Abortion

FOR

The procedure is still legal. So why are dangerous illegal abortions on the rise?

"Most commonly, they ingest a whole bottle of quinine pills, with castor oil…we try to get them to the ER before their cardiac rhythm is interrupted…Sometimes they douche with very caustic products like bleach. We had a patient, a teen, who burned herself so badly with bleach that we couldn't even examine her, her vaginal tissue was so painful…."

"Our local hospital tells me they see 12-20 patients per year, who have already self-induced or had illegal abortions. Some make it, some don't. They are underage or poor women mostly, and a few daughters of pro-life families…"

If you assume the quotes above come from a veteran of the abortion rights movement, talking about the "bad old days" before Roe v. Wade, when desperate women suffered death and injuries because abortion was illegal, you'd be partly right. The speaker is a longtime worker in reproductive health, whose involvement with abortion started before Roe. But the situations she describes are occurring now.

Jen (not her real name) is administrator of a women's health clinic in the South that provides abortions. She has noted with alarm the recent rise in illegal abortion in her community. For some of the women she sees -- after their initial attempts at abortion fail -- whether Roe v. Wade is technically still the law of the land is beside the point. The combination of the procedure's cost, the numerous regulations that her state imposes and the stigma surrounding abortion is leading a growing number of women to choose self-abortion or an untrained practitioner over legal abortion. Finding accurate data about the number of cases is almost impossible.

However, Jen's abortion-providing colleagues in other parts of the country, who communicate their experiences through a listserv, share her observation of a recent perceptible rise in illegal abortion in their clinics as well. Indeed, in another eerie echo from the pre-Roe era, the increase in illegal abortion in Jen's area is so significant that a doctor from the hospital mentioned above contacted her. He asked for her help in setting up a special ward for the treatment of illegal abortions when Roe is overturned, because he knows the caseload will mushroom then. "He didn't say 'if' -- he said 'when,'" Jen said. "Chills ran down my spine."

Why is all this happening when abortion is still legal? Though the cost of abortion has remained remarkably flat since Roe -- the cost of a first-trimester abortion at Jen's clinic is $380, actually less than it was 20 years ago, adjusting for inflation -- it's still too much for a woman who, as she puts it, "is on assistance, has two or three kids already and has no money whatsoever." Teenagers in the state where Jen works also need parental consent before they can have an abortion. And for many teens and adult women alike, the overwhelming culture of shame that hovers around abortion prevents many from going to a clinic.

The physical tragedies we are witnessing due to the return of illegal abortion are compounded by the social ones. Recently, two teenage couples, one in Michigan and the other in Texas, faced unwanted pregnancies. Both states have parental consent provisions; in both cases, the young couples received misleading information (in one instance from an anti-abortion "Crisis Pregnancy Center;" in the other, from a private physician's office) about how to obtain a legal abortion. In Michigan, the young man, with his girlfriend's approval, hit her abdomen repeatedly with a baseball bat until she miscarried; in Texas, again with the girlfriend's consent, the male stomped on his girlfriend's belly, producing a stillbirth of twins. Both young men were arrested, and the Texan, Geraldo Flores, is now serving a life sentence for fetal homicide.

In America's heartland, abortion is both difficult to access and often ground zero in the culture wars. South Dakota and North Dakota, for example, share the distinction (along with Mississippi) of being the states with only one remaining abortion clinic. South Dakota in fact, is currently engaged in a contest with Indiana to become the first state to ban abortion outright. Legislators in each state have introduced bills that they hope might become the vehicles for a friendlier (i.e., featuring two Bush appointees) Supreme Court to overturn Roe altogether.

And if one needed any convincing of the level of stigma associated with abortion in some Midwestern communities, consider how the issue recently factored in the confirmation process for an assistant police chief in Fargo, N.D. The candidate for the job was "outed" by a local anti-abortion activist for having gone through a (legal) abortion some 15 years ago, at the age of 24, with his then-18-year-old girlfriend. The police officer publicly expressed his deep "regret and shame" over the incident, and the mayor of Fargo called the abortion an "error in judgment." Only then did the appointment go forward.

To add an element of absurdity to the tragedies mentioned above, the very policies that could reduce unwanted pregnancies -- and thus abortions, legal and otherwise -- are resisted at every turn by right-wing extremists and their allies in the Bush White House. Funds for family planning services are cut back while millions of dollars of federal funding are spent on "abstinence only" sex education.

Emergency Contraception (EC), a higher-than-normal dose of regular birth control pills that can prevent a pregnancy if taken within 72 hours of unprotected sex, sexual assault or birth control failure, is denied over-the-counter status by the FDA, even though the agency's own panel of experts voted overwhelmingly to make EC available without a prescription. Researchers estimate that EC prevented some 51,000 abortions in 2000 -- the last year for which such data is available -- and OTC status would make this option far more accessible.

The latest front in the abortion war is the pharmacy. There are increasing incidents of anti-abortion pharmacists who are refusing to dispense both EC and regular birth control pills. Even in liberal California, where recently 70 percent of the population supports legal abortion, these pharmacist refusals are taking place. And Wal-Mart pharmacies -- often the only pharmacy in rural areas -- have long refused to fill prescriptions for EC. So, given the current realities of American society -- where teens take matters in their own hands to end a pregnancy, where anti-abortion lawmakers cut funds for contraception, where "pharmacists for life" lecture married women while refusing to refill their birth control prescriptions -- am I suggesting that American women really are in the same boat as they were before Roe? The answer, of course, is no -- or more correctly, not yet.

The number of illegal abortions in the United States -- and attendant injuries and deaths -- currently is nowhere near where it was in the 1950s and 1960s. Most unwanted teengage pregnancies obviously do not have as their outcome a life sentence in prison. Most public officials do not have to undergo humiliating questioning about past abortions in order to get a desired promotion. Rather, these incidents are cautionary tales. They are harbingers of what the American reproductive landscape could quite quickly become -- unless Americans demand a return to common sense and repudiate the madness that a powerful minority seeks to impose on us.

Carole Joffe is professor of sociology at the University of California-Davis, and a senior fellow at the Longview Institute.

Many physicians and researchers of fetal development believe that synaptic connections within the fetus' brain are necessary to perceive pain. These are not formed until the third trimester, when fewer than 1% of all pregnancy terminations are done. For example, researchers at the University of California, San Francisco, CA wrote that babies born before 30 weeks’ gestation lack "functional pain perception." They suggested that this is one indicator that "fetal perception of pain is unlikely before the third trimester." ₁₇

Some mental and medical professionals suggest that a fetus cannot feel pain, no matter how far developed. For example, Stuart Derbyshire, a psychologist at the University of Birmingham, UK, is an expert specializing in how the brain feels pain. He wrote that there is "good evidence that fetuses cannot experience pain." According to World Science, he argues that the complex medical processes necessary for the experience of pain cannot begin until the jolt of life outside the womb kick starts them. Thus, a fetus -- no matter how advanced in development -- cannot feel pain. The presence of pain in newborns is not a sign that a fetus at the same gestational age can feel pain. World Science comments:

"The brain circuitry for processing pain seems to be complete by 26 weeks' gestation, he wrote. But true pain requires not only development of the brain but also development of the mind to accommodate the subjectivity of pain."

"This mental development occurs only outside the womb, he added, through the baby’s actions and interactions with caregivers. The chemical environment in the uterus encourages sleep and suppresses higher-level brain activity necessary for pain perception, wrote Derbyshire, who uses brain scans frequently in his research." ₁₈

Others, mostly pro-life advocates, believe that a fetus as early as 7 weeks after conception can feel pain. Thus, they believe that a fetus can feel pain part way through the first trimester, when most abortions are actually performed

Some of the experts' opinions may be so heavily biased by their pro-life/pro-choice stance that they are incapable of making objective observations.

Many women seriously consider this factor when they are deciding whether or not to have an abortion. They are reluctant to submit to an operation that would be painful to the fetus. Women deserve to have precise information on which to base their decision. Unfortunately, emotional factors seem to intrude in this, as in all other matters related to abortion. Information is very easy to find. But its accuracy is difficult to evaluate.

Pain in an adult, child, newborn or late-term fetus originates as an electrical signal in some of the body's pain receptors. This signal is sent via nerve pathways to the spinal column, then to the thalamus - an egg-shaped structure within the brain. Finally the signal is transferred to the cerebral cortex where it is sensed as pain. In a fetus, the pain receptors develop around 7 weeks after conception; the spino-thalamic system at about 13 weeks. However, the connections to the cortex are established only after about 26 weeks into pregnancy. Some pro-life advocates believe that pain can be felt by the fetus when these systems are only partly formed. Most pro-choice advocates believe that the complete system has to be "wired up" before the fetus can feel pain - i.e. sometime after about 26 weeks into pregnancy.

The first direct scientific study of pain in premature babies involved 18 preemies aged 25 to 45 weeks after conception. According to World Science:

"Brain scans taken while babies were having blood tests registered a surge of blood and oxygen in sensory areas in babies’ brains, according to the researchers, showing that the pain was processed in higher levels of the brain."

"A key brain area involved, called the somatosensory cortex, helps process sensations from the body surface and is also linked to pain sensation in adults, according to the researchers....

" 'Repeated painful procedures are a significant stressor and lead to increased sensitivity to other non-painful procedures,' said Maria Fitzgerald of University College. The researchers said the study points up the need for better pain-control methods for infants.

They insisted, though, that the study says nothing about pain in unborn children." _19,20

1984: Statement by a Group of Physicians:

In a speech by then President Ronald Reagan to National Religious Broadcasters in 1984-JAN, he said "When the lives of the unborn are snuffed out, they often feel pain, pain that is long and agonizing." ₇
This belief was denied by some experts. However a group of "professors, including pain specialists and two past presidents of the American College of Obstetrics and Gynecology" wrote a letter to President Reagan supporting his statement. They wrote:

"We state categorically that no finding of modern fetology invalidates the remarkable conclusion drawn after a lifetime of research by the late Professor Arnold Gesell of Yale University. In The Embryology of Behavior: The Beginnings of the Human Mind (1945, Harper Bros.), Dr. Gesell wrote, 'and so by the close of the first trimester the fetus is a sentient, moving being. We need not speculate as to the nature of his psychic attributes, but we may assert that the organization of his psychosomatic self is well under way.' "

1996: Statement by an "All Party Parliamentary Pro-Life Group:"

A group of pro-life advocates from various political parties in England issued a statement on "Foetal Sentience" in 1996. They concluded:

"Since no direct objective method of assessing fetal pain exists, the crucial question with regard to fetal sentience is: At what stage of human prenatal development are those anatomical structures subserving the appreciation of pain present and functional?

The balance of evidence at the present time indicates that these structures are present and functional before the tenth week of intrauterine life." ₈

1997: Statement by Professor Robert White:

Dr. Robert White, director of the Division of Neurosurgery and Brain Research Laboratory at Case Western Reserve School of Medicine, gave testimony before the House Constitution Subcommittee of Congress. He stated that the fetus at 20 weeks gestation "is fully capable of experiencing pain...Without question, all of this is a dreadfully painful experience for any infant subjected to such a surgical procedure."

1997: Statement by Dr. Paul Ranalli:

Dr. Ranalli is a neurologist at the University of Toronto, in Toronto Canada. He is acting president of the de Veber Institute for Bioethics and Social Research. He gave a presentation called "Pain, Fetal Development, and Partial-birth abortion" on 1997-JUN-27 to the House Judiciary Committee of the State of Ohio. _2,3 He has concluded that the "spino-thalamic" system is fully developed at about 12 to 14 weeks of gestation. This is the system that conveys pain signals from pain receptors throughout the body to the thalamus. He apparently believes that the thalamus can feel pain, even though a connection between it and the cortex is missing.

To support his belief that a fetus in the second trimester can feel pain, he cites three signs:

A fetus will "withdraw from painful stimulation"

Two types of stress hormones which are detected in adults who are feeling pain are also found in a fetus from when a blood sample is withdrawn. He quotes:

Nicholas Fisk of London, England who observed this reaction as early as 19 weeks ₄, and

J Partch of Kiel, Germany who observed it at 16 weeks.

2000: Commission of Inquiry into Fetal Sentience:

The House of Lords in Britain conducted an inquiry into "fetal sentience." ₅ One part of the study dealt with the ability of a fetus to feel pain. Conventional wisdom among researchers is that the brain's cortex is the only location where pain can be felt. However, they mention recent evidence that if an adult suffers from an injury or disease which causes the cortex to function poorly, that some sensation may be felt from an area lower in the brain. They speculate that a fetus may be able to sense some "form of pain sensation or suffering" before the cortex is linked to the lower levels of the brain. They note that babies who are born with a major brain defect can sometimes feel pain. This includes babies born with hydranencephaly in which "the cerebral hemispheres are substantially or entirely absent at birth" and anencephaly, in which "the cerebral hemispheres and the top of the skull may be absent."

They concluded:

"After 23 weeks of growth, higher areas of the brain are active and starting to form connections with nerves that will convey pain signals to the cortex."

"By 24 weeks after conception the brain is sufficiently developed to process signals received via the thalamus in the cortex."

"While the capacity for an experience of pain comparable to that in a newborn baby is certainly present by 24 weeks after conception, there are conflicting views about the sensations experienced in the earlier stages of development. The current scientific understanding is that 6 weeks after conception the elements of the nervous system start to function. Most scientists currently agree that this marks the earliest possible point at which sensation might occur."₆

2000: Statement by Vivette Glover:

Professor Glover of Queen Charlotte and Chelsea hospitals in London, UK, believes that there is a possibility that a fetus aged 18 weeks can feel pain. On 2000-AUG, she recommended that late pregnancy terminations be done under anesthetic. She suspects that the fetus would not respond to sensations in the same way as newborns. It is unlikely to produce the feelings of anxiety that people have. ₁₀

2001: Statement by a panel of experts in the UK:

The issue of fetal pain was addressed by a working group appointed by the Royal College of Obstetricians and Gynecologists in the United Kingdom. The panel consisted of experts in fetal development, law and bioethics. Dr. Anne McLaren headed the group. She commented: "Fetal awareness of pain is a very emotive topic, of particular concern to pregnant women, but we have tried to approach it without preconceptions, to examine the scientific evidence dispassionately, and to identify areas where further research is urgently needed.'' ₁

The group determined that pain can only be felt by a fetus after nerve connections became established between two parts of its brain: the cortex and the thalamus. This happens about 26 weeks from conception. Professor Maria Fitzgerald of University College London, author of the working group's report, says that "little sensory input" reaches the brain of the developing fetus before 26 weeks. "Therefore reactions to noxious stimuli cannot be interpreted as feeling or perceiving pain." ₁₀

They recommended that the administration of painkillers should be considered before an abortion for any fetus which is 24 or more weeks since conception. This would give a 2 week safety factor in case the date of conception is incorrectly calculated.

Recent statistics show that of the 177,225 abortions performed in Britain during a recent year, only 92 (0.05%) occurred after 24 weeks.

2001: Statement by the Medical Research Council at Edinburgh University, UK:

According to Fox News for 2001-AUG-31, the Council's study revealed that "a fetus was absolutely aware of pain by 24 weeks." This is earlier than the 26 weeks previously generally accepted by medical specialists.

This essay continues below.

2004: Testimony by Kanwaljeet S. Anand:

Congress passed a law which criminalizes most D&X abortions (a.k.a. Partial Birth Abortions). Three temporary injunctions were obtained by pro-choice groups to prevent the law from being applied. U.S. District Judge Richard Casey ruled on 2004-MAR-19 that the testimony of Kanwaljeet S. Anandwould would be allowed when the constitutionality of the law is examined in New York, NY. Simultaneous trials on the constitutionality of the law also started in San Francisco, CA, and Omaha, NE on MAR-22. Dr. Anandwould is a pediatrician who specializes in the care of newborns and children. He has conducted research over the past two decades to study whether a fetus can sense of pain by a fetus. He concludes that a fetus at 20 weeks of gestation may be able to feel pain.

The law states that a partial-birth abortion is a "brutal and inhumane procedure" and that "during the partial-birth abortion procedure, the child will fully experience the pain associated with piercing his or her skull and sucking out his or her brain." This assertion will be studied during the trial. ₁₂

2005: AMA study:

During 2005-SEP, a meta-study -- a review of existing medical studies -- into fetal pain -- was conducted by six medical personnel and reported in the Journal of the American Medical Association (JAMA).

Medical News Today reported:

"The review found that a fetus's neurological pathways in its brain that allow for the 'conscious perception of pain' do not function until after 28 weeks' gestation. The researchers concluded that women seeking abortions before the third trimester of pregnancy should not be subjected to the risks of administering anesthesia to the fetus -- which could cause bleeding, breathing problems and other complications, including death -- for the woman."

A firestorm of criticism came from pro-life groups who claimed that the review of existing reports was biased. One of its six authors is the medical director of the abortion clinic at San Francisco General Hospital. The lead author, who is a medical student and lawyer, once did legal work for NARAL, an abortion-rights group, for eight months.

JAMA Editor-in-Chief, Catherine DeAngelis, is a Roman Catholic who opposes abortion. She said that she had received dozens of "horrible, vindictive" e-mails condemning her for publishing the review.

Alan Leff, a University of Chicago pulmonologist and editor of the Proceedings of the American Thoracic Society, said, "The standard for disclosure in medical and scientific journals is not your politics ...There's no obligation to tell people what your mind-set is ... as long as the data is sound and gathered objectively." _15,16

Laws regarding the use of fetal anesthetic during pregnancy terminations:

California: A bill was introduced to the Health Committee of the California Assembly on 1998-MAY-5. It would have required that pain medication be used to anesthetize the fetus during any late-term pregnancy terminations. ₉The cutoff age the start of the third trimester; after this gestational age, anesthetics would be compulsory during any hysterotomy or D & X procedure. The intent of the legislation was to make certain that the fetus did not feel pain. The bill was rejected by the committee.

There was some indication that Planned Parenthood Federation of America is opposed in principle to such legislation. This is not true. A spokesperson for PPFA responded to our inquiry on 1999-MAY-4 with:

"Planned Parenthood does not currently have an official statement specifically regarding fetal anesthetic use."

Texas: State Representative Leo Berman, (R-Tyler) introduced a bill "HB 569, The Fetal Pain Protection Act, which would require that women choosing to have an pregnancy termination first be told that fetuses can feel pain. They would also be given the option to have anesthetic administered to the fetus before the procedure. This would apply to fetus which are 20 weeks or older. Berman presented his bill to the House State Affairs Committee on 2003-APR-7. He noted that anesthesia is given prior to many dental procedures, and to inmates before being executed. He feels that fetuses should receive the same option. ₁₂

US Federal law: Senator Sam Brownback (R-KS) and Representative Chris Smith (R-NJ) introduced a bill to the Senate and House during 2004-MAY called the "Unborn Child Pain Awareness Act." It would required abortion providers to inform women who are about to receive a late-term abortion that her fetus can feel pain. It would also give the woman the opportunity to have pain control medication administered to the fetus before the abortion. This would affect fewer than 1% of all abortions -- those performed at 20 weeks or later gestation. The bill is supported by a number of pro-life conservative Christian groups: the Southern Baptist Convention, the U.S. Conference of Catholic Bishops, the National Right to Life Committee and the Family Research Council.

Tony Perkins of the Family Research Council said: "We cannot deny the medical evidence now before us. From testimony taken during the recent partial-birth abortion hearings and advancements in the field of in utero technology, science is telling us unborn children as young as 20 weeks old can feel pain. The evidence we have is clear, and we should not keep that evidence from women."

A Zogby poll conducted in 2004-APR found that 77% of American adults were in favor of "laws requiring that women who are 20 weeks or more along in their pregnancy be given information about fetal pain before having an abortion." Sixteen percent were opposed. ₁₃

Concerned Women for America, a Fundamentalist Christian group bringing "...Biblical principles into all levels of public policy" states: "The medical community’s consensus is that unborn babies are 'very likely' to be 'extremely sensitive to pain during the gestation of 20 to 30 weeks,' according to testimony of Dr. Kanwaljeet Anand in Nebraska for Carhart v. Ashcroft. Anand said, 'This is based on multiple lines of evidence. Not just the lack of descending inhibitory fibers, but also the number of receptors in the skin, the level of expression of various chemicals, neurotransmitters, receptors, and things like that'." The court case mentioned above refers to the constitutionality of the Partial Birth Abortion Ban. ₁₄

The cutoff date of 20 weeks gestation is significantly earlier in pregnancy than the 26 weeks that most medical researchers feel that fetuses can feel pain. However, it is far later than the seven weeks that some pro-life groups had been promoting as the fetal age when pain can be felt.