On the 42nd anniversary of Roe v. Wade, the United States House of Representatives will vote on a bill that would make all abortions after 20 weeks illegal. This is likely just a symbolic gesture on the part of the anti-choice, anti-woman Republican establishment; a reassertion of their general disdain for women’s access to necessary health care, like abortion, which few of us need reminding of (also see recent research on the increased maternal mortality in the US and its link to anti-choice policies over the last few years). Why focus on combating climate change, growing economic inequalities, the mistreatment of immigrants and racially driven police violence against black people (yes #blacklivesmatter), when controlling pregnant bodies is so much easier?
Beyond the sarcasm, the statements that many anti-choice Republicans make in defense of such policies, often based on spurious and inaccurate medical science (i.e. fetuses feel pain at 20 weeks, which isn’t true), serve only to perpetuate stigma around later term abortions. Gestational limits have a tendency to draw lines between ‘acceptable’ and ‘unacceptable’ terminations, redrawing the point at which the state’s interest in ‘protecting’ life trumps that of a woman’s sovereignty and autonomy over her body (acknowledging that a person’s bodily autonomy might already be contested depending on the individual’s raced, classed, gendered body). Legislation, like the one that is likely to pass the House, often occur because politicians do not care to listen to pregnant people’s stories about why they may need or choose a termination after 20 weeks.
So let’s talk 20 weeks… Here in Aotearoa/New Zealand, under the Crimes Act, abortion is legal under certain grounds (with the consent of two certifying consultants) until 20 weeks. At 20 weeks and beyond, the ability to access care is severely constrained and is limited to instances where it is necessary to save the life of the woman or girl or to prevent serious permanent injury to her physical or mental health . The Green Party, which is the only political party with a policy on abortion (so not having a go at them specifically), would maintain a 20 week gestational limit even after removing abortion from the Crimes Act. The question is – why? Medically, this is an arbitrary limit – the fetus is not viable at 20 weeks; it can’t feel pain; and while there are increased risks/complications associated with later term abortions, they are still much safer than giving birth. So why is 20 weeks a seemingly acceptable limitation? And why does 20 weeks get so much airtime when abortions at this stage make up such a small percentage overall (i.e. this is a non-issue issue)?
Before leaping into some thoughts on why later term abortions remain contentious, let’s review some facts about abortions after the first trimester:
- Globally, abortions after the first trimester (greater than 13 weeks) account for approximately 10% of all abortions (except for South Africa, which is around 25%). This has been a static number over the last 2-3 decades, remaining relatively stable despite improvements in contraception and a trend in many Western countries of decreasing abortion rates.
- In the United States, of the 11% post 12 weeks, 1.8% are performed between 18 and 20 weeks and 1.2% are 21 weeks or greater.
- In Aotearoa/New Zealand, where only 56% of abortions are performed before 10 weeks, those beyond 14 weeks still only accounted for 6% of abortions (790 abortions out of 14,073; see release of 2013 statistics).
- In 2012, of the abortions performed in Aotearoa/New Zealand during the second trimester, only 0.4% (66 out of 14, 745) were performed over 20 weeks.
These numbers are not meant as a judgment about ‘good’ or ‘bad’ abortions or to suggest that strict laws equate to fewer later term terminations (anecdotal stories suggest that in some instances pregnant people are instead forced to travel to Australia for care.) However, the figures question the focus on drawing a particular line in the sand – , 20 weeks?
I think there are two reasons for this, both of which require some considered thought and engagement: the cultural imaginary (aided by ever advancing technology) of a more ‘human’ looking fetus makes later term abortions seem ‘icky’; and the fact that pro-choice advocates often use the later diagnosis of foetal abnormalities (typically around 20 weeks) as a rationale for extending limits, which raises some very fraught concerns about the value of dis/abled people’s lives.
These are not insurmountable reasons to finding some common ground or contesting the need for gestational limits more broadly. However, they do require sincere and open dialogue amongst pro-choice activists ourselves (as we all don’t agree on limits and where these should sit – 20, 24, 26 weeks?) and with those who support disability rights, but who are uncomfortable or against abortions performed in response to a fetal diagnosis. In Aotearoa/New Zealand, a lot more work needs to be done in this area. Trying to bridge the real or assumed divides intra- and inter- groups through a willingness to listen and respectfully engage would be a great place to start.
This figure comes from a lecture given by Dr. Dan Grossman, Vice President Research for Ibis Reproductive Health in November 2014 as part of the open online course Abortion: Quality Care and Pubic Health Implications. Grossman also noted that post first trimester abortions are very safe and carry some additional abortion-related risks associated with the later gestational age, but still being safer than full term pregnancy and delivery.
These figures were presented as part the same open online course in a lecture by Dr Eleanor Drey, the Medical Director of the Women’s Options Center of San Francisco General Hospital and an Associate Clinical Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences of the University of California, San Francisco, on abortion after the first trimester.
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