as the 13th week. Late term refers mainly to the second half of the second term (Planned Parenthood, 2018). This article will focus on late term abortions, as third trimester abortions are extraordinarily rare and most literature does not differentiate for abortions specifically in the third trimester (rather just post 20-weeks and are referring mostly to second trimester abortions). Almost 99% of all abortions occur before 21-weeks as shown in figure 2 below (Guttmacher, 2018)
Figure 2: Percentiles of when women have abortions, less then 8 to over 21
Physicians perform one of two types of procedures to end late term pregnancies which include induced labor and Dilation and Extraction (D&E). Induced labor is when a mixture of medicines is injected into the mother which induces contractions and the mother delivers a stillborn baby. The procedure is rare. More commonly, a physician will perform a surgery that dilates the mother’s cervix and surgically removes the fetus. Since legislation prohibiting this procedure, the MOLD technique, which stands for Misoprostol, Oxytocin, Laminaria, and Digoxin, has been implemented which induces fetus death before the procedure is performed. This procedure takes three to four days to complete. Although there is some risk with all surgical procedures, second term abortions are considered one of the safest medical procedures; there is more risk to giving birth naturally then having this procedure (American pregnancy association, 2017).
Providers
In the United States, there are currently only four practicing doctors who will perform late term abortions. These physicians are Dr. Leroy Carhart in Maryland, Dr. Susan Robinson in New Mexico, Dr. Shelley Sella in New Mexico, and Dr. Warren Hern in Colorado. There was one additional doctor, Dr. Tiller in Kansas, but he was shot and killed while attending church by a pro-life extremist in 2009 (Shane, 2013). His killer, Scott Roeder, was a long standing anti-abortion extremist who was part of the anti-abortion organization Operation Rescue, although the organization has condemned his murderous actions (Fitzpatrick, 2009). His death has brought a lot of attention to the practice and media to ethics of the procedure.
Why?
Many wonder why this topic is even a discussion- why do women who want to end their pregnancy just get an abortion earlier in their pregnancy? It seems like the logical decision as ethics become increasingly complicated the longer the pregnancy lasts. There are many reasons women need access to late term abortions. First, there are huge barriers to access of abortions earlier in the pregnancy. According to Jones, who is considered a “leading expert on abortion in the United States”, 27% of people have to travel more than 50 miles to obtain an abortion because 89% of counties in the US do not have abortion clinics (Jones, 2008). In addition to physical barriers there is a financial barrier; the average cost of an abortion early in pregnancy is $451. Many low-income women need time to acquire these funds, which goes up with every week of pregnancy, which contributes to abortions being pushed back. (Jones, 2011) Second, one of the largest reasons women get late term abortion is because the baby has a genetic disease that would give them a low quality or short life (Shane, 2013). Lastly, women have abortions for numerous extenuating circumstances. Women receive late term abortions because of the child is a product of rape, they lack financials to raise a child, they lack emotional support from their partners/families, they are unaware of their pregnancies or it is too mentally straining to have a child (Planned Parenthood, 2015).
Demography
According to a study by the Guttmacher Institute of almost 10,000 women who received late term abortions, the demographic that had these services done at the highest proportions are black women, uneducated women and adolescence. The factors that lead women to have late term abortions as discussed above (i.e. provider availably and finances) disproportionally effect black and uneducated women. Young girls are more prone to hide an unwanted pregnancy from a parent or caretaker making abortion occur later (Jones, 2011).
Legislation
In 2003, President Bush signed into law the “Partial-Birth Abortion Ban Act”. Partial- birth is a nonmedical term that refers to the D&E procedure. This ban criminalizes doctors who knowingly preform this procedure. Physicians who still preform D&E procedures get around this band by ending the fetus’s life before the surgery using the MOLD technique (Rovner, 2006). According to the National Right to Life website, an anti-abortion organization, it is referred to as partial birth because when a fetus is fully removed at this stage (usually 20-24 weeks) it may have the ability to take a breath, making “the term ‘partial-birth’…perfectly descriptive”. (National Right to Life, 2018). The legislation was struck down by several lower courts in 2003, but was ultimately upheld by the supreme court in 2007. This is the first time since 1973 that terminating a pregnancy is federally illegal. Pregnant women medical decisions are still in the hands of politicians (Stout, 2007).
Controversy
Against
Operation Rescue
One of the largest anti-abortion organizations in the United States is Operation Rescue, whose mission is to take “direct action to restore legal personhood to the pre-born and stop abortion in obedience to biblical mandates.” This organization is responsible for many of the rallies against late term abortions which often occur in front of the clinics. Another trade mark of their organization, and many organizations like them, is side walk “counseling”, where followers stand in front of abortion clinics and offer advice as the women enter. Their organization is particularly concerned with late-term abortion. Operation Rescue Senior Police Advisor Cheryl Sullenger states “[Late term abortion] procedures are barbaric and hold serious risks to women, the act of killing a pre-born baby is in itself immoral and until we can come to grips with that as a society, we never be able to value life as we should.” (Operation Rescue, 2018).
Fetal Pain
Much of the argument against late term abortion is that the fetus’ feel pain. This is highly debated among the scientific community. Some research has shown that fetuses are able to feel pain as early as 20 weeks, while most research agrees that the body has the neural structure for pain at 24 weeks (Mellor, 2005). However, a lot of research indicates that the womb allows the fetus to stay in sedative state and does not actually experience painful events (Bellieni, 2005). Currently, there are many states that are attempting to pass legislation and 17 states that already have legislation in order to ban abortions past 20 weeks based on the fetal pain assumption (Guttmacher, 2018)
Fetal Heart Beat
There are many other factors that people believe should be used to determine when abortions should no longer be allowed. For example, one belief is that when a fetus gains a heartbeat, only five to eight weeks into pregnancy, it gains personhood and it is too late to receive an abortion (Mayo Clinic, 2017). This kind of legislation has been tried to pass in nine states starting with Alabama in 2014, but has all failed (Gates, 2014). The argument of when a fetus gains the right as a person keeps the abortion debate alive and the late term abortion argument even more charged.
In Favor
Planned Parenthood
The largest national organization that supports late term abortions in the United States is Planned Parenthood. The organization believes that a 20-week band is “dangerous, out-of-touch legislation”. Banning abortion past 20 weeks is just the beginning, if it were to be legalized nationally, it would be the first step toward outlawing abortion all together. Women have the right to their own body at any point during their pregnancy, not just the first 20 weeks (Planned Parenthood, 2018). Moreover, this kind of legislation would criminalize doctors and potentially put mothers in dangerous medical situations. Before Roe vs. Wade, 18% of maternal death was from black market abortions; women deserve the opportunity for a safe abortion at any stage of their pregnancy (Guttmacher, 2017).
Late Term Abortion Physicians
The four-remaining late term abortion physicians, focus their reasoning for preforming these procedures mainly on the well-being of the mother as well as the quality of life of the child. As Dr. Shelley Sella says in Doctor Tiller, a documentary following these four doctors after the killing of Dr. Tiller, “It’s inside the mother and she can’t handle it”. It is the mother’s body and she has to be the one to carry the child, if she does not wish to do so that is her right. Furthermore, a large percentage of the women that they give such services to have babies that are incredibly ill and may die early in life or have very low qualities of life. The parents want to spare their children the suffering. Many of these mothers even want to spend time with the tiny baby after the procedure to find closure (Shane, 2013).
Public Opinion
In a Huffington post poll, about 60% of voters supported a 20-week band on abortion (Swanson, 2017). According to NYTimes only 24% of millennial voters believe that abortion should be legal under all circumstances (Brookes, 2018).
Politics of Health
Structural Violence
As discussed above, a disproportionate amount of uneducated black women are in need of late term abortions. This is no coincidence. According to Farmer, structural violence is “suffering that is structured by historically given (and often economically driven) processes and forces that conspire whether through routine, ritual, or, as is more commonly the case, these hard surfaces -to constrain agency. For many…life choices are structured by racism, sexism, political violence, and grinding poverty.” (Farmer, 1996, p.263). Lack of access to abortion clinics, inadequate reproductive health education, stigma around abortion and high costs (which often are not covered by insurance) are all part of the structure that forces that cause these women to be put into a place where late term abortion is there only option (Jones, 2008). Women are not choosing this fate; the structure pushes them into a position where they have no choice. This is coupled with the fact that if they were to have the child, for example, into poverty or with a terrible disease, there is very little support from the state for medical and other expenses. They take the agency away from the mother when she is pregnant and throw it back at her when the child is born.
Scientific Knowledge Production
In an age where information is incredibly accessible and also often unreliable, it is important to realize who is producing said knowledge. Many do not believe in the late term abortion procedure because they believe it is unsafe for the mother. Sources such as Livestrong, a conservative news website, produce false information that plants doubt in the minds of many Americans. An article on their website states that risks of such a procedure include infection, sepsis, heavy bleeding and ruptured uterus (McAtee, 2017). What they fail to mention is that these could all be consequences to giving birth as well. Furthermore, many of these anti-abortion organizations use claims that fetus’s feel pain to make their argument. It is claim that makes the debate seem finished, when in reality it is incredibly unclear what the true answer is. Moreover, National Right to life website states that the “vast majority of partial-birth abortions are performed… on healthy babies of healthy mothers.” (National Right to Life, 2018). This statement is simply false, as the majority of late term abortions occur when babies have incredible fetal anomalies or mothers are not mentally healthy enough to have the child (Shane, 2013). Lastly, many believe that this procedure happens when the baby is almost identical to that of a full-term bay. It should be noted that the survival wright of babies weighing less than one pound, one once (which is about the weight of a fetus at 23 weeks) is 14%. (Slate, 2003) As seen in the polls, many Americans disagree with the practice of late term abortion. What many do not know is that it is safe for the mother, it is unclear if the fetus feels pain, about 1% of all abortion are late term, and most mothers receive them for planned pregnancy that resulted in an incredibly sick baby.
Biopower
According to Foucault, biopower is “an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations” (Foucault, 1990, p.140). One of these techniques is restricting abortions. The government is taking the right away from women to make decisions about her own body. Legislation is stating that an unborn baby, who could not survive without the mother, deserves more rights than the woman who is carrying it. The state does this to gain control over women’s body and control her actions. They use their power to push them into the role of motherhood. America is rooted in Christian ideals, and according to this faith, fertilization is sacred and therefore ending a pregnancy is a sin. The government uses their biopower to further the values of this faith.
De-medicalization
Medicalization takes nonmedical entities and gives them a name and a treatment (Conrad, 2005). There are two obvious examples of de-medicalization, taking a medical entity and turning it into something nonmedical in order to humanize the action, in the fight against late term abortion. For example, by using “late term” rather than second trimester, the actual time of the act is disregarded and people just understand late meaning past the appropriate time. Moreover, the term “partial birth” is used rather than D&E which confuses what is actually occurring during the procedure. The baby is not partially alive, as that is not medically possible; the baby has no life without the mother. This change in terms attempts to make medical terms into an ethical debate. The debate on late term abortion is a valid one, but using the correct terms is the only way to make it a fair debate.
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