November 30, 2003

Frank Talk About Abortion

The current debate about so-called partial birth abortion has produced some strange and unfortunate consequences. Among the most disheartening is the widespread impression that the pro-choice movement does not regard abortion as a serious matter, and that women seeking to terminate a pregnancy require a condescending reminder from Congress to understand that the fetus they are carrying is a potential life.

Now that the debate has moved from Congress to the courts, the public could benefit from a fuller and franker discussion about abortion policy. The profound nature of the issue must be acknowledged. But it must also be made clear that few understand its practical, heart-wrenching dimensions better than the doctors who perform the procedures, and the people fighting in a difficult political environment to preserve a woman's hard-won right to decide whether she will carry a pregnancy to term.

The 'Partial Birth' Strategy

"Partial birth" is a political battle cry, not medical terminology. People who want to end all abortion rights have made no secret of the fact that their strategy is to single out the aspects that create the greatest popular discomfort, chipping away until, as a practical matter, access to legal abortions is no longer available.

The strategy is potent because the clinical details of abortion are disturbing to consider. The chief sponsors of the "partial birth" ban recently passed by Congress said it was intended to outlaw a procedure the American College of Obstetricians and Gynecologists calls an intact dilatation and extraction. That generally involves the doctor's pulling out the fetus up to the neck and then collapsing the skull. It is hard to imagine a doctor performing such a procedure on an almost fully developed fetus except under the most drastic medical circumstances. And, although no definitive statistics exist, the evidence suggests no doctor does.

The "partial birth" controversy has given millions of Americans the idea that abortions in the final months of pregnancy are common and easy to obtain. But unless a serious medical problem occurs, a woman's right to choose abortion correctly ends at the point of viability, when the fetus is developed enough to survive outside the womb. Even before viability, abortions in the seventh month and beyond are illegal in 41 states. Although many of those prohibitions are undoubtedly unconstitutional, since they make no exception for times when a pregnant woman's health or life is endangered, they remain on the books because no one, including the reproductive freedom movement, has made a concerted effort to overturn them.

More common, though still rare, are abortions performed during the second trimester of pregnancy, roughly the fourth through sixth month. During the most common procedure for this stage, the fragile fetus is generally broken apart during extraction. Legislators who supported the "partial birth" bill claimed it would have no effect on these second-trimester abortions. But because the law does not single out one procedure to be banned, physicians who perform midpregnancy abortions have good reason to fear being prosecuted. That is one reason the current "partial birth" law is being challenged in federal courts in three states, and it was one reason the Supreme Court overturned a Nebraska statute remarkably similar to the one just passed by Congress.

The other reason the Supreme Court overturned the Nebraska law was that it provided no exception to protect a woman's health. That was a particular concern to the swing justice, Sandra Day O'Connor, and the Republican majority in Congress could have gone a long way to protecting the new law from successful challenge by taking the health of the pregnant woman into consideration. Many average Americans who shrink from the procedure described as "partial birth" would also want to make an exception if, for instance, a woman discovered that the fetus she was carrying was hopelessly deformed and that extracting it later or by another method could leave her unable to have children in the future.

Why, then, did the Senate majority leader, Bill Frist, and the other crucial proponents of the ban fail to seize Justice O'Connor's virtual invitation to add this exception? The answer, of course, is that it would have diverted public attention from the details of how the abortions are performed, to the thought of women who might be put at risk. A full debate on the floors of the House and Senate about which dangerous pregnancies should be exempted from the ban would have been welcome, but it would not have served the sponsors' purpose of fuzzying up the abortion issue by portraying pro-choice advocates as heartless extremists.

Drawing the Line

Abortions always mean ending a potential human life. But most people do not regard terminating a pregnancy that is only a few hours old, or a few weeks old, in the same light as ending one in the seventh month. Drawing a clear line about when an abortion can be performed is a difficult and divisive problem. The wisest line, in our view, is the one laid down by the Supreme Court 30 years ago in Roe v. Wade: Government should have the right to step in only when the fetus has developed fully enough to be able to exist on its own.

Another clear line, of course, would involve banning abortions entirely, from the moment an egg is fertilized. That would mean no IUD's or other contraception methods that involve dislodging the fertilized egg, no ending of pregnancies in which the fetus is discovered to be terribly deformed, no exemption for women who have been raped. That option is preferred by many people of good faith. But most Americans do not agree, and enforcing it would constitute an enormous and unconstitutional intrusion on the bodies and lives of women.

As a practical matter, no law even an act of Congress can prevent women bent on aborting a pregnancy from doing so. All it can do is make abortions unsafe. That lesson is being brought home today in countries like the Philippines, where an estimated 400,000 abortions take place each year despite a strict ban. One unsurprising result is the alarming rate of medical complications and of abortion mortality.

Finding Common Ground

It would obviously be better to avoid abortions entirely by eliminating unwanted pregnancies. That will never happen, but we should strive to reduce the need for abortions as much as possible. President Bush and Congress could help by moving beyond their backing of programs to promote abstinence and embracing a wider range of approaches, including effective sex education and easier access to contraception, including over-the-counter availability of the so-called morning-after pill.

There is no denying that America's pro-choice majority has become increasingly queasy about even second-trimester abortions. Modern sonogram technology has contributed to that feeling by allowing people to view the features of a developing fetus with amazing clarity. But too often obscured in the ruckus over "partial birth" is a perverse fact: It is the opponents of reproductive freedom, not pro-choice advocates, who pose an obstacle to achieving the humane goal of reducing the number of unwanted pregnancies and second-trimester abortions. Through political harassment and the imposition of various restrictions, they have made it increasingly difficult for women who are young or poor, or who live in rural areas, to obtain access to abortion services in the first weeks of pregnancy, thereby needlessly delaying procedures until the fetus is further along. While the pro-choice movement has been fighting to protect women from the need to have abortions later in pregnancy, the other side has been vigorously engaged in a battle that will inevitably make them more common.

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