Magazine article Conscience

Confronting Our Ambivalence: The Need for Second-Trimester Abortion Advocacy

Magazine article Conscience

Confronting Our Ambivalence: The Need for Second-Trimester Abortion Advocacy

Article excerpt

ABORTION CONTINUES TO BE one of the most politically contentious and divisive issues in the United States. In attempts to reframe the issue, many prochoice groups are prioritizing messages of "prevention" and "reducing the need for abortion." These frames mirror public sentiment that abortion should be "safe, legal and rare," but are problematic. While it is critically important to increase access to comprehensive sexuality education and contraception, these flames may be used to support those who seek to impose increased restrictions on abortion access. Our messages must embrace the reality that women will always need contraception and abortion services, that these services need to be more accessible and that they need to be available throughout pregnancy.

Since abortion was legalized in 1973, the right to abortion has been eroded through laws that create barriers to care. Second-trimester abortion is particularly vulnerable. Opinion polls show that only a quarter of the public agrees that abortion should be legal in the second trimester.

Intense public debate over so-called "partial-birth abortion" has inserted graphic descriptions, often misleading, of later abortion into the public arena. The widespread availability of high-resolution ultrasonography, which brings vivid images of fetal development into the public eye, adds fuel to the debate. News stories about very premature infants being "kept alive" through medical intervention call into question for some the definition of "viability."

As a movement, we have not engaged fully in the debate over later abortions, aware that we do not have public support or compelling ways of talking about the women who need these services. Some prochoice writers, such as William Saletan, have even questioned the wisdom of continuing to fight for later abortions, arguing that efforts should be focused on securing first trimester abortions. (Washington Post, March 5, 2006) This position threatens the reproductive rights of the thousands of women every year who need second-trimester abortion services, and reflects a lack of knowledge about who these women are and why they do not seek abortion care earlier.

Too many conversations about second trimester abortion start defensively with the statement, "Of course, most abortions take place in the first trimester." However, approximately 55,000 women in the US obtain abortions at 16 weeks or later every year. This is not new; women have consistently needed access to later abortions. The distribution of abortions by gestational age has remained fairly constant since 1983 with approximately 88 percent of abortions occurring before 13 weeks, six percent occurring between :3 and 15 weeks, four percent occurring between 16 and 20 weeks and one percent occurring after 21 weeks.

Who are these women? The women who seek later abortions are disproportionately young women, low-income women and women of color who often face numerous delays in obtaining services that contribute to the later gestational ages at which they present for care. Of the abortions provided to white women, 11.5 percent occur after 12 weeks compared to 13.1 percent of abortions to African Americans. A Guttmacher Institute study found that adolescents took a week longer to suspect a pregnancy than adults.

While women who detect severe fetal abnormalities in the second trimester have been the "face" of advocacy for later abortions, in fact they represent a minority of the women who need this service. Two recent studies of why women obtain abortions in the second trimester suggest that late detection of pregnancy, cost and access barriers, and difficulty making a decision, all play a role in the use of second-trimester abortion. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier, but faced barriers. These barriers include a shortage of second-trimester abortion providers, the cost of a second-trimester abortion (which is covered by Medicaid in only 17 states), referral issues and low public support for women who seek later abortions. …

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