Later-term abortions: Stigma versus reality

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“We consider ourselves to be potential targets for domestic terrorism.”

That’s the reason one abortion provider gave for not wishing to be named when asked for comment about the situation facing later-term abortion providers in Australia.

Such concerns are well founded. In 2001, Steven Rogers, a security guard at a Melbourne abortion clinic was shot dead before a group of patients’ partners wrestled the rifle from the shooter. In 2013, a man entered a Sydney abortion clinic brandishing a wooden stake, asking the receptionist “How many babies have you aborted today?”

In the US, in 2015 a man opened fire at a Planned Parenthood clinic in Colorado Springs, killing three people and holding 24 people hostage for hours.

While doing a quick search of recent violent incidents at abortion clinics, on the very second page of results is an entry from a New Zealand-based Christian blog, titled: “Why shouldn’t we bomb abortion clinics?” It casually argues that “it’s hard to find a principled reason not to”. It’s chilling stuff.

Hostility towards later-term abortions is also rife in Australian political debate, often used as an argument against decriminalisation. Just this week, the Liberal National Party passed a resolution requiring a future LNP government in Queensland to “uphold the value of human life” and reinforce adoptions as an option for people with pregnancies at 18 weeks or later, in a move that’s reconfirmed the party’s stance against abortion.

Later-term abortions inspire a particularly intense response from groups opposed to abortion. In NSW, when Dr Mehreen Faruqi’s bill to decriminalise abortion was before Parliament, claims that the proposed reforms would result in abortions “up until birth” were bandied about by conservative columnists and religious leaders alike.

Federal LNP Senator Barry O’Sullivan warned that a bill to decriminalise abortion in Queensland would lead to “barbaric” late-term procedures. The bill was withdrawn and referred to the Queensland Law Reform Commission.

Is concern about later-term abortions valid?

In reality, abortions after 20 weeks are costly, difficult to access and sometimes subject to individual doctor’s personal ethics about upper term limits, which can be earlier than the law stipulates. Later-term procedures also tend to be more complex procedures, and require different training.

Queensland, where abortion is still in the criminal code, only has one private clinic that provides elective abortions at 18 weeks, with many people forced to travel interstate to access them past 16 weeks.

Marie Stopes’ Maroondah clinic in Victoria offers terminations for pregnancies of up to 23 weeks and 6 days, which they say is the latest the procedure can be accessed electively in Australia. Past that term limit, an abortion in Victoria requires ethics approval from two doctors. In many states the limit where ethics approval is legally required is earlier.

Tracy Little, the nurse unit manager at Maroondah, says that there is a lot of stigma surrounding later-term abortions.

“I think that when I first started working here I was probably a little bit guarded to say where I worked and what I did but I’ve changed my attitude about that,” Little says. 

“I’m very proud of what I do now that I’ve been here and see what great work we do and how we help women.”

Dr Jane Baird, a GP surgeon at Maroondah, says one myth about second trimester abortions is that they’re inherently risky procedures for women.

“Abortion is much safer than a vaginal delivery, and infinitely safer than a caesarean. “We still see women who die in childbirth in Australia. People haven’t got that possibility even in their mind.”

Late-term abortions: Rare, and not without reason

A 2013 study examining the experiences of women in the US who had abortions past 20 weeks compared with women who had earlier abortions found that women seeking later abortions were younger, more likely to be unemployed and less likely to be married.

According to the study: “Most women seeking later abortion fit at least one of five profiles: They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and nulliparous [never had a child or carried a pregnancy beyond 20 weeks].”

It’s difficult to find accurate figures around later-term abortions in Australia. One fact sheet from Women’s Health Victoria suggests that less than 1 per cent of all abortions performed in Australia occur after 20 weeks.

And data on why abortions are sought at later stages is even harder to come by.

“We get a lot of women with foetal abnormalities,” says Little. Dr Baird remembers one case of a woman from WA who had travelled to the clinic. A morphology scan had showed that the fetus had a 50 per cent chance of having severe complications. But in WA, the cut off for elective abortions is 20 weeks.

“You have to go before a panel and they decided she wasn’t able to have a termination in Western Australia.”

Little says another factor in later-term abortions is simply not being aware of pregnancy immediately.

“People wonder how people can possibly get to that late term without knowing they’re pregnant. [But] women can get to full term and not know they’re having a baby.”

The idea that people seeking abortions haven’t been using contraception is a myth, says Dr Baird: “Most of the women I meet were using contraception.”

She points out that many people assume that contraception is infallible, and don’t realise that contraception has an increased failure rate over time, as the efficacy of birth control is usually communicated as its effectiveness over the course of a single year.

As a result, “30 per cent of people on the pill will have an unintended pregnancy in five years”.

According to this interactive New York Times piece, even following permanent sterilisation methods, five in 100 people could become pregnant in 10 years.

Dr Baird also says that later-term abortions attract more criticism because while early-term fetuses can resemble a “peanut”, after 18 weeks more identifiable human features emerge.

“I think it’s easy to target second trimester abortions because it’s easy to get an ultrasound picture of a fetus that has a heart and legs and a brain. Just because it has a brain, doesn’t mean it’s all wired up.

“People don’t understand what happens over 40 weeks.”

Threshold of viability

While continuing developments in neo-natal care have vastly improved the outcome for premature babies, they have also caused debate about limits for termination.

In Australia, pregnancies between 22 and 26 weeks are regarded as being at the “threshold of viability”. According to the “perinatal care at the threshold of viability” Australian guidelines, babies born alive between 23 and 25 weeks have a 50-90 per cent chance of a “poor outcome” if intensive treatment is provided – poor outcome defined as death or “profound impairment”.

“The thing I’ve learned is that, what could be something that I could manage in my situation in my family, versus what someone else could manage in their situation in their family is very different,” says Dr Baird.

“If someone has the resources to care for this baby [born severely premature] then that’s terrific. If someone’s saying to me ‘I don’t have the resources to care for a healthy normal baby in 20 weeks time’ that’s a different argument.”

Dr Baird says she understands why people struggle with the concept of later-term abortions, but believes it’s just a question of timing. She says many of their patients are vulnerable and in difficult life situations.

“It’s really important that they can access services. And if I believe in choice I have to put my money where my mouth is.”

Despite the backlash from some sectors of the community, Dr Baird says her job is very satisfying.

“I do get a lot of hugs. People do feel tremendously grateful to access services. And that’s why I do the work – I know it makes a difference to people’s lives.”



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