Pro-Choice Thoughts on the "Partial-Birth Abortion" Issue

Ellen Smith

The subject of late-term abortion is an emotional one that has been difficult for pro-choice people to deal with. In several recent sessions, both houses of Congress passed a measure to ban the abortion procedure known medically as "intact dilation and extraction" and dubbed "partial-birth abortion" by anti-choice forces. President Clinton vetoed that measure, but the issue is still before us. Anti-choice leaders have promised that a ban will be the first step in "outlawing abortion--one procedure at a time."

What is the intact D&E procedure?

The intact D&E procedure is one method that can be used to end a pregnancy in the 3rd trimester or late in the 2nd trimester. It may have been developed originally to deliver a woman of a dead fetus. The woman's cervix is dilated over a period of time by inserting absorbent dilators. When the cervix is sufficiently dilated, the fetus is removed feet-first. A spinal needle may be used to take fluid from the skull and decrease the size of the head enough to bring it out safely, but the procedure does not involve stabbing a baby's head with scissors as has been depicted by some abortion opponents. Anti-choice groups have fostered revulsion toward the procedure by emphasizing that fetuses are partially delivered while they are still alive.

Late abortions can also be done by the induction method (by injecting saline solution or prostaglandins to induce labor). The intact D&E procedure seems to have partially replaced a more classic D&E procedure in which the fetus is dismembered with surgical instruments before it is removed from the uterus. The intact D&E procedure has less risk of accidental perforation of the uterus, and thus better protects a woman's health and future fertility. Unlike the induction procedure, it can be done on an outpatient basis. Also, some couples who must abort a wanted child because of fetal abnormalities or maternal health problems reportedly appreciate the intact D&E procedure because the fetus is delivered intact and they can hold it while they say good-bye.

When the "partial birth" abortion issue came up in 1996, pro-choice spokespeople reacted to it as an attack on late-term abortions. Defenders of abortion rights pointed out that almost all of the states already prohibit abortion after fetal viability except to preserve the life or health of the mother, and that no more than 600 3rd-trimester abortions are done each year nationally.

Congress heard testimony from women who had 3rd-trimester intact D&E abortions in tragic circumstances involving fetuses with severe abnormalities that were incompatible with life and even made it risky to continue the pregnancies. Abortion rights supporters argued that doctors should be able to offer this procedure to patients when it is medically appropriate. Meanwhile, opponents claimed that intact D&E's are done for frivolous reasons -- "so a pregnant teenager could fit into her prom dress."

A Congressional ban now seems likely.

In February 1997, Ron Fitzsimmons, identified as the director of a national organization of abortion providers, announced that he had lied earlier when he had gone along with statements that intact D&E abortions are rare. He told the press that the procedure is often chosen for abortions in the late second trimester, which may involve healthy women and healthy fetuses. This was terrible publicity, but no one was lying. What appears to have happened is that the two sides of the controversy had been talking about different things -- anti-choice groups attacked a particular procedure while pro-choice groups defended the availability of 3rd trimester abortions under the rare circumstances allowed under Roe v. Wade. Pro-choice groups can be excused for citing statistics about timing of abortions rather than specific procedures, as no one has good data on the frequency of any specific abortion procedure. Available statistics give numbers of abortions by the week of pregnancy, not by procedure.

The intact D&E procedure is in trouble. Measures to enact a ban have passed both houses of Congress, and we can't always count on a Presidential veto. A ban was enacted by the Tennessee legislature. Medical groups which previously opposed a ban as government interference in medical decisions are now supporting these measures, as are some politicians who were considered pro-choice.

Where do we go from here?

If the intact D&E procedure is banned, there will be ways around the ban. There are other ways to do a late abortion.

The larger concern is that any abortion procedure could be vulnerable to a negative public relations campaign, particularly the procedures used after the first 12 weeks of gestation. This issue is about late-term abortions, which are disturbing to most people, and no late-term abortion procedure is pleasant to contemplate. After intact D&E is banned, abortion foes could next attack other forms of D&E--banning abortion one procedure at a time.

Instead of trying to defend a particular procedure, supporters of reproductive choice should refocus on some familiar themes:

1. Government should not interfere in a woman's right to make critical decisions about herself or to have access to the procedures her doctor considers best for her medically.

Neither Congress nor the Tennessee legislature should be in the business of regulating specific medical procedures.

2. Abortion should be not only safe and legal, but also rare, particularly in the second half of a pregnancy.

Only about 1% of abortions occur after 20 weeks. The demand for late-2nd-trimester abortions is largely from two groups: women who learned from amniocentesis that they were carrying defective fetuses, and women who were unable to get abortions earlier in pregnancy.

It should be possible to reduce the numbers of women in both of these groups. The size of the first group can be reduced by continuing improvements in early prenatal diagnosis. The size of the second group can be reduced by eliminating reasons for delaying an abortion (by improved access to providers, eliminating parental consent and waiting-period requirements, and providing funding so poor women don't delay abortions for financial reasons), and especially by preventing unwanted pregnancies in the first place -- through effective sex education and family planning programs, as well as by addressing the needs of poor families so their "choices" are less likely to be dictated by limited finances.

Tennesseans for Choice. First published in 1997, last modified May 6, 2000.

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