How late is too late for abortion?
For two months the American senate has been involved in the most perverse discussion about abortion. What started as an attempt to challenge the legality of a particular method of late abortion has developed into a discussion about whether late abortion should be permitted at all. The emerging consensus seems to be that 'post-viability' abortions are indefensible.
Well, perhaps we should think about 'post-viability' abortions - the ones that take place at the stage of pregnancy when babies can be born alive and have a chance of surviving. We have all heard the apocryphal stories of the hospital where one doctor is aborting a 24-week-old fetus while down the corridor another doctor is fighting to save the life of a 24-week 'preemie'.
Late abortions are, in the abstract, abhorrent, but of course they never happen in the abstract. Behind every abortion is the story of why this particular pregnancy must end in this way. But those who are anti-abortion self-consciously avoid the 'whys' and concentrate only on what happens, how it happens and what it does to the fetus. They know they have a compelling recruitment tool in pictures of aborted late-gestation fetuses. Those where the pregnancy has been ended by a medical induction look like tiny sleeping babies. After 'destructive' dilatation and evacuation abortions, fetuses look like the dismembered victims of a massacre.
People who argue that the discarded human tissue from any operation looks disgusting and that that resulting from abortion is no different are woefully out of touch with normal sentiments. Abortion is not like any other operation. It ends a potential human life and for this reason most people find it significantly more distressing than anything else that happens in a hospital theatre.
It would be ridiculous for those of us who support the right to abortion not to recognise that anxiety about late procedures is inevitable and understandable. Even women who are determined to end their pregnancies usually find that their attitude to the pregnancy changes as it develops. Lynn Kelly - the woman whose husband recently dragged her through the courts to prevent her from having an abortion - is not untypical in her confession that she could not have gone through with the abortion, if she had had to undergo a medical induction and be delivered of a dead fetus. The gynaecologists I have asked say that the reason there are relatively few late abortions is not because women are refused such operations, but because few requests are made.
It is worth remembering that by the time a woman's pregnancy reaches 20 weeks she is visibly (and therefore publicly) pregnant and she is probably feeling pretty robust fetal movements. The abortion procedure at this stage usually involves an induced labour similar to that which the woman would have experienced at term - the difference being that prior to the induction a doctor will have passed a needle through her abdomen to inject a poison into the fetal heart so as to make sure there is no live birth.
Last month the Office of National Statistics released the 1995 abortion statistics for England and Wales. I found them particularly interesting given the current US discussion because for the first time they break down the exact circumstances of post 24-week (post- viability) abortions and the exact week of gestation in which the pregnancy was terminated.
All were carried out on grounds of fetal abnormality - abortions for other reasons are not permitted after 24 weeks in the UK (except to save the life of the woman). The range of abnormalities reads like the litany of human misery it is. Twenty-eight late abortions involved fetuses affected by severe brain malformations, 19 had chromosomal abnormalities such as Down's syndrome. The rest had malformations of the skeleton, urinary system, heart and lungs, blood disorders or a congenital infectious disease. Those readers who are concerned about the much-discussed late abortions for cleft palate will be comforted to know that none were carried out for malformations of the lip and palate; nor were there any for malformations of the eye, ear, face or neck. No evidence of late abortions for trivial, cosmetic reasons then.
Those who wish to restrict late abortions need to decide which of these 76 women should have been denied the abortion that she, the potential child's mother, believed was the best end to the pregnancy. Should the women carrying the fetuses affected by Down's have been told that their reason was not good enough, that they must give birth to a child they feel they cannot bear?
I admit I balked on seeing the lateness of the gestation at which some of these pregnancies were terminated: six at 35 weeks or later. The one that really jolted me was the abortion at 38 weeks. Still I wonder about that woman, who she was, why?
Perhaps the reason why it made such a big impression was because my own baby was born at 38 weeks - just two weeks before he was due and not even early enough to be called 'premature'. But there are two ways you can respond to this, and perhaps which way you jump depends on how you view women. Either you see this woman as somebody who needed to be constrained by law and forced to complete the rest of her pregnancy - or alternatively you can wonder at the awfulness of the situation that made her, undoubtedly with the approval of her doctors, decide that it was better that the pregnancy ended without a live birth, even so close to term. In which case you might conclude that she must have been the most desperate woman in the world.
An American feminist once said that a woman does not want an abortion like she wants an ice cream cone or a Porsche. She wants an abortion like an animal caught in a trap wants to chew off its leg to be free of the trap. This is never more true than of late abortion for fetal abnormality. Legislators should stay out of these women's faces: their decisions are hard enough.
Reproduced from LM issue 102, July/August 1997