Abortion is in the news in the U.S. this week as two states pass legislation designed to reduce barriers to access for patients who need later abortion. The right is screeching about baby killing, while the left is eager to defend later abortion from attack. That’s a noble and important cause, except that this is defense is taking a familiar form.
Instead of simply saying that abortion is health care and patients have an absolute right to make personal health care decisions based on their needs and those of their families, people are focusing on the rarity and frequent heartbreak of later abortion.
The overall abortion rate in the U.S. is actually on the decline, for a variety of reasons, and that’s something to celebrate only inasmuch as preventing medical procedures, even very safe ones, is generally a good thing. Most abortions take place very early in pregnancy, as people who do not want to be pregnant generally make that decision shortly after discovering that they are pregnant, though not always — and it’s worth noting that restrictions on abortion access are pushing patients into having abortions later than they would like.
About 1.3 percent of abortions in the United States take place at 21 weeks of gestation or more, and most of those happen before 25 weeks. Most progressives are familiar with what leads patients to make the decision to have an abortion halfway through pregnancy: it’s possible they only just found out they were pregnant; they just learned about a lethal prenatal diagnosis because testing for such things isn’t very accurate until 18 weeks or later; they just learned about a serious health complication that would make continuing with pregnancy dangerous; they just received a prenatal diagnosis of disability that they feel unprepared to deal with.
Conversations about later abortion tend to lean heavily on fetal demise and threats to the health of the pregnant person; a number of people have written compelling, painful, and stark essays about their decisions to have later abortions. Many have received death threats and vicious hate mail for doing so. No small wonder that most choose to remain anonymous, wanting to tell their stories for the benefit of others going through the same experience but unwilling to expose themselves and their families to abuse. These stories call upon reason: Surely even abortion opponents must understand that extenuating circumstances are an issue, and that exceptions should be made. (Extremists do not, in fact, understand this.)
But in the process, people do two things.
The first is to make a dangerous assertion about disability and the value of disabled lives. Abortion is absolutely a personal choice and right. Why defend it on the justification that being disabled is a tragedy and no one would want to parent a disabled child, and blurring the line between a lethal diagnosis or fetal demise and a prenatal diagnosis of disability? Doing so only feeds the rhetoric of the right, which is fond of advancing selective abortion bans designed to make it difficult or impossible to get an abortion on the basis of disability.
Such bans would actively endanger people by discouraging prenatal testing parents need to make informed decisions about pregnancy, including keeping a pregnancy. Some prenatal diagnoses are accompanied by increased risks to the pregnancy or the pregnant person, making it critical to identify them early so medical providers can make recommendations for interventions designed to help people carry their pregnancies to term. Diagnoses also help expecting parents prepare so they’re lined up with resources when the baby is born, rather than being startled and unable to provide the care their child needs.
The second is to create a tier of justified abortions, and to imply that having a later abortion is bad, unless you have a very good reason. It’s clear that advocates fear feeding into myths about “abortion up until birth” or “careless” people using abortion as birth control, but in the process, they are stigmatizing the procedure. Early abortion isn’t “better” but sometimes this framing makes it sound like it is, much like the “safe, legal, and rare” tagline that was once extremely popular. Later abortions are more invasive and expensive, and, yes, tend to be necessitated by tragic circumstances, which are three reasons to avoid them if at all possible, but they’re not wrong.
As with early abortions, they reflect a situation where someone is pregnant and does not wish to be, sometimes because something has gone terribly wrong with a wanted pregnancy, which is a heartbreaking experience. In all cases, abortion should be defended as a basic right; questioning patients for their decisions and insisting that people justify their abortion sets up a perilous situation where failure to justify is grounds for denial of care.
There must be a way to talk about later abortion that keeps the focus on autonomy, privacy, and respect for patient choice without contributing to right-wing propaganda or suggesting that there are good and bad abortions. An abortion is just an abortion. Anyone who needs one should be able to get one. Anyone who does not want one is not required to get one, but in the event their needs change, they should receive the high-quality, compassionate medical care they need from trained providers in a safe setting. Unfortunately, their quest to deny access to this right is leading to fewer and fewer qualified providers and facilities offering the procedure, endangering everyone — including pregnant people who wish to remain so, for they depend on many of the same medical advances that abortion patients rely on for safe, minimally-invasive procedures.
The bottom line is that abortion is health care, and health care does not need to be justified.
Photo: Ted Eytan