Alright, Let's Talk About Abortion
I'm tired of hearing about "rape & incest"
As an unrelated note, it is frustrating trying to write this article, looking for accurate medical information, and finding anti-abortion disinformation sites showing up in top Google results. I wrote about right-wing disinformation in a previous post.
In the weeks following the Dobbs v. Jackson Supreme Court decision that eliminated federal protections for abortions, there have been increasing references to whether or not states with anti-abortion laws have “exceptions for rape and incest”.
I do have a less substantial, quibbling annoyance with that phrase
But the deeper implication in those words is that it is more outrageous to disallow abortion in those cases than others, despite it commonly being referenced by abortion advocates. This being a talking point emphasizes the need for better understanding of what abortion is, when it happens, why it happens, and what the consequences are.
What is abortion?
Legally, before being able to discuss where abortion is now, and what it should be, we need to know where it was. Previous law in the United States was founded primarily on two Supreme Court Cases: Roe v. Wade, and Planned Parenthood v. Casey. Roe v. Wade was the case that established a constitutional right to abortion. That, however, devolved into these types of discussions on lines and what’s acceptable, leading to Planned Parenthood v. Casey, which established what constitutes the legal line for getting an abortion as fetal viability; that is, you cannot be legally prevented from getting an abortion so long as the fetus is not viable. It’s rather intuitive, as the medical removal of a fetus from the body of the mother of an non-viable fetus is an abortion, whereas for a viable fetus it’s essentially a delivery.
Medically, abortion is a collection of procedures. If early enough in the pregnancy, it can be via pills, most often mifepristone followed by misoprostal. The experience isn’t exactly pleasant, as it results in essentially a hellish period day of cramps and bleeding over several hours, sometimes days, but is less invasive than surgery.1 If a medicinal abortion isn’t an option, that leaves a surgical abortion. If it’s early enough, usually within the first trimester, it may be a vacuum aspiration, where a tube with suction device is attached the amniotic sac to remove the embryo and placenta, which may be accompanied with scraping for thoroughness.2 In the second trimester, that is more likely to be a dilation and evacuation, where the process is more similar to childbirth in which the cervix is dilated, and the fetus and placenta removed with medical instruments such as forceps.3 The final method, reserved for later-term abortions, is dilation and extraction, which is a version of dilation and evacuation where the fetus is removed in-tact while in the breech position. These constitute only 0.2% of all abortions, though these numbers are from the early 2000s when this procedure was the target of anti-abortion politicians.4
When does abortion happen?
92.7% of abortions were performed at ≤13 weeks’ gestation; a smaller number of abortions (6.2%) were performed at 14–20 weeks’ gestation, and even fewer (<1.0%) were performed at ≥21 weeks’ gestation.5 The most common timing to find out you’re pregnant is between 4 and 7 weeks. However there is a high variance as it can depend heavily on symptoms, all the way up to rare cases of women going into labour without knowing they’re pregnant.6 As a consequence, the timing of abortions can vary.
The ceasing of a pregnancy can happen without an abortion, and commonly does. 10 to 20 percent of known pregnancies end in a miscarriage, with the overall number certainly being higher as miscarriages can happen earlier than many know they’re pregnant at all.7
Why does abortion happen?
Overall, the discussion is about exceptions, but abortion itself is a case of exceptions. Every abortion scenario is a little unique, but even grouping the categories, it is very broad. The most glaring omission from simply trying to list out the atrocities of absolute anti-abortion laws are ectopic pregnancies. The result of not aborting an ectopic pregnancy can be death.8
But the hunt for the most emotionally impactful abortion story is ignoring the realities of abortion itself. This becomes most clear when evaluating the abortion boogeyman: late-term abortions. For some reason this seems to conjure images of someone who loves casual sex for some reason deciding to abort seven months into a pregnancy. The reality is that isn’t a scenario that happens. Pete Buttigieg clearly described an empathetic view of that situation back in 2020.
Let’s put ourselves in the shoes of a woman in that situation. If it’s that late in your pregnancy, that means almost by definition you’ve been expecting to carry it to term. We’re talking about women who have perhaps chosen a name. Women who have purchased a crib. Families that then get the most devastating medical news of their lifetime. Something about the health or the life of the mother that forces them to make an impossible, unthinkable choice. And the bottom line is, as horrible as that choice is, that woman, that family may seek spiritual guidance, they make seek medical guidance, but that decision’s not going to be made any better medically or morally because the government is dictating how that decision should be made.
Outside of the extremes, for what are more typical experiences for the approximately 24% of American women who will have an abortion in their lives9, there are still complications.
The most obvious complications are… complications. A 2018 study of women in the United States aged 18-44 had 16.4% of pregnancies having some form of complication, with the incidence of those complications being on the rise.10 Of course this dataset is incomplete, because not everyone who becomes pregnant is between 18 and 44; worldwide approximately 15% of all those who give birth are under the age of 18.11 Complications can include too much or too little amniotic fluid, bleeding, or the placenta disconnecting too early, among many others.12
As of 2017, for girls aged 15-19, the number one cause of death globally is complications related to pregnancy, helped along by lack of abortion access.13 The US is already among the worst for developed nations for maternal mortality rate, at approximately 17 per 100,000. This rate varies heavily by circumstance. In Louisiana, the rate is triple that of the national average. For black women in Louisiana, it’s 12 times higher.14
For those with a perfectly healthy delivery, there are still potential consequences beyond having a child to take care of. Ligaments stretching and resulting in changing breast shape. Change in pigmentation of the skin on the face. On average, women between 35 and 49 who have had a child lose 2 teeth. Bladder damage causing incontinence. About 1 in 10 Americans have diabetes; the incidence among the 1 in 10 women who develop elevated blood sugar due to pregnancy, the incidence of diabetes is 50%. Varicose veins. Hemorrhoids. All the way down changing shoe size. 15
Despite these many medical considerations, there is something insidious about the discussions around the cases of life-threatening complications, or other extreme cases such as a 10 year-old in Ohio who had to travel out-of-state for an abortion.16 These are an exercise in justifying an abortion, as if there is some bar that is required to be reached to warrant permission or forgiveness for having an abortion.
The most important, central reason abortions happen is not everyone wants to be pregnant. There are endless varieties of abortion stories. So many, in fact, there’s a book dedicated entirely to those stories.17 There is a world of reasons to not want to be pregnant, without even getting to whether someone is in the position or has a desire to raise a child. It may be an obvious statement, but love of a parent is crucial to a child’s development.18 Forcing someone to have a child they don’t want will result in resentful relationships. These stories already exist for those who had the option of an abortion.19 Here’s an example anecdote from a Reddit thread of stories,
I had my son when I was 23 years old and I can honestly say it was the worst mistake of my life. I'm not with his father anymore and while he’s a good dad and helps out as much as he can, I can’t help but feel regretful. I don’t have the typical 'motherly bond' that you see plastered all over Instagram and Facebook and this makes me feel so guilty.
However, this is predicated in part on abortion laws reducing the number of abortions. Studies appear to indicate that abortions restrictions have no negative effect on the incidence of abortion, but rather just increase the incidence of less safe abortions.20
In countries with the fewest restrictions, only 1% of abortions were the “least safe” kind from 2010 to 2014. That number jumps to 31% in the most restrictive countries, according to the report, released Tuesday by the Guttmacher Institute, a reproductive rights think tank.
During the same period, abortions happened roughly as frequently in the most restrictive countries as they did in the least restrictive: 37 versus 34 abortions each year for every 1,000 women aged 15 to 44.
The most effective means of reducing the incidence of abortion is comprehensive sex education and access to birth control. While it doesn’t address what the goals should be and what the best way to get there is, it should give pause to anyone acting in good faith in opposition to access to abortion that the groups pushing anti-abortion laws also oppose sex education and birth control. Clarence Thomas, in his concurring opinion in Dobbs v. Jackson overruling Roe v. Wade indicated he thought the court should revisit Griswold v. Connecticut, the 1965 ruling that decided laws preventing the purchase of contraceptives were unconstitutional.21
What are the consequences?
Bringing a pregnancy to term is a life-altering experience before even considering the resulting child, and bringing a pregnancy to term does not always result in a child. Abortion is a common medical procedure whether it is legal or not, that results in significant quality of life improvements for those who seek it.
Purely from a utilitarian standpoint, abortion availability leads the the most positive outcomes without affecting the incidence of abortion, even if the premise were granted that there was something undesirable about the procedure. Abortion access increases the likelihood women who become pregnant during college actually graduate by 20%. Of those who give birth to children, 43% leave their jobs. Studies already indicated before Dobbs that elimination of abortion restrictions that already existed would increase women’s earnings on average by $1600 per year.
Ultimately whether it is by an urgent medical necessity of an ectopic pregnancy, an economic pressure of not being able to support a child, or simply a desire to not have a child at the present time, or alternatively ever, it comes down to different motivations to the same end: not wanting to be pregnant. Litigating these stories is an exercise in judging whether their reasons are good enough for someone not involved. Litigation that tells those who carry the 1 in 4 pregnancies that end in abortions that their lives and bodies should be or have been forever altered at the whim of their moral prescription.
Mona Eltahawy, in a longer article writing about her own past abortions that is worth reading, recently summarized it clearly,22
I wanted simply to say, I was not raped. I was not sick. The pregnancies did not threaten my life. I did not already have children. I just did not want to be pregnant. I did not want to have a child. My abortions were not traumatic – rather the silence around them was traumatic. I am glad I had my abortions. They gave me the freedom to live the life I have chosen.
Advocates for women want to talk about rape and incest because they think that makes it easy. Anti-abortion, forced-birth advocates want to talk as if a fetus is a fully grown and delivered child with no impact on the mother because they think that makes it easy. The world is complicated. Healthcare is complicated. And trying to legislate healthcare for simplicity’s sake will only serve to make everyone worse off. It’s that simple.
Planned Parenthood. (2022). Plannedparenthood.org. https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-does-the-abortion-pill-work
Cowett, A. A., & Lichtenberg, E. S. (2007). Pregnancy Loss and Termination. General Gynecology, 225–256. https://doi.org/10.1016/b978-032303247-6.10010-3
Dilation and Evacuation (D&E). (2022). Michigan.gov. https://www.michigan.gov/mdhhs/adult-child-serv/informedconsent/michigans-informed-consent-for-abortion-law/procedures/dilation-and-evacuation-de
Rovner, J. (2006, February 21). “Partial-Birth Abortion”: Separating Fact From Spin. NPR.org. https://www.npr.org/2006/02/21/5168163/partial-birth-abortion-separating-fact-from-spin
CDCs Abortion Surveillance System FAQs. (2022). https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
Goad, K. (2016, July 19). Can You Be Pregnant and Not Know It? WebMD; WebMD. https://www.webmd.com/baby/features/can-you-be-pregnant-not-know-it
Miscarriage - Symptoms and causes. (2021). Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298
North, A. (2019, September 11). Ectopic pregnancy: the latest frontier in the abortion debate. Vox; Vox. https://www.vox.com/2019/9/11/20859034/ectopic-pregnancy-abortion-federalist-intrauterine-ohio-surgery
Abortion Is a Common Experience for U.S. Women, Despite Dramatic Declines in Rates. (2017, October 18). Guttmacher Institute. https://www.guttmacher.org/news-release/2017/abortion-common-experience-us-women-despite-dramatic-declines-rates
Trends in Pregnancy and Childbirth Complications in the U.S. (2020). Bcbs.com. https://www.bcbs.com/the-health-of-america/reports/trends-in-pregnancy-and-childbirth-complications-in-the-us
Early childbearing and teenage pregnancy rates by country - UNICEF DATA. (2022, January 27). UNICEF DATA. https://data.unicef.org/topic/child-health/adolescent-health/
Complications of Pregnancy. (2019, November 19). Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/complications-of-pregnancy
Davis, N. (2017, May 16). Pregnancy problems are leading global killer of females aged 15 to 19. The Guardian; The Guardian. https://www.theguardian.com/global-development/2017/may/16/pregnancy-problems-are-leading-global-killer-of-females-aged-15-to-19
Why Louisiana’s maternal mortality rates are so high. (2022, May 19). POLITICO. https://www.politico.com/news/2022/05/19/why-louisianas-maternal-mortality-rates-are-so-high-00033832
What permanent post-pregnancy body changes to expect. (2019, December 11). Legacy Community Health. https://www.legacycommunityhealth.org/newsblog-what-permanent-post-pregnancy-body-changes-to-expect/
Gabbatt, A. (2022, July 14). Man charged with rape of 10-year-old who had abortion after rightwing media called story “not true.” The Guardian; The Guardian. https://www.theguardian.com/us-news/2022/jul/14/man-charged-10-year-old-abortion-rightwing-media-indiana-ohio
You’re the Only One I’ve Told: The Stories Behind Abortion: Shah, Meera: 9781641603638: Amazon.com: Books. (2022). Amazon.com. https://www.amazon.com/Youre-Only-One-Ive-Told/dp/1641603631
First Five Nebraska. (2016, May 5). Study: A mother’s love is good for child’s brain development. First Five Nebraska. https://www.firstfivenebraska.org/blog/mothers-love-good-for-childs-brain/
Zhou, M. (2022, June 28). Meet The Parents That Wish They Were Child-Free. Refinery29.com; Refinery29. https://www.refinery29.com/en-gb/regretful-parents-reddit
Nedelman, M. (2018, March 21). Abortion restrictions don’t lower rates, report says. CNN; CNN. https://www.cnn.com/2018/03/21/health/abortion-restriction-laws/index.html
Kornfield, M., Bella, T., & Wang, A. B. (2022, June 24). Biden, other critics fear Thomas’s “extreme” position on contraception. Washington Post; The Washington Post. https://www.washingtonpost.com/politics/2022/06/24/contraception-supreme-court-clarence-thomas-griswold/
Eltahawy, M. (2022, July 14). Essay: On Abortion--It’s Time To End The Silence, Secrecy And Shame. Feministgiant.com; FEMINIST GIANT. https://www.feministgiant.com/p/essay-on-abortion-its-time-to-end