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Published : 01 Jun 2019, 04:25 AM
Recent state-imposed limits on abortion — from Georgia to Missouri, from Ohio to Mississippi — are rightly seen as a broadside aimed at women's reproductive freedoms. But it is also worth examining a more particular, and potentially agonising, consequence of these new restrictions. It is a hard one to talk about. It is, to some extent, taboo. But it must be discussed.
Namely: These new laws, should they survive judicial scrutiny, would ensure that a generation of women would be forced to carry pregnancies to term despite the detection of foetal anomalies — some of them cruel, painful and fatal.
Foetal anomalies are seldom discovered before week 12. In many cases, they remain undetectable until week 20 or beyond. But Ohio, Kentucky, Mississippi and Georgia have just banned abortion beyond six weeks. Missouri has done so beyond eight. Alabama has basically banned abortion entirely.
I recognise that to those who believe abortion is a sin or a moral wrong, a life is a life. Whether a foetus is healthy or ailing is beside the point. We are all God's children, all deserving of life and love. On Tuesday, Justice Clarence Thomas suggested that pregnancy terminations on the basis of race, gender or disability "would constitutionalize the views of the 20th-century eugenics movement," though he ultimately concurred with the Supreme Court's decision not to reinstate an Indiana law banning abortions of foetuses diagnosed with disabilities.
And I'm hardly suggesting that children born with significant genetic differences can't lead meaningful lives or enrich their families' worlds. "When we love them," Andrew Solomon wrote in "Far From the Tree," his landmark book about children with identities radically different from their parents', "we achieve above all else the rapture of privileging what exists over what we have merely imagined."
But these children will have special needs, and special needs demand extra resources — both emotional and material. Only families, not states, can determine whether they are up to such a challenge; coping with an unplanned child is hard enough as it is. The women with the scantiest resources — the least money and education, the weakest ties to family and other forms of social capital — will be the most likely to have to follow through on these pregnancies, because they won't have the means to seek abortions out of state.
These are just the social and material costs. The emotional toll that some of these anomalies exact on women — on entire families — can be debilitating. Consider Trisomy 13. Fifty percent of the babies born with this chromosomal condition do not live beyond two weeks. Or anencephaly, which can sometimes be seen on a 12-week ultrasound, but almost never before. The median survival rate is 24 hours. Or infantile Tay-Sachs, in which babies have a normal early infancy and then rapidly deteriorate, experiencing seizures, paralysis and sensory loss before dying in early childhood.
"Individually these conditions are rare," said Cara Heuser, a specialist with the Society for Maternal Fetal Medicine who practices in Salt Lake City. "But taken together, I see several per month."
The patients whose pregnancies she ends in these situations — many of whom were staunchly anti-abortion before the diagnoses, she added — are notably appreciative. "For the longest time, I didn't understand why, because I hadn't fixed anything for them. I couldn't save their baby," she told me. "But then I realized that the one thing I could give them was a modicum of control. And the idea that you could take away the one thing they've got is heartless."
The new restrictions in Heuser's state are not as draconian as some of the others. Utah, like Arkansas, passed an 18-week gestational limit on abortion in March. For now, a federal judge has issued an injunction against it, while Planned Parenthood takes the case to court.
But these later gestational limits, should they stick, could have unforeseen consequences of a different kind. Lisa Harris, an obstetrician-gynaecologist in Ann Arbor, Michigan, who has written with nuance about the ethical complexities of second-trimester abortion, said she worries that 18 weeks is so close to the time many women first hear about foetal anomalies that they might decide, under pressure, to choose an abortion, rather than carry to term, because they won't have the time to consult with those who could help them decide: pastors, geneticists, specialists, extended family, parents with similar children.
"I want people to gather the people they need to make the decision," she said. "I don't want people pushed up against a deadline they may or may not be able to make."
Data support her concern. One of the most cited studies of abortion, which looked at more than 5,000 procedures in an unidentified clinic in 2008, concluded that 87% of women who chose to terminate their pregnancies had a high degree of confidence about their decision, even before counselling. But among those who didn't were pregnant women whose foetuses were found to have abnormalities. (The paper does not say explicitly why, but my suspicion is that more of those pregnancies were planned.)
Another ugly outgrowth Harris fears: These time pressures will turn physicians and counsellors into exactly the crass stereotypes their opponents have claimed them to be all along — providers of swift abortions on demand, rather than thoughtful family-planning specialists who see women through pivotal decisions.
It used to be that so many of the favoured tactics in the abortion wars were about delay: parental notification, waiting periods, dutiful marches through literature so that women could give so-called informed consent. These recent laws have been all about hurrying women up.
Neither allows women to search, contemplate and reason on their own. And they are all designed to awaken fear.
© 2019 New York Times News Service
