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Wednesday, Nov 25, 2009
Despite its prevalence in the public debate, the term "partial birth abortion" is not recognized by the American Medical Association or the American College of Obstetricians and Gynecologists. The phrase came into use shortly after Dr. Martin Haskell presented an abortion technique called intact dilation and extraction, or intact D&X, at the 1992 National Abortion Federation Risk Management Seminar.
Intact dilation and extraction is a variation on the most commonly used -- and constitutionally protected -- second trimester abortion procedure: dilation and evacuation, or D&E. (Most first trimester abortions involve dilation and curettage, or D&C, a technique that uses suction to terminate a pregnancy.) The Centers for Disease Control and Prevention (CDC) reports that dilation and evacuation procedures account for the majority of abortions performed after 12 weeks of pregnancy.
During a dilation and evacuation, the doctor terminates the pregnancy by dismembering the fetus inside the uterus or as it is extracted from the uterus into the vagina. The fetal skull, which after approximately 16 weeks of pregnancy is too large to pass through a cervix that is only partially dilated, is crushed with forceps prior to extraction from the uterus. Fetal bones begin to calcify at about 17 weeks of pregnancy, so with each dismembered fetal part comes the attached risk of injury to the woman of uterine tears or perforations by bony fragments, as well as the possibility of leaving a fetal fragment inside the uterus -- something one district court judge called a "horrible complication."
In an intact dilation and extraction, the not-yet-viable fetus is removed from the uterus as a whole, except for the fetal skull, which is collapsed via a cervical incision and suction rather than crushed with forceps. In this procedure, say those who defend it, there is no fragmentation of bone, which minimizes the risk to the woman. For this reason, say proponents, intact dilation and extraction significantly reduces the number of times that potentially damaging instruments are introduced into the uterus; it prevents certain medical complications to the woman, such as uterine perforation; reduces the likelihood of retained fetal parts in the womb, which can lead to infection; and, finally, as a shorter procedure, it allows for less bleeding and a lower risk of infection.
Antiabortion activists, infuriated by the advent of a new variation on an unforgivable act, adopted the phrase "partial birth abortion" to describe a procedure they believed amounted to murder. The term became ingrained in the public debate, and helped shift the focus of antiabortion activists from opposing women's health-and-reproductive rights to supporting fetal rights.
Meanwhile, abortion-rights advocates did some dissembling of their own. They focused on the idea that partial birth is only used to terminate severely deformed fetuses, instead of airing a concern that if the procedure is banned, women will not have the right to the safest abortion available. As the debate has raged for nearly a decade, doctors and pro-choice activists who support the legal option of abortion by intact dilation and extraction argue that, because the end result of an abortion is always the end of a pregnancy, it should be the goal of the surgeon to deliver the best possible care to the woman as he or she accomplishes that task. The debate over when life begins may never be settled, they argue, but the issue of the woman's relative health can be medically determined.
The issue of the primacy of a woman's health is crucial to the debate over bans on abortion by intact dilation and extraction. Under Roe vs. Wade, a woman may choose to terminate a pregnancy up until the point when the fetus is considered able to live outside the womb. Fetal viability, as this condition is called, generally happens around 24 weeks, but can come as late as 26 weeks or the end of the second trimester. After that point, Roe allows states to restrict abortions or even prohibit them; however, exceptions must be made to preserve the life or health of the woman.
In Doe vs. Bolton in 1973, the Supreme Court further defined health as it relates to abortion: "Medical judgment may be exercised in the light of all factors -- physical, emotional, psychological, familial, and the woman's age -- relevant to the well-being of the patient. All these factors may relate to health."
According to the Alan Guttmacher Institute, a reproductive health research group, an estimated 43 percent of women in the United States will undergo at least one abortion by the time they are 45. Intact dilation and extraction is only an option for abortions done after 16 weeks, which means it is not a common procedure. The CDC reports that 88 percent of abortions in the U.S. occur in the first 12 weeks of pregnancy; nearly 99 percent occur within the first 20 weeks; and only about 1 percent of terminations occur past 21 weeks of pregnancy. The annual total of intact dilation and extraction procedures was estimated to be approximately 650 of the 1.4 million abortions performed in 1996, the last year for which data is available.
