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The Need for Later Abortions

by Jill Doctoroff
Director, Elizabeth Bagshaw Women's Clinic, Vancouver

June 18, 2009

In the words of a wise, kind, and compassionate man: “Abortion is not a cerebral or a reproductive issue.  Abortion is a matter of the heart, for until one understands the heart of a woman, nothing else about abortion makes any sense at all,” Dr. George Tiller.

We often hear discussions about abortion but not as much, until the tragic murder of Dr. Tiller on May 31st, about later abortion. 

While 89% of abortions occur in the first trimester (Guttmacher, 2004) and 99% by the mid-second trimester, the need for later abortions and access to them is essential.  Later abortions are usually the ones that occur after the 21st week of pregnancy.  The story of later abortions isn’t one story but many: the stories of women, and women and their families.  Most of these stories involve wanted pregnancies that have either gone horribly wrong or the circumstances around them have gone in a different, unanticipated direction.  The stories of later abortions involve fetal anomalies that are incompatible with life, fetal anomalies that would result in a quality of life that would be so unbearable I couldn’t imagine it for myself, let alone for babies or infants. These stories include states of denial which help a girl survive sexual abuse at the hands of a family member only to confront an unwanted pregnancy and a later abortion. Theses stories involve threats to maternal health like cancer and the associated treatments.  But most of all the stories of later abortions are the unique, individual stories of women. 

These are often women we don’t know and have a hard time imagining as real or someone we could know.  As a result, many people don’t know much about later abortions.  While we all know women who have had abortions, even if we don’t know who they are, few of us know someone who has experienced a later abortion.  For this reason, it is easy to have a knee jerk reaction to later abortions, mainly due to the misinformation that has been spread about these procedures and the reasons that surround them.  Anti-choice, anti-abortion groups have been successful at framing the discussion about later abortions.  They talk about women deciding to abort on a whim, for frivolous reasons like vacation plans or to fit into a dress.  These are sound bites that have an impact on public opinion.  They enter our subconscious and help to form our opinions and judgments. This is able to happen because we don’t know much about later abortions; they aren’t part of most of our daily lives.  Because we don’t understand the complexity involved we feel better able to be judgmental, to translate our beliefs that babies are precious to later abortions equaling those precious babies.  We don’t want to think about all the things that can go horribly wrong with a pregnancy, with our circumstances, with our health.

We don’t want to think about the young woman from the interior of BC who faced obstacle after obstacle—no sex education in her school, parents who are uncomfortable and unwilling to talk about sex and contraception, a boyfriend who doesn’t like to use condoms, a doctor who tells her that abortion is murder and won’t tell her about available abortion services, a nearby clinic with a five week wait, trouble trying to come up with the money needed to travel to Vancouver for an ultrasound and then utter fear and despair when she finds out that she is too far along in her pregnancy to be cared for in British Columbia.  This is one story of a later abortion.

We don’t know about the Burnaby couple who are happy and ready to start their family but find out their prenatal genetic screen is positive.  They then have to book an appointment for diagnostic testing and wait 2-3 weeks for the test results.  Sadly these results indicate the fetus has trisomy 18.  All these tests plus appointments with physicians and genetic counsellors result in a later abortion for this woman and her wanted pregnancy.

We don’t know about people like my sister and her husband who, after trying to conceive for two years, got lucky on their first try with in-vitro fertilization only to have her “water break” at 17 weeks.  After weeks of almost no amniotic fluid, which is required for lung development, the prognosis for my sister’s pregnancy was dire.  While in the end she decided to continue her pregnancy, which resulted in a premature baby boy dying on the day he was born due to under-developed lungs, she needed the option of and access to a later abortion in order to make a fully informed choice.

However, the success of the anti-choice in framing this issue runs deep.  When I told my sister about this tribute and asked if I could share her story, she asked me why as she wasn’t considering having an abortion but rather a “termination”.  Her situation was different because this was not what she wanted, she wanted a healthy pregnancy.  I started telling her the stories of women who had or considered having later abortions.  Women like the young woman from the interior of BC and the woman from Burnaby.  As I told her their stories my own pro-choice sister started to understand and learn the stories of later abortion.

It is thanks to the courage, dedication and competence of providers like Dr. George Tiller that women have access to later abortions. One positive thing that has been happening in the weeks since his murder is that people are starting to talk and women are telling their stories. 

People talking about the real stories surrounding later abortions helps, but it needs to come with access to later abortion care services.  Unfortunately, access to abortion, and especially later abortion, remains an unnecessary barrier in Canada.  In the past we have relied on the compassion and skill provided at the Women’s Health Care Services in Wichita, Kansas.  With the murder of Dr. Tiller, that clinic is closed.  Now that we are talking and know a little more about later abortions, we need to ask: Can’t we provide better comprehensive reproductive care, which includes abortion care, to women?  I think we can.

I would like to leave you with the response to later abortions that makes the most sense to me and happens to be Dr. Tiller’s motto: “Trust women.”  Thank you.