Kermit Gosnell and late-term abortions: An answer to pro-choicers.

Science, technology, and life.
Jan. 24 2011 8:04 AM

The Baby Butcher, Revisited

Is it OK to abort a viable fetus? An answer to pro-choicers on Kermit Gosnell.

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The Gosnell grand jury report provides no evidence that women who came to him for post-viability abortions did so for medical reasons. On the contrary, the report indicates he was indiscriminate: One of his employees testified that "she rarely, if ever, saw Gosnell decline to do a procedure because a woman was too far along." And the only abortion on which the report offers evidence either way seems to have been elective. According to the report:

In 2004, a 27-year-old woman went to Gosnell, pregnant with her first child. She testified that she was surprised when Gosnell told her she was 21 weeks pregnant. On the first day of what was to be a two-day procedure, Gosnell inserted dilators in the woman's cervix. After Gosnell had finished inserting the laminaria, the woman asked him what happened to the babies after they were aborted. She testified that Gosnell told her they were burned.
At home, thinking over how Gosnell disposed of the fetuses, the woman had a change of heart. She called her cousin and the cousin called Gosnell to tell him that they wanted him to take the laminaria out. Gosnell said that he could not do that once the procedure was started. And he did not want to return the $1,300 that the patient had already paid. The pregnant woman ended up going to the Hospital at the University of Pennsylvania to have the laminaria removed. It was determined at the hospital that she was 29 weeks pregnant. A few days later, the 27-year-old delivered a premature baby girl. She was treated at Children's Hospital of Philadelphia and is today a healthy kindergartener.

It isn't clear how pregnant this woman thought she was. But the report says Gosnell knew how far along his patients were and lied to them (in many cases manipulating the ultrasound) to bargain up his price or fake compliance with the law. At 29 weeks, the survival rate for premature infants is 97 percent. Gosnell apparently knew he was aborting a healthy woman's healthy, viable baby. This was an elective third-trimester abortion. And we have no idea how often this happens. We know about this incident only because 1) the woman changed her mind and went to a hospital, and 2) the doctor was later investigated for non-abortion reasons.

The grand jury recommended that Gosnell be prosecuted for 33 violations of Pennsylvania's Abortion Control Act. If those charges are pursued, we may find out how many of these abortions were for medical reasons. The Abortion Control Act prohibits abortions after 24 weeks except when the "physician reasonably believes that it is necessary to prevent either the death of the pregnant woman or the substantial and irreversible impairment of a major bodily function of the woman." If Gosnell can't produce evidence of such risks, that might answer the question.

9. Late-term abortions can be blamed on access problems. According to Herold:

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Women have second trimester abortions because they need to, not because they want to. Why? Because their insurance doesn't cover abortion, because they needed time to raise money for the cost of an abortion, because they needed to arrange travel/childcare/time off of work in order to spend a full day at the clinic, because they needed time to make the decision with confidence, because they needed to make time to travel out of state to access an abortion provider.

Herold is right, of course, that women don't prefer late abortions. But to what extent do access problems account for their lateness? Herold cites two studies. In the 2004 Guttmacher survey, nearly all second trimester patients said they wished they'd had their abortions earlier. Of these women, 67 percent said it had taken a long time to arrange the procedure. But 50 percent said (in addition or instead of that answer) that they'd taken a long time to decide. A 2002 study in Northern California found a narrower gap: 63 percent of second-trimester patients cited logistical factors, while 51 percent cited emotional factors such as changing their minds or difficulty making the decision. And in a third study, conducted in England and Wales in 2005, the most common reason cited by second-trimester patients for the lateness of their abortions was that "it took me a while to make my mind up and ask for one."

The next most common reasons cited in the English study were 2) "I didn't realize I was pregnant earlier because my periods are irregular," 3) "I thought the pregnancy was much less advanced than it was," 4) "I wasn't sure what I would do if I were pregnant," 5) "I didn't realize I was pregnant earlier because I was using contraception," and 6) "I suspected I was pregnant but I didn't do anything about it until the weeks had gone by." The most commonly logistical factor—"I had to wait more than 5 days before I could get a consultation appointment"—was eighth on the list. Abortion Review, a news update service produced by the British Pregnancy Advisory Service (whose executive director, Ann Furedi, is one of the pro-choice writers I challenged in last week's article), concluded: "Perhaps the most striking finding of this study is the extent to [which] the delay in obtaining an abortion arose, not from factors within the abortion service such as lack of appointments, but from women's delay in seeking an abortion in the first place."

So here's my challenge to these pro-choice writers: I agree with you on most abortion policy questions. Contraception or abstinence is best, emergency contraception is next best, early abortion is next best, and we should make these options more accessible, not less. But we'll still be left with some women who, for no medical reason, have run out the clock, even to the point of viability. Should their abortion requests be granted anyway? I've answered your questions. Now it's your turn to answer mine.