The Inconvenient Truths (For Both Sides) About Late Term Abortions

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.

 

Comments

[Wiberforce]

I am staunchly pro life but I admire the balance of your article and the way you tried to find facts and statistics.It is very difficult for parents if a severe foetal abnormality is predicted and this is where society must do more to support and help parents of children with special needs even to the point of full institutional care.They say the measure of a civilisation is the way it treats the young,the old and the vulnerable.I know of one young couple who were pressured to have an abortion by their specialist because the child was going to be badly handicapped and when they refused after much soul searching he was so angry he refused to continue as their doctor.They had a perfectly healthy baby.

[schatsie]

That is just it, neither side should be attacking, this is a matter of personal choice....­period....

Just like pain reporting is best done by the patient, not by observation or any other subjective criteria,,,the patient knows...

[valkyrie607]

Several reports have indicated that Dr. Tiller wore a button that said, "Trust women."

That, I think, is the essence of the issue.

[lisakaz2]

I guess the prochoice position being about "trusting women" is not (in their minds) helped by the details of women with fetal problems like you mentioned. But the examples surely should be brought up, since the pro-birthers seem not to care if the fetus has no face, no chance for survival or perhaps even has died in utero. I head of one doctor who wanted a woman to carry a dead fetus for weeks rather than have it removed "prematurely" via abortion. Sounds like torture to me in service of a principle that does not apply.

The pro-birthers seem to think empowered women are a threat. And yet who should be making such painful decisions? Them? The state? When did women because juveniles or property again?

[RealityBaseCamp]

Given that some of the same people also oppose same sex marriage on the grounds that it doesn't directly produce children, the phrase "pro-birthers" is very apt.

[crowepps]

Considering that carrying a dead fetus is a huge risk in terms of infection, septicimia and hemmorhage, any doctor who doesn't see the need for an abortion in that case shouldn't be practicing medicine at all. I can, sort of, understand being motivated by 'respect for life' - but I absolutely cannot grasp what sort of thinking process is behind the idea that abortion isn't an absolute necessity in the case of a dead fetus.

[BOHICA]

How can the removal of an already dead fetus be considered abortion? If the fetus has died, then the pregnancy has been ended and is officially a stillbirth, isn't it?

I agree with crowepps. This 'doctor' should not be allowed to practice any longer. He's holding his patients hostage to his religious beliefs and not following his Hippocratic oath.

[anitaj]

A few years ago a friend of a friend found out that the fetus she was carrying had severe deformities and would not survive long after birth. She decided to carry the pregnancy to term and delivered a child that lived only a few hours in what the doctors indicated was excruciating pain.

While I do not have to agree with her decision, I understand that she was in a horrendous position. As the individual bearing this burden, she is the only one who should decide what to do. She weighed the factors and made the decision she believed to be the least bad for herself and her family.

This is all we can ask of anyone.

[KMT]

Waldman, your assumption that pro choice folks can't engage in meaning conversation about late term abortions because it means recognizing women's concern for their children is false. In the early days pro choice arguments did focus primarily on women's rights, but the arguments have broadened. The pro choice movement is more than able to respond with a holistic perspective. In fact, in the many vigils held for Dr. Tiller, stories that you say would face a difficult reception have been front and center.

This broadening happened because of the growing presence of religious progressives in the movement. Their holistic view understands that women facing an unwanted pregnancy rarely think only of themselves. They take into consideration their families and the potential life they carry. Their decision is anything but selfish.

Check out the website of an organization called Faith Aloud: The Religious and Ethical Voice for Reproductive Justice www.faithaloud.org. This non profit organization provides free pastoral counseling for women facing unplanned pregnancies or grieving a reproductive loss. Faith Aloud supports abortion clinics in responding to patients' spiritual needs. Religious progressives have helped the movement stand within paradox and complexity, which is the reality of life itself.

Your assertion that the pro choice movement cannot have this conversation demonstrates that even among progressives, anti-choice rhetoric defines the parametres; reproductive justice organizations have a difficult time getting a fair hearing. That needs to change.

KMT

[crowepps]

Part of the problem is that ProChoice activists are extremely reluctant to invade the privacy of or use the pain of these women for politics. Anti-legal abortion activists, on the other hand, don't seem to have any problem doing so whatsoever and are willing to increase women's pain in service of their warped principles.

[Opaline]

Thanks for this comment! It's like you were reading my mind as I read this article.

Waldman, you say that the results of the Guttmacher survey you quoted don't easily support either side. I disagree. The results in fact strongly support one side.

Let's look at the top two reasons for having a late-term abortion:

71% -- Woman didn't recognize she was pregnant or misjudged gestation

It is the pro-choice side that fights for comprehensive sexual education, and wants women to be aware of and curious about how their bodies work. Knowledge such as how to track ovulation and spotting early pregnancy signs could prevent many of these cases. And which side gave us "Our Bodies, Ourselves", that groundbreaking resource on women's health? Not pro-lifers.

48% -- Woman found it hard to make arrangements for abortion

Come on! Pro-choice means accessibility. Pro-lifers have been fighting - sucessfully - to make abortion access as difficult as possible since they have so far failed to criminalise it completely.

Example: Crisis Pregnancy Centers. These pose as medical facilities while deliberately not disclosing their anti-abortion stance so as to mislead clients; they then surprise them with aggressive anti-abortion coaching. At the very least, they waste precious time needed by these women to receive the counselling they've sought, make an informed decision about their pregnancies and recive appropriate care!

I'm surprised you would think the results of the survey didn't easily support either side, that possibly it leaned toward supporting pro-lifers!

[luziannagirl]

A logical look at the facts of why women have late-term abortions wouldn't help them, because the absolutist "pro-lifers'" real goal is not to save babies or "protect life".

It's to gain control over other people.

And, control over someone's very bodily integrity is about as absolute as control gets.

Forcing a person to carry a pregnancy to term against her will is almost a form of sadism, you know?

[wendyxxixx]

Can we please stop using the loaded phrase "PRO LIFE"? I dare say we are all 'pro life', even if we are "pro choice" as well.

Semantics matter in this case and the anti-abortion crowd are winning by forcing the media into calling them pro-life...when in many cases they are not at all pro life, but pro capital punishment and also have no qualms about sending other peoples' children into war zones.

[LeftRight]

That's why we call them anti-choice....

[hopefullee]

Many of us here refer to them as "anti-choice", but the article and the MSM continue to refer to them as "pro-life".

[crowepps]

The most accurate term I have seen is anti-legal abortion.

[oakley9]

I have not been up on this issue for awhile and I'm glad to hear the truth about many of these LTA's, as sad as ALL of these situations are.
As far as unwanted healthy pregnancies terminated late term ( which I feel is horrible), I place most of the blame on the anti-choice, anti-abortionists themselves. They have created an environment where young men and women have difficulty getting effective birth control, decent health care, and decent sex education and counseling in school, prior to unwanted unplanned pregnancies. I know it's been said before, but it just irks me. These people take no responsibility for what is happening to women.
They are great at judging and pointing the finger, but will they be the ones to care for these unwanted kids?
No. They just enjoy their own self righteousness it seems.

[truestarr]

But we have "proof" that all those tragic aborted fetuses can be SAVED! Dr O'Reilly and Dr Beck told us so!

GLENN BECK (Fox News host): You know, what amazes me is late-term abortions, I mean -- and especially partial-birth abortion -- there's never, ever been a case, ever --
O'REILLY: No. There's no case.
BECK: There's no case --
O'REILLY: That's right.
BECK: There's no case --
O'REILLY: Not with the technology they have today.
BECK: No.

O'REILLY: We all know that.

[leftparadise]

You'll hve to excuse Beck and OReilly - they are considered proof that babies born without brains can survive and even thrive in the right environment

[overlander]

Litigate every pregnancy in court. That's the only solution, Great Thinker.

[spikemom]

I wish someone would describe the graphic truth of these tragic pregnancies. These are babies who are without a skull and without a brain, sometimes without a face or any features, such as nose and eyes and mouth, that are required to be alive.. Some are born with a head full of fluid where the brain belongs. My friend's child was born with all organs outside the body, and no brain. Some are conjoined twins, both with deformities, and sharing defective organs. Sometimes the baby has already died in utero.. When alive, the baby often presents incorrectly and can't be delivered wthout danger to the mother. These are children who have no hope of life, not kids with Down or CP.
Google "ananencephaly images". And LOOK at them . Then look up "congenital disorders" on wikipedia and read about them. And then ask yoursxelf if anyone but the mother can decide what to do.

[adey]

Great post. Thank you.

[FabulousAt52]

Thank you... every pregnancy is different, every decision being made is PERSONAL and for reasons specific to THAT woman and HER pregnancy.... we don't need mandatory laws and religious-based morals across the board that ultimately force ANYONE into parenthood... men OR women.

[lisakaz2]

Pro-birthers always act like we're talking about a normal baby. I think maybe there should be some counter pictures, ya know?

[mydwyf]

Also google 'Depleted Uranium and Birth Defects' and realize that we have poisoned the desert sands of Iraq and Afghanistan with Depleted Uranium. Dust storms carry those sands into the upper atmosphere and all around the world. We may have more, not less, of these tragic situations in the future. And the future is now in some parts of Iraq and Afghanistan . . .

[AvgPseudoIntellectual]

This is absolutely true and unconscionably under-reported. Thousands of birth-defects are occurring due to the spread of depleted uranium as a result of our wars over there.

[Cuyahoga]

Saw a bumper sticker once: Abortion on Demand - No Apologies.

After this week - reading some blogs - most of which (here in Ohio at least) tell women they basically MUST carry through to delivery no matter what - I'm kinda tired of all this. This must remain a woman's issue - in the hands of WOMEN.

No apologies.

[DRaymond]

The fact that the study is so old says a lot about how little we really know about this situation. and besides 16 weeks does not fit current definitions of 'late term' which generally is either after the twentieth week or the third trimester (27 weeks)

One thing that is clear though, is the mysogony of much of the anti-choice side. They presume that women are incapable of coming to a proper choice, that they will carry a baby for eight and a half months and then dump it just because they feel depressed that day or can't fit into their prom dress or whatever. They believe that women are incapable of making the decision themselves.

One contrarian result of the 'parental notification' laws has been an increase in late term abortions. a seventeen and a half year old girl often decided to wait a couple of months and get a late-term abortion without having to notify anybody.

[crowepps]

Actually, the second trimester ends at 24 and a half weeks, but apparently 'late-term' means anything close to the second HALF (18 and a half weeks). A lot of women don't even SHOW at 4 and a half months.

[snesich]

Nonsense.

There is no such thing as "late term abortion". This is "Luntz Language", specifically developed for political advantage on the part of conservatives to try and break the solid public support for abortion rights that has held solid for almost 40 years.

[HankDennemann]

Um, no. Since Roe v. Wade--come to think of it--IN Roe v. Wade, the court divided the abortion framework into three trimesters. The notion of a late term abortion has been around since it was recognized as a constitutional right. Not every term is politically motivated, no matter how much extremists on both sides would like to think so.

[teresasa]

There is no such thing as a "partial-birth" abortion either.