Marcy Bloom, Executive Director of Aradia Women's HealthCenter, has testified to the Washington State Legislature and hasspoken extensively to the media on the issue of the D&X abortionprocedure and why it must remain a medical option.
The recent controversy regarding the dilation nand extraction(D&X) abortion procedure (incorrectly named "partial birth"abortion by abortion opponents) prompts me to share my thoughts andexperiences after 27 years in the world of abortion provision. AradiaWomen's Health Center has been providing health care services towomen from all over the Northwest since 1972. Women come to us frommany different places for safe abortion care. With over one millionwomen annually in the U.S. alone choosing abortion, the stigma ofabortion remains. We want the public, the media, and electedofficials to understand the truth about abortion, why women haveabortions (whether in the tenth, twentieth, or thirtieth week ofpregnancy) and why different abortion procedures may be needed.
The truth about D&X abortion is as follows: when deemednecessary by an attending physician concerned ultimately with thelife and health of the woman, this procedure can be used anytime fromthe twentieth week of pregnancy on. At that point in pregnancy thefetus is not viablethat is, not able to live independentlyoutside of the woman's body. Viability is usually believed to beginanywhere from 24 to 28 weeks of pregnancy. Very few premature infantsborn at 24 weeks of pregnancy actually survive. A survival rate of50% or more is achieved only in live births at 27 weeks or more ofpregnancy.
Women can choose to have abortions before viability for anyreason. This is not the same thing as saying that women chooseabortions at this or any other point in the pregnancy for reasonsthat are frivolous or trivial. For the most part women are havingabortions at this time due to: compelling life circ*mstances that mayhave changed since earlier in the pregnancy; fear of violence orharassment at clinics; inability to afford the abortion; arrangingtravel to a clinic or provider (close to 85% of U.S. counties do nothave an abortion provider); the development of a life-threateninghealth condition (such as kidney disease or cancer); informationabout fetal abnormalities that is not available until the secondtrimester; and denial and fear about the pregnancy, particularly (butnot exclusively) in the case of teenagers. In the third trimester(after viability), virtually all of these pregnancies were initiallywanted, and women have abortions at this time because of devastatinglife and health effects on either the woman or the fetus, or both. Inthe third trimester, most often the fetus would ultimately die in theuterus because of severe malformations, or very shortly after birthif the pregnancy goes full-term.
It is important for the public to understand that the practice ofmedicine is not always exactly the same with all health careproviders. As a physician performs the best abortion techniqueavailable to him/her, the critical considerations should ALWAYS be:the training and skill of that particular doctor, his or her comfortlevel with a specific abortion procedure, the safest procedure forthe particular woman at that particular time, the medical facilityavailable, and what instruments/tools/emergency back-up proceduresare accessible. The goal of any abortion procedure--irrespective ofthe length of pregnancy--is to empty the woman's uterus quickly andsafely to reduce the potential risk for infection, heavy bleeding,cervical lacerations, and trauma to the uterus. Indeed, the primaryconcern of any medical procedure, including abortion, is to keep thewoman alive and healthy.
We at Aradia Women's Health Center certainly understand thatdilation and extraction abortion can be a difficult and disturbingprocedure for some to comprehend, whether it occurs pre-viability inthe second trimester of pregnancy, or post-viability in the thirdtrimester. The information that we have from the WashingtonDepartment of Health is that three third trimester abortions occurredin Washington state in 1995, as well as 591 second trimesterabortions, and that none of these (out of a total of approximately25,000 abortions performed) were D&X procedures. But for us, theissue is not, and never has been about the numbers. The real issueis: Will women be able to receive the best, most medicallyappropriate care, when faced with the decision to have an abortion?
Opponents of abortion who are sponsoring both the state andfederal bills against the D&X abortion have consistently usedinflammatory, inaccurate descriptions of D&X and have attemptedto sensationalize the campaign against its use by calling it"infanticide" and showing healthy, fully-formed third trimesterfetuses in cartoon propaganda. They have attempted to confuse thetruth about the REAL issues: WHY, WHEN, and HOW do women haveabortions? These dangerous bills will not change the reasons womenhave abortions, or when in pregnancy women make this decision. Whatthey will do is reduce the availability of much-needed medical carefor those women who need it.
The physician and the woman facing this decision must be the onesto weigh the risks and alternatives to D&X based on herindividual health background. They are the only ones qualified to doso. Blood loss to the woman having a D&X procedure is four timesless than blood loss with a normal vagin*l delivery and 16 times lessthan with a Cesarean section (which is major abdominal surgery). Thematernal death rates associated with D&X are nine times less thanthe maternal death rates of Cesarean sections. This is why D&Xmust remain an option.
If there is a fetal anomaly, genetic specialists can bestdetermine the nature of the abnormality if the fetus is intact, andthis is considered to be one of the medical advantages of D&X. Aspart of the grieving and closure process, a woman can hold the intactfetus after this procedure. These must remain medical decisions, notbecome political ones.
Opponents of abortion want to ultimately outlaw all abortions, atany time, for any reason, regardless of the procedure. There iscertainly more than one medical technique for abortion procedures,and we have always stated that there are medical alternatives to theD&X abortion (such as labor induction methods, or a hysterectomy,which is similar to a C-section). The woman and her doctor are theones who must decide which of these procedures is the safest and mostappropriate for her.
We must bring the debate about the D&X abortion back to thehealth and the lives of women. We at Aradia Women's Health Centerunderstand that all abortion procedures may seem "horrifying" and"brutal" to some, and we respect that opinion even as we disagreewith it. But does being disturbed by a procedure mean that it shouldbe banned? We say "NO."
Moreover, if a medical procedure can preserve a woman's life,health, and fertility, we must speak out to preserve itsavailability. The true "brutality" and "horror" in our society occurswhen women are denied access to the best, safest, and mostcompassionate health care that they deserve.
