Abortion is Always an Option

I don't actually identify myself as "pro-choice," though those who identify as "pro-life" don't want me, and the various issues around abortion seem to have been defined with only two sides. I find the "pro-choice" label (and probably "pro-life" as well, for that matter) redundant because, since the first time a woman made a causal connection between something she did or had done to her and her miscarriage, every pregnant woman in the history of the world has made the choice, at least once a day on something like 280 days, to continue or terminate her pregnancy.

All legislation can do about it is limit the choices a woman has in how to carry out the choice she makes: Can she go to a qualified medical provider and get skilled care and advice before, during, and after? How far does she have to travel? How much money does she have to come up with? How much must she risk her own life and health? Does she need anyone else's permission or participation? And what's funny is that almost all of these questions confront women who decide to continue, as well as those who want to terminate.

Some of the choices are made along a spectrum from unconsciousness to willful ignorance. For instance, one of my social groupings consists mostly of Roman Catholic grandmothers. They speak vociferously against abortion. But even they have been known to ask each other "when," not "if" their daughters will be having amniocentesis. (This contradicts the only recent study I came across, in which only a little more than a tenth of the women offered amnio accepted it, though they were all in the age range, over 35, for which it's recommended.) No one discusses what one does with the results of amniocentesis (abort a fetus with any of the serious genetic defects amnio is designed to diagnose) or that no one should undergo amnio unless they're prepared for even a healthy fetus to miscarry (that is, "spontaneously abort," as the doctors say).

As reported by WebMD, the 2006 study noted above overturned initial studies of amniocentesis in the 1970s (and still reported on another WebMD page), which found that as many as one in 200 amnios resulted in miscarriage. The 2006 study found only a statistically insignificantly higher rate of miscarriage, extrapolated to one in 1600, among 3200 women who underwent amnio. Among the headlines that announced these findings were statements that doctors' experience with the procedure and improved techniques were to be credited with this lower risk. It could also be that amnio is now performed only rarely before the 16th week of pregnancy, when there's more room for collecting amniotic fluid containing fetal cells. But amnio is a test of the second trimester, after the time for most abortions. In fact sometimes a post-amnio miscarriage is late enough to be considered "pre-term labor" and stillbirth.

An alternative to amnio, and one that can be performed as much as a month earlier, is chorionic villus sampling. But it still carries an accepted risk of miscarriage in one of every hundred tests. And as far as I can determine, neither the Stupak amendment adopted by the House of Representatives, the Nelson amendment rejected by the Senate, nor the federal laws in place since 1976 have ever restricted funding of amniocentesis or chorionic villus sampling. The tests are generally covered by private health insurance, but unavailable, like most of what is considered quality prenatal care, to uninsured women. If the Stupak restriction prevails in the final health bill that President Obama will sign, will women receiving federal subsidies to buy health insurance be able to buy coverage for these tests, however small or large the risk of accidental termination? Oh, and by the way, amniocentesis and chorionic villus sampling both require "culturing," or growing fetal cells in the lab, multiplying them, just as for in vitro fertilization, to have enough to examine their genetic maps.

I'm not saying that anyone opts for prenatal testing in the hope that it will trigger a miscarriage. But if coverage for such risky tests becomes easier to get than coverage for abortion (according to the Guttmacher Institute, in 2002 covered by 87 percent of private insurance plans), they could join the list of painful choices a woman faces with an unplanned pregnancy. That's almost half of American pregnancies, in Guttmacher's highly trusted statistics, 40 percent among White women, 69 percent among Blacks, and 54 percent among Hispanics. Even less surprising than the racial breakdown is the finding that poor women are four times as likely to have unintended pregnancies - and abortions - than are rich women. Still, the number of abortions per thousand women aged 15-44 has been declining since 1980 and by 2005 was back down to about where it had been at legalization in 1973. About 60 percent of abortions are obtained by women who already have one or more children, but a third of all the women having abortions are in their early 20s; only 17 percent are teenagers, and half are older than 25.

This is what's the crime to me: our societal failure to make abortion unnecessary. Going back to Guttmacher statistics, they found that "Family planning clinics funded under Title X of the federal Public Health Service Act have helped women prevent 20 million unintended pregnancies [over] 20 years. An estimated nine million of these pregnancies would have ended in abortion." Spread that number even wider, across the 32 years of statistics, and you still get more than 280,000 additional abortions every year. OK, only about a ten-percent increase over the peak years in 1980 and 81, but it's 280,000 women who didn't have to tear their hearts out every year. There's actually a bill, apparently languishing in Congressional committees now, known as the "Prevention First Act" (S 21, HR 463), that would strengthen Title X and other steps toward making abortion rarer.

Those who think they can legislate abortion away are not heartless, or at least not impractical. Even the Stupak amendment includes the familiar exceptions for rape, incest, and danger to the life of the woman, as required by Supreme Court rulings against several attempted state bans. But at least those bans were straightforward. It seems to me that any exception proves the weakness of an argument that abortion is murder. The plain fact is that pregnancy is a unique condition of mammalian life, and in human life, it's unique as well in its social, emotional, and spiritual dimensions. We can't, as a society, treat some pregnancies differently than we do others, just because we are more embarrassed by the circumstances under which the pregnancies with more choices were begun. Every unintended pregnancy is an equal tragedy and its own unique wrench of the longings of a woman, though some come with additional tragedies and forms of violence. Instituting a partial abortion ban through complexities of insurance coverage will only add to the choices faced by the unintentionally pregnant; they will need to figure out whether they can make a case for having been raped.

Finally, I object to federal regulation of abortion (other than in the ways it regulates all medical care) because I've never heard an argument against allowing women who want professional care in this situation to get it that doesn't fall back on religious argument, particularly the question of ensoulment. This makes pregnancy a legally unique circumstance, defined by a moment that is legally and medically unknowable. Medically (as anyone watching a commercial for "Plan B" can figure out), it isn't defined as a pregnancy until the fertilized egg has implanted, usually after traveling all the way down a fallopian tube to the uterus. When it implants in the tube, it either becomes one of those life-of-the-woman exceptions, or loses its own viability. But I don't know of anything in U.S. law, except perhaps by reading back from abortion restrictions, like a definition of when pregnancy begins.

In fact, most women don't know when they've become pregnant by either the relevant religious or the medical definition. In both of my experiences, I had my suspicions, but had to wait some time for confirmation by specific symptoms, and in one case by a medical test that got there before I started barfing. WebMD (citing the March of Dimes) says "as many as 50% of all pregnancies end in miscarriage - most often before a woman ... even knows she is pregnant. About 15% of recognized pregnancies will end in a miscarriage." The medical term, again, is "spontaneous abortion." And there's no way at all to tell how many of what some religious pronouncements consider conceptions never achieve the medical definition of pregnancy or the chance to produce any detectable symptom. Do these unimplanted products of conception have souls? Even if they do, we have no way to know. But if we believe that the same products, given the chance to implant and multiply for a few weeks, had souls at the same early stage, shouldn't we mourn as well for the unrecognized children discarded by their mothers' ignorant bodies?

I do believe in the soul, and I believe I know how it begins. But it depends, first and foremost, on the woman in whose body a pregnancy may be established. It is not a matter that can be known to either civil or canon law, or measured by the most sensitive medical instruments. It can begin before the fertilization of egg by sperm, and it may take weeks, or months, or in the saddest cases, of pregnant women deprived of the choice to be a mother or not, it may never happen. Then it becomes a tragedy of the child as well, and may be much more costly to society.

I believe that relationship is what makes me human and ignites my soul. I believe my children's souls were born when I began to think of them as my children, when I began to think of myself as their mother, when yearning turned to possibility, or when medical symptoms were transformed into a future we would share. My children's ensoulment was supported with choices that trended toward continued relationships, and my own soul warmed through prenatal procedures and practical preparations, and through letting other family members and friends into the relationship. Both of those children are hovering around age 30 now, and our flames flare and sometimes sputter. I only pray that they, and the partners with whom they have joined their souls by choice, will have life-affirming, soul-kindling choices available to them and never have to face the imposition of more difficult choices by legislators who have no idea who my children are.

Sources:

"Pregnancy Loss Rates After Midtrimester Amniocentesis," Obstetrics and Gynecology November 2006 (108:5); cited at http://www.webmd.com/baby/news/20061101/amniocentesis-risk-overrated; older statistics are cited at http://www.webmd.com/baby/guide/amniocentesis).

New England Journal of Medicine 1989; http://content.nejm.org/cgi/content/abstract/320/10/609

Adam Sonfield et al., "U.S. Insurance Coverage of Contraceptives and the Impact of Contraceptive Coverage Mandates, 2002," Perspectives on Sexual and Reproductive Health (Guttmacher Institute) 36:2, pp. 72-79; pdf downloaded from http://www.guttmacher.org/pubs/psrh/full/3607204.pdf

http://www.guttmacher.org/pubs/fb_induced_abortion.html#1

Read about HR 463/S21 and other related issues at http://capwiz.com/aauw/issues/alert/?alertid=14329551 and http://www.aauw.org/advocacy/issue_advocacy/actionpages/reprorights.cfm

http://www.webmd.com/infertility-and-reproduction/guide/pregnancy-miscarriage