Examining the reality of “late term” abortions

Limiting or banning abortions is not the answer.

Across the country, new laws and judicial rulings about abortions are enraging both the right and the left.

Here in Washington, family planning organizations are fighting against rule changes, proposed by the federal Department of Health and Human Services, about how these organizations can receive Title X funding.

These proposed rules would affect the entire nation, but they would likely have real, local effects here in Enumclaw, Buckley, and Bonney Lake.

Here are those changes in a nutshell:

• Title X-funded organizations would no longer be required to inform their patients about all their options regarding abortion, adoption, and bringing a pregnancy to full term, and can no longer refer patients to abortion services;

• Organizations that do provide abortion procedures must perform them in a separate facility away from where other services are performed;

• Finally, organizations that do provide abortion services must create separate financial records pertaining to abortion services from other health services.

These changes will place an enormous financial strain on abortion providers around the nation and in our state, including Planned Parenthood, Cedar River Clinics, and All Women’s Health, which happen to be the three closest abortion service providers in our area.

If these rule changes come into effect, they “would create some real survival issues for providers as it will be a significant financial challenge to open separate locations for Title X and abortion [services],” said Mercedes Sanches, communications director for Cedar River Clinics.

This could mean our local clinics in Renton, Federal Way, and Tacoma would have to seriously consider whether they can continue offering abortion services. If not, then locals wishing to seek an abortion may have to travel farther, likely to Bellevue, Seattle, or Lynnwood — if those clinics are able to afford to continue providing abortion services.

That’s a huge issue for women in our area, especially women of color or those with little financial means.

These laws that limit abortion access and services stem from a slew of misinformation, especially regarding “late-term abortions” — abortions performed after 24 weeks of pregnancy, about when a fetus could survive outside the womb.

The reality is, abortions after 24 weeks are rare, and abortions during the third trimester rarer still, and are almost always medically necessary.

So let’s break it down and examine the statistics.

From 2006 to 2015 the number of abortions in this country have been dropping — from 843,000 abortions to around 640,000, according to the Center for Disease Control.

The majority of abortions happen early on in pregnancy. Around 65 percent of abortions in 2015 were performed at 8 weeks gestation or less, and 91 percent of all abortions at 13 weeks or less, or during the first trimester.

Less than 8 percent of abortions were performed between 14 and 20 weeks, and only around 1 percent after 21 weeks.

Put into perspective, that’s an estimated 8,300 abortions performed after 21 weeks. Keep in mind the third trimester doesn’t start until week 27.

Since a supermajority of Americans believe first-trimester abortions should be legal, I just want to focus on second- and third-trimester abortions. Unfortunately, because there are significantly less second- and third-trimester abortions performed, we have much less information gathered about them.

It should come as no surprise that first-trimester abortions are less expensive, time consuming, and emotionally draining than later trimester abortions. So why, exactly, do some women wait so long to get an abortion?

A study published by the Guttmacher Institute explored what barriers women face when seeking abortion services, which leads to women getting a later abortion.

The study, in part, looked at 272 women who received abortions at or after 20 weeks of pregnancy.

While the study did not disclose how long each woman was pregnant before getting an abortion, one of the study’s co-authors — Diana Greene Foster, professor at the Bixby Center for Global Reproductive Health — said fewer than 5 percent of the women studied received an abortion after 24 weeks of pregnancy.

Her study also excluded any woman who received an abortion for medical reasons, and none of the women received a third-trimester abortion.

Around 45 percent of these women said they delayed in getting an abortion because they were unaware of their pregnancy until an average of 12 weeks, already making a first-trimester abortion unlikely.

Not recognizing the signs of pregnancy until the second trimester isn’t as far-fetched as it may seem. One possible explanation is that even the most trusted birth-control methods fail — another Guttmacher-published study estimated 51 percent of women who received any kind of abortion in 2014 were actively attempting to prevent pregnancy, with 24 percent using condoms and 13 percent on a birth control pill.

The biggest reason a woman reported a delay in getting an abortion was cost — 65 percent of those seeking a later abortion said they had to delay the procedure until they could raise the money. According to the institute, women seeking a later abortion had to pay an average of $2,014, whereas the average cost of a first-trimester abortion was only around $519.

But cost doesn’t just stop at the procedure — women who got a later abortion also had to pay an average of $100 in transportation costs to get to the clinic. The range of transportation costs were as small as nothing to more than $2,000.

This can be a lot of money, especially considering nearly half of women who get an abortion live below the federal poverty line, according to the Guttmacher Institute.

Difficulty securing insurance, not knowing where to get an abortion, and having trouble deciding about whether to get an abortion were all reported as significant barriers by around 40 percent each of these women, and another third said an inability to easily get to an abortion facility was a large barrier — a 2017 Business Insider article shows 23 states, plus the D.C. area, have five or less abortion providers.

Then, of course, there are the women who receive later abortions for medical reasons.

The American College of Obstetricians and Gynecologists says many fetuses and babies die because of fatal birth defects like anencephaly, when a fetus is missing parts of the brain and skull, or the limb-body wall complex, where organs develop outside the body. When doctors discover these defects, “patients may decide whether to continue the pregnancy and deliver a nonviable fetus or have an abortion,” the ACOG said.

There’s also the health of the mother to consider — a large number of pregnancy complications can lead to extensive blood loss, stroke, and septic shock, which can kill an expecting mother.

A C-section could save the life of both mother and child in some of these instances, but “politicians must never require a doctor to wait for a medical condition to worsen and become life-threatening before being able to provide evidence-based care to their patients, including an abortion,” the ACOG said.

I would also add it’s unconscionable and inhumane to force a woman to carry an unviable fetus to term, or require her life to be on the line before an abortion can even be considered.

It’s not known how many women receive a third-trimester abortion for their medical health or because of the inviability of the fetus. However, the National Vital Statistics System estimates 20 percent of all infant deaths in 2013 were due to some form of birth defect, making birth defects the leading cause of infant death.

The CDC estimates more than 23,000 babies died in 2016 — that’s an estimated 4,600 deaths related to fatal birth defects, based on the 2013 statistics.

Pre-term birth and low birth account for another estimated 17 percent of infant deaths (around 3,900), and pregnancy complications account for an additional estimated 7 percent of deaths (around 1,600), along with Sudden Infant Death Syndrome.

And then there are the estimated 700 women a year who die as a result of pregnancy or delivery complications in the U.S.

This is the state of abortion in our country. It’s a vastly complicated mess of emotional volatility, failed contraceptives, limited health care access, financial inability, lack of knowledge, social stigma, family expectations and personal values, domestic violence, rape, medical complications, and life-or-death situations.

I’m pro-choice because of this immense complexity. Blanket solutions that ban or restrict abortions, such as the Department of Health and Human Services’ proposed rules, have severe consequences on our most vulnerable populations. You can’t legislate these issues away.

But we can legislate practical solutions: we should increase access to safe and effective short- and long-term birth control; implement and improve sexual education in public schools; require all insurance plans to cover contraceptives and abortions; fund modern, scientifically-accurate family planning organizations that are allowed to inform about and provide abortion services; and create an affordable health care system, especially for the underprivileged members of our society.

These changes can decrease the number of unwanted pregnancies and late-term abortions, increase the health of mothers, children, and families across the country, and lead to myriad other benefits for everyone.

Left or right, that’s something everyone should get behind.