In routine prenatal care, for those women privileged enough to receive prenatal care, there is typically a screening ultrasound done at around 18-20 weeks to check for serious birth defects. Earlier than that time it is possible to do tests to check for genetic defects, but not structural abnormalities. That means that wanted, planned pregnancies that go horrifically wrong are frequently discovered exactly at the point when anti-abortion bills would cutoff access to abortion. Here are some examples of what that might look like.
The first image is of an anencephalic baby, meaning "no brain". The baby is born without the cerebrum, and will never be conscious. But it may have enough of a functioning brainstem to live for a short period of time. Half will be still born, and the rest usually die hours or days after birth from infection in the exposed brain. But sometimes they may live for a few weeks, even months. The second image is of a cyclops defect. These are one extreme in a spectrum of birth defects called neural tube defects, that includes spina bifida. At the mild end of the spectrum are minor defects in the bones of the spine that cause no disability at all.
Here are some pictures of parasitic twins. They start out as two separate embryos. Along the way, one twin is partially absorbed by the other.
Horrible birth defects are more common than we would like to think, causing about 20% of the deaths
in the first month of life. Others lead to a painful life of disability and medical procedures. A loving parent could reasonably decide that the best thing to do for such a child is to terminate a pregnancy. But here is the problem as it relates to 20 week abortion bans - they may not be immediately fatal.
That means that even if the abortion ban has some sort of exception for severe fetal anomalies, it is still going to be open to interpretation in individual cases. And doctor's will err on the side of limiting patient options if their own license is on the line, or if they are under threat of criminal penalties.
Something similar happens with "life of the mother" exceptions. The only way to be absolutely sure that a woman will die of a complication of pregnancy unless she gets an abortion, is to actually let her die. That is basically what happened to Savita Halappanavar, the Indian dentist who died in Ireland. There was a 20 year old Supreme Court ruling in Ireland that said abortion had to be allowed to save the life of the mother. But until this month, there was no law on the books actually allowing for that. Rather than take a chance, the doctors taking care of her waited until the fetal heart beat stopped before emptying her infected uterus. By then it was too late. In El Salvadore, which has some of the most severe criminal penalties against abortion on the planet, the New York Times reported the same thing happening in cases of tubal pregnancies - doctors waiting until the heart beat stopped to intervene, even though it meant risking the mother's life.
What if there were no restrictions on abortion at all? Would we have irresponsible harlots dawdling until the eighth month and then rushing to abortion clinics for trivial reasons? Actually, no. Canada has had no legal restrictions on abortion since the Morgentaler supreme court decision in 1988. It is treated by the government as a health issue. What is the situation there?
Over 90% of abortions in Canada are done in the first trimester, only 2-3% are done after 16 weeks, and no doctor performs abortions past 20 or 21 weeks except for compelling health or genetic reasons. The risk of maternal mortality is probably greater in carrying a pregnancy to term (7.06 per 100 000 live births) than the risk associated with abortion (0.56 per 100 000 terminations) (Grimes D. Am J Obstet Gynecol 2006; 194: 92-94).
I think that what most people believe is that zygotes, embryos, and fetuses have more moral value as they become more developed, and that the reasons for terminating their existence should be stronger. That was the reasoning behind the trimester division in Roe v. Wade. And that is generally how things will work out if politicians stay out of it.
Women and their partners and their doctors are not going to come up with the same decisions when facing problem pregnancies. They may not make the same choices you or I would. People do not come up with the exact same course of action about any medical issue. But on balance, they will come up with better decisions, and more reasonable decisions, if politicians are not trying to define "reasonable" for them.
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