Partial birth abortion, Part 1

You created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made... -- Psalm 139:13-14a (NIV)

Photo of 18-week-old living fetus,
as seen on the cover of the April 30, 1965 issue
of Life Magazine. Photo by Lennart Nilsson.

On the morning of the election last week, I posted a comment on Facebook about one candidate's position on what's commonly referred to as partial-birth abortion. One of my Facebook friends challenged me with several questions, legitimate questions that deserve a thoughtful reply.

Before I begin, I want to say something in response to the violent demonstrations that our nation has experienced in the last week following the elections. I've been struck more than ever by the importance in all our controversies of holding fast to our love for one another. Love does not mean saying, in effect, "I'm ok, you're ok." Rather, when we love, "kindness and truth shall meet." (Psalm 85:10) Or, as Carmelite nun and philosopher St. Edith Stein put it, "Don’t accept anything as truth if it is without love. And don’t accept anything as love if it is without truth. One without the other is a harmful lie." With that thought in mind, and with the help of the Holy Spirit, let's proceed.
 
As I reflected on my friend's questions, I felt that it might be helpful to group them into roughly two categories: the procedure itself, what it involves, its frequency, etc.; and the women who undergo the procedure, their needs, concerns, etc. I'm going to use this post to try to address the first category. I'll then follow up with another post on the second category.

In an effort to be as objective as possible, I asked myself, "Has my knowledge about this topic been gleaned solely from pro-life resources, which might be simply 'pro-life propaganda'?" Therefore, I've made an effort to find sources that are as free as possible of pro-life bias, such as the Guttmacher Institute and the records of the U.S. Congress and Supreme Court.

First, what exactly is a "partial-birth abortion"? 

This is a common term for a late-term abortion procedure known in the medical community as "intact dilation and extraction" (IDX). The Medical Dictionary portion of the Free Dictionary describes the procedure as follows:

IDX first involves administration of medications to cause the cervix to dilate. Dilation usually occurs over the course of several days. Next, the physician rotates the fetus to a footling breech position. The body of the fetus is then drawn out of the uterus feet first, until only the head remains inside the uterus. The physician then uses an instrument to puncture the base of the skull, which collapses the fetal head. Typically, the contents of the fetal head are then partially suctioned out, which results in the death of the fetus and reduces the size of the fetal head enough to allow it to pass through the cervix. The dead but otherwise intact fetus is then removed from the woman's body. [1]

The same source notes that the procedure "is typically performed between weeks 19 and 26 of pregnancy." It should be noted that, although there is some controversy over the subject, there is much evidence that the fetus is able to feel pain by 20 weeks gestation. (See www.doctorsonfetalpain.com for more information.)

But partial-birth abortion is rare, isn't it? 

The answer to this question depends on your perspective. For example, if you're talking about now, in November 2016, then yes, it is rare in the U.S. because of a Federal law passed in 2003 that made it illegal [2]. That law was challenged in court, but ultimately the constitutionality of the ban was upheld by the U.S. Supreme Court in 2007 in the case Gonzales v. Carhart. [3]
 
If you go back to the years before that law was passed, then again, whether or not the procedure was rare depends on your perspective. According to the Guttmacher Institute, "Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000." [4] That is a very small percentage of all abortions. However, according to the same report, there were a total of 1,313,000 abortions performed in 2000. [5] Therefore, there were approximately 2,232 abortions performed by dilation and extraction in 2000. Translating the percentage into an actual number makes it seem less rare, at least to me, but again, it depends on your perspective.

This information brought to my mind another question, one that my friend didn't ask: If partial-birth abortion has been illegal in the U.S. for almost 10 years, then have late-term abortions dropped, or are there other procedures used for late-term abortions?

The Guttmacher Institute September 2016 Fact Sheet on "Induced Abortion in the United States" cites statistics from 2011 and 2012. [6] According to the chart "When Women Have Abortions," calculated in weeks from the last menstrual period, 1.3% of all abortions that occurred in 2012 took place at 21 weeks of pregnancy or later. [7] The same fact sheet states that in 2011 there were approximately 1.06 million abortions performed in the U.S. [8] The fact sheet does not provide total number of abortions for 2012. Applying the 2012 percentage of abortions taking place at 21 weeks of pregnancy or later to the 2011 total number, in 2011 approximately 13,780 abortions took place at 21 weeks of pregnancy or later.

So, I wondered, if partial-birth abortion was illegal by 2011, then what methods were being used to perform these over 13,000 abortions? I found the following methods listed on the internet as abortion procedures that could be used after 20 weeks of pregnancy:

• Dilation and evacuation (D&E): "A surgical abortion performed during the second trimester of pregnancy by dilation of the cervix and removal of the fetus and other products of conception, usually by use of vacuum aspiration and surgical instruments." [9]
  
• Induction abortion: Abortion performed by inducing early labor and delivery. According to WebMD, "Starting (inducing) labor and delivery in the second or third trimester of a pregnancy is done using medicines. To prevent complications, the cervix may be slowly opened (dilated) with a device called a cervical (osmotic) dilator before the induction is started." [10]
  
  Wikipedia, citing several medical sources, states, "If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not. Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended to avoid this." [11] An IDX abortion in which the fetus dies inside the uterus does not fall under the ban on partial birth abortions.

My friend's next question had to do with when a partial-birth, or by extension, other late-term abortion takes place. The common understanding is that these abortions occur only when the fetus is highly unlikely to survive after birth or when the life of the mother is at stake. Answering this question requires bringing in several pieces of background information that will make this blog post even longer than it already is! Therefore, I'm going to address the question of when these abortions take place in a separate post. Stay tuned for Part 2!


Footnotes:
[1] partial birth abortion. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved November 12 2016 from http://medical-dictionary.thefreedictionary.com/partial+birth+abortion
[2] Public Law 108-105--Nov. 5, 2003, 117 Stat. 1201. Retrieved November 12 2016 from www.congress.gov/108/plaws/publ105/PLAW-108publ105.pdf
[3] See www.law.cornell.edu/supremecourt/text/05-380, retrieved November 13 2016. See also en.wikipedia.org/wiki/Gonzales_v._Carhart, 
[4] Finer, Lawrence B., and Stanley K. Henshaw, "Abortion Incidence and Services in the United States in 2000," Perspectives on Sexual and Reproductive Health, Jan./Feb. 2004. Retrieved November 12 2016 from www.guttmacher.org/about/journals/psrh/2004/01/abortion-incidence-and-services-united-states-2000. 
[5] ibid. Retrieved November 12 2016 from www.guttmacher.org/sites/default/files/pdfs/tables/3500603t.html#t1
[6] "Induced Abortion in the United States," Guttmacher Institute Fact Sheet, September 2016. Retrieved on November 13 2016 from www.guttmacher.org/fact-sheet/induced-abortion-united-states.
[7] ibid. For a link direct to the chart, go to www.guttmacher.org/sites/default/files/images/whenwomenhaveabortionsgraph.png
[8] ibid.
[9] dilation and evacuation. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved November 13 2016 from http://medical-dictionary.thefreedictionary.com/dilation+and+evacuation 
[10] See www.webmd.com/women/induction-abortion, retrieved on November 13 2016.
[11] "Late termination of pregnancy," Wikipedia.com, retrieved on November 13 2016 from https://en.wikipedia.org/wiki/Late_termination_of_pregnancy#Methods.