Opinion: I’m a believer and a doctor. Our abortion debate is broken
I’m hopeful that a sober analysis of facts can help politicians, judges and citizens alike craft the right balancing act
As a person of faith who values the sanctity of unborn life, and as a medical professional who seeks to provide the best advice to patients, I’m concerned with the polarization of our contemporary abortion debate. I’m hopeful that a sober analysis of facts can help politicians, judges and citizens alike craft laws that balance medical realities and noble human rights designed to protect both life and liberty.
Fifty years ago, the case of Jane Roe v. Henry Wade was first argued before the United States Supreme Court in which the plaintiff, Norma McCorvey, using a pseudonym of Jane Roe, sued the state of Texas because of her inability to obtain an abortion.
When an abortion could not be obtained because of Texas law that only allowed abortion to be performed to save the life of the mother, she filed a lawsuit. In the case — which eventually made its way to the Supreme Court, seven of the justices agreed that (1) in the first trimester (weeks 1 to 13), the woman had the exclusive right to pursue an abortion and should not be subjected to any state intervention; (2) in the second trimester (weeks 14 to 28), the state cannot restrict a woman’s right to an abortion if her life is in jeopardy; and (3) when the fetus is viable (29-40 weeks), the state may restrict the right to an abortion, but must always include an exception to protect the health of the mother.
According to a recent analysis, more than 62 million abortions have occurred in the United States since 1973, when the Supreme Court decided Roe v. Wade. Since 1993, however, the abortion rate has declined from 1.5 million per year to 862,302 per year in 2018, a 43% decrease. According to 2017 data from the Guttmacher Institute, 18% of all pregnancies ended in induced abortions; 1 in 4 women are predicted to have an abortion before age 45; 12% of abortions were adolescents under the age of 18, and 50% were in their 20s; 62% reported some religious affiliation while 38% reported no religious affiliation; and, in 2014, 75% of abortion patients had income below the poverty level of $15,730 for a family of two.
In May, the United States Supreme Court agreed to hear a case reviewing a Mississippi law that would ban abortions after 15 weeks of pregnancy. Since 2019, lower courts have struck down more than 20 state laws that attempted to restrict the period an abortion could be performed. However, with the composition of the Supreme Court changing, the Mississippi case may overturn Roe v. Wade.
The Mississippi bill in question, House Bill 1510, points out the following:
- The United States is 1 of 7 nations in the world that allow abortions after 12 weeks of pregnancy.
- By 12 weeks of pregnancy the embryo has developed a “human form.”
- The United States Supreme Court has recognized the state has an “important and legitimate” interest in protecting the potentiality of human life.
- Abortions after 15 weeks involve procedures that dismember the fetus.
- Abortions after 15 weeks may increase the health risk to the mother.
- Abortions occurring after 15 weeks may be considered for acute maternal emergencies or in cases of a severe fetal abnormality.
- A woman on whom the abortion is performed when the statute is violated may not be prosecuted.
If Roe v. Wade is overturned, and the Supreme Court points to the Mississippi law as a new model, there are several factors worth considering. First, states might begin to define the gestational age limit when an abortion can be performed. Some states have already attempted to select 12 weeks as the upper limit, while others have tried to select a limit tied to the identification of a heartbeat at six weeks of pregnancy. For example, a recent law in Texas currently allows for an abortion only before the fetal heartbeat is detected, usually between six and seven weeks of pregnancy. From a clinical perspective, abortion prior to 12 weeks is the safest time period to perform an abortion, having the lowest complication rate for the woman. For those patients concerned about birth defects, blood tests are available as early as 10 weeks that screen for a number of birth defects, some of which are lethal, while others are not. Depending upon the state law, termination of pregnancy for fetuses with Down syndrome may or may not be available.
Thirteen states have passed legislation to ban abortions after 12 weeks of pregnancy if Roe v. Wade is overturned by the Supreme Court. While this may seem restrictive to proponents of unrestricted abortion, the Guttmacher Institute reported that 65.4% of abortions occurred before eight weeks of pregnancy, 88% before 12 weeks of pregnancy, 96.4% before 15 weeks of pregnancy and 98.7% before 20 weeks of pregnancy.
The Mississippi law redefines the latest time period that an elective abortion can be performed at 15 weeks of gestation, with an exception for lethal fetal malformations and adverse maternal health circumstances. If upheld by the Supreme Court, the new legal standard may find additional support from medical professionals for the following reasons:
First, a pregnancy with an increased risk for certain birth defects — which are potentially fatal for an unborn child — may only manifest for prenatal detection after 15 weeks. Therefore, a mother already at risk for such a pregnancy may choose to continue her pregnancy knowing that if a malformation turns fatal she has options but is empowered to move forward with the hope of bringing a normal unborn child to term. This may make the difference for a woman who would otherwise forgo trying to become pregnant in the first place, but now knows she has the possibility of detection later in the process and so moves forward with pregnancy.
While, as mentioned, some blood screening for chromosomal and other birth defects can occur as early as 10 weeks of pregnancy, not all abnormal blood screening tests reflect a fetal defect. Additional tests can be performed to determine if the suspected abnormality is present. Furthermore, a fetal ultrasound can be performed between 12 and 14 weeks which can detect most lethal malformations of the fetus that include the brain, heart and other structures that when abnormal result in a diagnosis of a lethal malformation. For high-risk patients, this would allow reassurance of a normal fetus as well as encourage them, in some circumstances, to consider pregnancy instead of abortion.
If Roe v. Wade is overturned by the United States Supreme Court after hearing the Mississippi case later this year, then each state may craft its own laws and regulations regarding elective abortion. Whether all elective abortions are banned by some states, or allowed with stricter gestational age limitations, it’s worth considering the reasonable guidelines from a medical perspective that were suggested by the American Medical Association as early as 1967:
“The Committee on Human Reproduction urged the adoption of a stated policy of opposition to induced abortion except when there is ‘documented medical evidence’ of a threat to the health or life of the mother, or that the child ‘may be born with incapacitating physical deformity or mental deficiency,’ or that a pregnancy ‘resulting from legally established statutory or forcible rape or incest may constitute a threat to the mental or physical health of the patient.’”
As a practicing member of The Church of Jesus Christ of Latter-day Saints, I find it striking that the above recommendations are similar to the church’s position on abortion, which reads as follows:
The Church of Jesus Christ of Latter-day Saints believes in the sanctity of human life. Therefore, the Church opposes elective abortion for personal or social convenience, and counsels its members not to submit to, perform, encourage, pay for, or arrange for such abortions. The Church allows for possible exceptions for its members when:
• Pregnancy results from rape or incest, or
• A competent physician determines that the life or health of the mother is in serious jeopardy, or
• A competent physician determines that the fetus has severe defects that will not allow the baby to survive beyond birth.
The Church teaches its members that even these rare exceptions do not justify abortion automatically. Abortion is a most serious matter and should be considered only after the persons involved have consulted with their local church leaders and feel through personal prayer that their decision is correct. The Church has not favored or opposed legislative proposals or public demonstrations concerning abortion.
The Roe v. Wade standard has more or less been in place for half a century. If the precedent changes with this new law out of Mississippi, it’s important for policymakers to be guided by the best medical science and the conscience of the community, which compels those of faith in particular to care for the most vulnerable, including and especially the women struggling with such a grave decision and the unborn children who deserve our care and protection.
Greggory DeVore is the director of the Fetal Diagnostic Centers in California and a clinical professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA.