One of the most pressing moral problems of our day is abortion. It is the second most common surgical procedure in the U.S., circumcision being the first. Since the historic Roe v. Wade decision on January 22, 1973, in the United States abortions have risen from about 775,000 in 1973 to about 1.6 million annually. Statistics in the U.S. from 1983 through 1988 suggest that about 30 percent of the pregnancies of married women were unintended. Of those that were unintended, about 30 percent were unwanted, while the other 70 percent were mistimed (i.e., they were wanted, but wanted at another time). U.S. figures that include both married and unmarried women suggest that one of every two pregnancies is unintended. Of those that are unintended, one out of every two is aborted. This means that in the U.S. approximately one in every four pregnancies ends in an abortion.
Who is having these abortions? Statistics here are also interesting. In 1987, for example, it was estimated that the largest group of women having abortions were in the twenty- to twenty-four-year-old group (33.1 percent of U.S. abortions), while the second largest group ranged from twenty-five to twenty-nine years of age (22.3 percent of U.S. abortions). Moreover, the largest portion of abortions (63.3 percent) were among those never married, while only 18.5 percent of abortions involved married women. Twice as many white women were responsible for abortions (67 percent of all abortions) as nonwhites (33 percent of all abortions). Income seemed not to be a major factor, as 33 percent of abortions were obtained by women whose family income was less than $11,000, 34 percent by those in the $11,000 to $24,999 range, and 33 percent in the group making $25,000 or over.
Worldwide abortion is rather prevalent and is quite frequently seen as an appropriate method of birth control. In Red China—approximately one out of every four persons in the world today lives in China—the government felt that population control was a necessity. As a result, in 1979 it introduced a policy that no family is allowed to have more than one child. This policy has led to infanticide (usually of female babies) and massive numbers of abortions. Abortions can range as high as 800,000 a year in a single province of China. Those who refuse face significant pressures to comply one way or another, as the government can impose severe financial penalties for failure to comply. In other parts of the world, especially developing countries, women are having a significant number of abortions as well. It is estimated that about thirty million to forty-five million women in those countries have abortions annually, and about 125,000 to 250,000 of them die from botched procedures.
Though many countries in the world seem relatively comfortable with the numbers of abortions that occur, the abortion debate in the U.S. is one of the most divisive issues confronting the country. Hence, we believe that before turning to the argumentation surrounding this issue, it would be helpful to sketch major developments in the U.S. with respect to abortion.
Prior to 1973, there were abortions in the U.S., but the Roe decision in essence legalized abortion on demand. That decision struck down existing laws against abortion, but did agree that the government still has a legitimate interest in protecting fetal life. Still, the way the decision was written and interpreted essentially abrogated any governmental ability to stop abortion.
The Justices divided pregnancy into three trimesters (a trimester is approximately thirteen weeks). They ruled that within the first trimester, abortion was a decision between the woman and her doctor alone. The state cannot intervene. During the second and third trimesters, the Court said abortion could be reasonably regulated by the states and even prohibited once the child reached viability (the ability to exist outside the mother’s womb). However, the right to prohibit abortion could be overturned in order to save the woman’s life or simply to protect her health. Moreover, Doe v. Bolton defined the health of the mother in the broadest terms to include psychological, emotional, and familial factors. In essence, so long as a doctor certifies that an abortion is necessary to protect the mother’s “health,” abortion is thoroughly legal well into the ninth month of pregnancy. Still, it is estimated that 90 percent of abortions in the U.S. are performed much earlier than the twentieth week, and only about 2 percent after the fetus is viable.
In the years after the Roe decision, anti-abortion groups have organized and mobilized in an attempt somehow to overturn or at least restrict Roe. At one point there was talk of a right-to-life amendment to the Constitution, but that seemed like an unlikely avenue for success since such an amendment would have to pass both houses of Congress and be ratified by the states. A better hope seemed to rest in the judiciary. Various members of the Supreme Court were coming to retirement, and with the election of Ronald Reagan there was hope that the texture of the Court could be changed so as ultimately to overturn Roe. Reagan, and Bush after him, have used appointments to the Supreme Court to change the direction of that Court. So far, however, gains for the pro-life side have been somewhat slim.
What pro-life forces hoped would be a major breakthrough came on July 3, 1989 with the Supreme Court’s ruling in the Webster v. Reproductive Health Services case. This case, which involved Missouri’s abortion laws, did not overturn Roe, but it gave states more leverage to rewrite their statutes so as to restrict abortions. The ruling upheld three basic points of Missouri law. It agreed that Missouri’s public hospitals and public employees could not perform abortions except in a case where it was necessary to save a mother’s life. In addition, the ruling refused public funds for abortion counseling and made it illegal for public officials to encourage a woman to have an abortion unnecessary to save her life. Finally, and most significant, in cases where women have been pregnant for twenty weeks or more, it is now mandatory that doctors perform tests to determine if the fetus can exist outside the womb. If the fetus can survive, the doctor cannot carry out the abortion.
While the decision in Webster restricted abortion rights in Missouri, it also sent the message that individual states could go back and rewrite their laws concerning the handling of abortion. At the time of the Webster decision, there were some 140 anti-abortion bills before state legislatures nationwide.Previously, states might pass anti-abortion legislation and the governor sign it, but there was little concern about negative political fallout from pro-choice groups, because it was assumed the law would be appealed to the Supreme Court and struck down. Now the political implications of voting for these bills has changed, because an anti-abortion law passed in a given state might not only be upheld by the Supreme Court; it might serve as the occasion for the Court to overturn Roe altogether.
After the Webster decision, pro-life forces were very optimistic about the prospects of restricting abortion rights. Unfortunately, that optimism has not been matched with much change. One of the few victories came on May 23, 1991 when the Supreme Court upheld federal rules that prohibit family planning centers which receive government funds from counseling women about abortion or telling them where they can get one. The controversy surrounds Title X of the Public Health Services Act of 1970. That act provides $140 million annually to family planning clinics. The law bars federal funding of abortions as a method of family planning, but until the Reagan Administration in 1988 drafted more restrictions, such clinics could inform women about abortion and refer them to clinics that performed abortions. The restrictions, known as the “gag rule,” were challenged as a breach of the First Amendment, but the Court ruled to uphold the restrictions. Since this decision, Congress has passed legislation to overturn the gag rule, but President Bush vetoed the bill, and Congress was unable to muster enough votes to override the veto. Restrictions eased slightly, allowing doctors but no one else at these clinics to discuss abortion with patients. Many clinics responded to the gag rule by simply refusing federal funds in order to continue counseling women about abortion. Of course, now the issue seems to be dead, since President Clinton threw out the “gag rule.”
These events are discouraging, especially in light of the number of lives of unborn babies who are at stake. Pro-choice advocates have found renewed hope of keeping abortion rights intact with the election of a pro-choice U. S. President. Pro-life forces are reorganizing, but are less hopeful than before that the demise of Roe will come soon.
A Definition of Abortion
While most know the term “abortion,” few realize the variety of uses it has. Abortions can be divided into those that are spontaneous and those that are induced. Spontaneous abortions are not usually thought of as abortions. What characterizes this class of abortions is that there is no outside or external intervention. There are two basic kinds of spontaneous abortions. On the one hand, there are a surprisingly high number of cases where an egg is fertilized by sperm, but never implants in the woman’s womb. Instead, it simply passes out of her body in her monthly period. J. N. D. Anderson in Issues of Life and Death says it is estimated that 30 percent, and perhaps as many as 50 percent, of the eggs fertilized are lost before they implant in the mother’s womb. Second, there are miscarriages. In this case a developing fetus is expelled from the mother’s body before the baby is able to live outside the womb. Anderson thinks that as high as 30 percent of the fertilized and implanted eggs may miscarry.
Induced abortions are commonly what we think of when we hear people talk about abortions. This class of abortions is characterized by outside or external intervention into the reproductive process with a view to terminating pregnancy. There are several kinds of induced abortions. Therapeutic abortions are performed to save the mother’s life. Because of the present state of medicine, such abortions are rare. Ectopic or tubal pregnancies are examples. In this kind of pregnancy the fertilized egg does not implant in the uterus but in the fallopian tube. Only two options are open to the doctor. Either he intervenes to take the baby’s life in order to save the mother’s life, or both baby and mother die. Another potential cause of therapeutic abortion is maternal heart disease. At one time women with heart disease were at risk in full-term pregnancies. However, that is almost never the case today. The most common candidates for therapeutic abortions are pregnant women with cancer (especially uterine cancer). If treatment of the cancer requires either radiation or chemotherapy, that will likely kill the baby. Hence, it must be decided whether to delay treatment until the birth of the baby, or begin it immediately and risk losing the child.
Eugenic abortions are a second category of induced abortions. They are performed to abort a fetus that has or is at risk for some physical and/or mental handicap such as Down’s syndrome. The most typical method of determining such problems is a procedure called amniocentesis.Amniocentesis cannot be performed until around the fourth month of pregnancy, since it requires the development of the placental sac and its fluid. A needle is inserted into the sac, and fluid is removed and examined to determine any abnormalities. Amniocentesis is very good at determining problems such as Down’s, but it has two limitations. There is a very small group of diseases that it can detect, and it cannot be performed until relatively late in the pregnancy. However, as other techniques for detecting problems are developed for the first trimester, eugenic abortions will probably increase, particularly since some doctors pressure parents to abort a child where there is the slightest risk of any handicap. For instance, some diseases are gender specific. Sickle-cell anemia is a disease only males get. So, if a family is at risk and the baby is a male, there will be great pressure to abort this child on eugenic grounds.
Finally, elective abortions complete the category of induced abortions. Here the mother’s life is not threatened, and there is no known risk of physical and/or mental handicap for the child. The reason for abortion is simply the convenience of the parents (e.g., control of family size, physical and/or mental strain on the parents, or financial hardship on the family). Moreover, as it becomes easier to choose the sex of a child, families can choose a gender specific child and abort those of the “wrong” sex.
Techniques of Abortion
Several different methods are used in performing abortions. One is dilation and curettage (D & C). This is one of the two preferred methods for aborting a fetus during the first trimester of pregnancy. The mother’s cervix is dilated, and the surgeon inserts an instrument to scrape the wall of the uterus, cutting the baby’s body to pieces and removing the placenta from its place in the uterine wall.
Suction21 is the other preferred method of abortion during the first trimester of pregnancy. According to some estimates, it is used in 80 percent of these abortions. It is often used in conjunction with D & C. The cervix is dilated, and a suction tube is inserted into the womb. The suction tears both the baby and his or her placenta from the uterus, sucking them into a jar. The force of the suction is twenty-eight times stronger than a normal vacuum cleaner. With both methods mentioned so far, it is possible to identify human arms, hands and legs.
Saline injection is the most commonly practiced method of abortion during the second trimester. Neither D & C nor suction can be practiced during the second trimester because of the danger of hemorrhaging. By the fourth month of pregnancy the water bag or placenta has developed. A long needle is inserted through the mother’s abdomen into this sac surrounding the baby, and some of the fluid is removed and replaced with a solution of concentrated salt. The baby breathes in and swallows the salt, and is poisoned by it. Often the outer layer of skin is burned off. With saline injection there are osmotic pressure changes in the fetus, causing brain hemorrhages. It takes about an hour for the solution to slowly kill the baby. About a day later the mother goes into labor and delivers a dead, shriveled baby.
Hysterotomy is the technique that must be practiced in the final trimester of pregnancy, because the baby is simply too large to use the other methods. In light of the Roe decision, it is legal in the U.S. to have an abortion into the ninth month of pregnancy. Hysterotomy is typically the technique used, and medically it is exactly the same procedure as a cesarean section. However, a C-section is done to save the life of the child; a hysterotomy is done to take it. Though the aborted fetus is alive, he or she is allowed to die of neglect or through some deliberate action. In a case where the latter was done, a Boston jury found the doctor guilty of manslaughter. However, with the Supreme Court decision Planned Parenthood v. Danforth, July 1, 1976, physicians have been given the right to do whatever they want with the fetus!
A final method of abortion is prostaglandin. It may be used at any stage of pregnancy. The drug prostaglandin is taken in some form, and it induces labor. The result may be the delivery of a live infant who is allowed to die, or prostaglandin may be used in conjunction with a saline solution to assure the birth of a dead fetus.
Not infrequently we hear that abortion is a simple, painless medical procedure. But painless for whom? The mother? Not necessarily. Abortion is not always as safe and painless as we are led to believe, even when the abortion is legally performed by a doctor. One must be careful in using maternal complications statistics, since medical techniques have improved dramatically in all health care. Furthermore, it is difficult to get exact figures because even these will be influenced by one’s point of view on abortion. Also, medical complications vary widely based on age, social class and the number of previous pregnancies.
Despite these notes of caution, we can offer specifics. For example, there are cases of maternal deaths from legal abortions ranging from 1.2 to 75 per 100,000 abortions. There are, however, much more common complications. The most immediate problems are infection and bleeding. Bleeding is related to the difficulty in getting the cervix to dilate in the first pregnancies of young girls. Thus, in the very cases where abortion may appear to have the strongest argument, likelihood of injury is greatest. The long term complications are equally as problematic. If an infection is severe enough, it may result in infertility. Even a legal abortion may hinder a woman’s ability to carry a child in future pregnancies. The most difficult damage to assess is the psychological damage to the mother and the father. Both parents of an aborted fetus often experience severe depression over what has been done.
What about the baby? Does the fetus feel pain? The best way to answer is to set forth the particulars of the physiology of a developing baby and then compare those data with what has been said about the different abortion techniques and the stages of pregnancy when they are used. This is a matter of no small import, since some claim that abortion is not cruel to the baby since it feels no pain.
Feinberg & Huxley, A. Ethics for a Brave new world , Wheaton,: Crossway Books.