The murder of George Tiller has prompted many families to post first-person accounts of their own heart-wrenching decisions about abortion and child birth.
There's a broad national consensus against late term abortions yet these stories raise the question of just how much do we know about why women have them. Are these stories actually representative? What do they imply for policy?
The liberal blogger Hilzoy at the Washington Monthly published an essay by one woman who, in the eighth month of pregnancy, found out that she had conjoined twins. One of the twins had died. And the other was unlikely to survive:
"At best only one child would survive the surgery to separate them and the survivor would more than likely live a brief and painful life filled with surgery and organ transplants. We were advised that our options were to deliver into the world a child who's life would be filled with horrible pain and suffering or fly out to Wichita Kansas and to terminate the pregnancy under the direction of Dr. George Tiller."
Another woman discovered that one of her twins had died and that delivering the other would likely have killed her; another twice opted for a "partial birth" abortions after learning the babies had "no faces, with no way to eat or breathe," and would die almost immediately after birth. Andrew Sullivan has published a number of stories too.
These examples startled me because they didn't fit the stereotypes that either pro-life or pro-choice activists have offered about late-term abortions. Pro-life activists have tended to suggest that late abortions are matters of taste or convenience or, as Bill O'Reilly, put it "temporary depression."
On the contrary, most of the stories are from women who desperately wanted their babies but were faced with horrible dilemmas of whether to give birth to a child that would suffer and then die. Some of the abortions were, in effect, mercy killings.
When I expressed surprise, one commenter on my regular blog chided me for my ignorance: "The pro-life movement has done a great job of spreading the lie that women are aborting their 8.5 month pregnancies because they only want to fit into a prom dress or swimsuit."
But the pro-choice movement bears some blame, too. Whenever we have a debate about late term abortion, pro-choice activists emphasize the need to protect the life and health of the mother. While that is sometimes a factor, these heart-wrenching stories point to a completely different set of dilemmas -- in which it's not the mother's health but the fetus/baby's quality of life in question. These are tough questions because often times the baby can, in fact, survive, at least for a while but possibly in great pain.
Pro-lifers don't like to discuss such cases because it's quite easy to have sympathy for the mothers who clearly wanted the child and are choosing abortion for anything-but-casual reasons. Pro-choicers don't like to talk about them because, despite the mitigating factors, it still involves killing a baby late in a pregnancy. Protecting a mother's life - i.e. self defense - is a much easier case to make.
A Beliefnet member named "Connie" put it eloquently:
"The harsh truth is that is it very, very difficult to have an explicit conversation about what to do when the child you are having is not the child you wanted. And I'm not talking about sex selection.
Pro-choice people are understandably squeamish about having a forthright discussion about this. Pro-lifers, on the other hand, find it easy to say "have the baby no matter what," when they aren't the ones who have to suffer emotionally and financially to care for it....
We've gotten used to both sides of the discussion around rape, incest, life/health of the mother hard cases. The I-don't-want-THIS-child, or I-don't-think-my-child-should-live-the-sad-life-it-will-have discussion is carefully avoided by both sides."
So, how many of the late term cases are mercy killings? How many relate to babies that would survive but in an impaired state (i.e. Down Syndrome)? And how many were more casual "change of mind" cases?
Amazingly, given how controversial these abortions are, we really don't know much about why women have them. According to the Guttmacher institute, 1.1% of abortions, or 13,310 happen after 21 weeks, including roughly 1,700 after 25 weeks.
A very old 1988 Guttmacher survey of abortions taking place after 16 weeks -- still the most detailed study on the subject -- listed these reasons for why an abortion was happening late in the gestational cycle:
71% -- Woman didn't recognize she was pregnant or misjudged gestation
48% -- Woman found it hard to make arrangements for abortion
33% -- Woman was afraid to tell her partner or parents
24% -- Woman took time to decide to have an abortion
8% -- Woman waited for her relationship to change
8% -- Someone pressured woman not to have abortion
6% -- Something changed after woman became pregnant
6% -- Woman didn't know timing is important
5% -- Woman didn't know she could get an abortion
2% -- A fetal problem was diagnosed late in pregnancy
11% -- Other
The data don't end up cleanly supporting one side or the other. Fetal illness is listed infrequently as a reason, indicating that maybe these heart-wrenching stories are not typical. And saving the life or health of the mother wasn't mentioned at all. Points for the pro-life side.
But these data undercut some pro-life arguments, too. Some abortions happen because of problems that pro-life policies exacerbate. Pro-life groups work diligently to make it harder for women to get abortions, yet these studies show that the difficulty in making arrangements is one of the reasons that abortions happen later. (More on that in my piece, "Safe, Legal and Early."
It's also quite possible that if a study were done on those in the 25th week, as opposed to the 17th week, that the results would be different.
Perhaps the lesson from this renewed wave of attention to late term abortions is that we might want to understand what's actually happening before we attack the other side.