Debating Abortion

    In 538's summary of the GOP debate, I was struck by this item:

    In his closing statement, Ben Carson said that since the debate had started, 200 abortions had been performed. That stat caught our ear. Turns out, he’s right. In 2011, according to the Guttmacher Institute, the abortion rate in the U.S. was 121 per hour, or 242 over the course of the debate.

    According to the CDC, there were 730,322 legal abortions in the U.S in 2011. That breaks down to about 83 per hour, or close to 170 for the two-hour debate.

    Hillary has caught a lot of grief for her "safe, legal, and rare" formulation. Fortunately, abortion is currently rather safe - from Guttmaccher, " a first-trimester abortion is one of the safest medical procedures, with minimal risk—less than 0.05%—of major complications that might need hospital care."

    Relatedly, "The risk of death associated with abortion increases with the length of pregnancy, from one death for every one million abortions at or before eight weeks to one per 29,000 at 16–20 weeks—and one per 11,000 at 21 weeks or later."

    Causes of delay? "Fifty-eight percent of abortion patients say they would have liked to have had their abortion earlier. Nearly 60% of women who experienced a delay in obtaining an abortion cite the time it took to make arrangements and raise money. ...Teens are more likely than older women to delay having an abortion until after 15 weeks of pregnancy, when the medical risks associated with abortion are significantly higher."

    The good news is medication abortions lower the delay to abortions - the bad news is after a dozen years or so, it's only 1/4: "early medication abortions have increased from 6% of all abortions in 2001 to 23% in 2011, even while the overall number of abortions continued to decline. Data from the CDC show abortions shifting earlier within the first trimester, likely due, in part, to the availability of medication abortion services."

    Medication abortions probably are much safer & simpler as well, as indicated by: "Medication abortion accounted for 23% of all non-hospital abortions and 36% of abortions before nine weeks’ gestation, in 2011."

    But Medication abortion services are less successful market-wise than Windows 7 (sorry, best analogy I had): "in 2011, 59% of abortion providers, or 1,023 facilities, provided one or more early medication abortions. At least 17% of providers offer only early medication abortion services."  I suppose 3/5th coverage isn't terrible, but it isn't fabulous on what should by now be a baseline.

    And the decrease in abortions is likely not due to demand: "As of January 1, 2014, at least half of the states have imposed excessive and unnecessary regulations on abortion clinics, mandated counseling designed to dissuade a woman from obtaining an abortion, required a waiting period before an abortion, required parental involvement before a minor obtains an abortion, or prohibited the use of state Medicaid funds to pay for medically necessary abortions."  Cost for medical abortion ranges from $300-800, with mean about $500.

    How are the restrictions on medicinal abortion?

    The U.S. Food and Drug Administration (FDA) approved the use of mifepristone for early nonsurgical abortion in 2000.

    Since then, states have enacted several types of restrictions targeting medication abortion.

    Many states limit provision of medication abortion to physicians, despite recommendations from the World Health Organization and the National Abortion Federation that midlevel providers, such as physician assistants and advanced practice nurses, can safely provide medication abortion.

    Several states have adopted laws that require mifepristone to be provided in accordance with the FDA-approved protocol, which is based on a regimen for mifepristone developed in Europe in the late 1980s. It has been surpassed by a newer regimen that, based on scientific studies, has been shown to be just as effective while using less medication, resulting in fewer side effects and requiring fewer visits to the provider.

    Since health care providers are legally permitted to adapt FDA-approved protocols, and many medications are prescribed “off label,” including drugs for children and cancer patients, these protocol laws interfere with accepted medical practice.

    In an effort to reach rural women, some providers began offering medication abortion services via telemedicine. However, some states require clinicians to be in the physical presence of the patient when prescribing abortion-inducing drugs. These laws therefore restrict the use of telemedicine in the case of abortion and reduce access to abortion services in rural areas.

    So let's say that if medicinal abortions could be prescribed and provided by non-physician health care providers remotely, access to and use of safe abortion would likely approach Europe's 50%. (if you think we're backwards, Canada just approved Mifepristone this year).

    What's it like? Here's a shot, not a pill, from Vice:

    My best friend, a nurse, urged me to get an abortion shot. (A what? I thought.) She swore it would be the easiest and quickest option, and told me where I could find it. She even accompanied me on the visit — though I wasn’t required to bring a second party for the procedure, which was a simple injection in the hip.

    The subsequent abortion felt mercifully easyThe subsequent abortion felt mercifully easy. It was quick and entailed almost no pain. Giddy with relief, I hugged the doctor on my follow-up visit, when successful termination was confirmed.

    A far cry from backroom abortions of the past (in the west, present elsewhere). In general, medical abortion is safer than antibiotics, much safer than pregnancy and the various complications surround than pregnancy. Chance of death less than 1 per 100,000 (<0.001%), about the same as for miscarriage. ABORTION CLINICS ARE LARGELY NOT NEEDED FOR EARLY MEDICAL ABORTIONS, up to 9 weeks because of US regs - at least 12-13 weeks in Europe (possible complications after 12-13 weeks). Some figures show 2-3% of women need further medical care up to using RU-486 in the first 11 weeks.

    So let's get on to the "rare" part - what will make abortion more rare? Better access to simpler & effective contraception (though the side-effects of long-term use of the pill should be acknowledge, vs. a medical abortion even up to 5-10 times during more sexually active ages). Will guys ever use contraceptives effectively? Fairly unlikely, and the "male pill" is still a myth.

    So should abortion be "rare"? I'm just one opinion, but as I think about the evolving facts and methods around abortion in writing this piece, I've come to not think so, though as I can't experience pregnancy, I'm sure I'm not quite clued in on all the feelings it entails.

    But if it's safe, easy, not too expensive, and is a natural solution for our need and desire to have sex, why not?

    We're talking about a socially and medically evolving situation, where many of the repercussions that were unavoidable before are no longer required. We don't have "till death do you part" marriages, we don't have saving yourself for marriage outside of strict religious circles. We also know that much of the horror and dread about both getting pregnant and getting an abortion is about the pain involved - fairly negligible in this day & age. And we know that the first weeks of pregnancy are pretty unnoticeable, and we've just established that most of the ickyness takes place within those first 9-10 weeks, and are more likely to if the medical procedure is simpler so less to contemplate. And if the abortion itself isn't a painful horrid physical and psychological mess, the negatives have largely gone away - we're pretty much talking about going to a dentist twice a year vs. running away to a monastary.

    The contentious part for some is the state of the foetus, which is without a central nervous system, e.g. non-functioning brain or feelings, so not a functioning human being by most measures through the allowed period of abortion. Short of that, our concept of "rare" is affected less by the dangers and discomfort of the past, and the fact that it's no longer such a big deal. Yes, we will likely expect our children to have some kind of control of their sexual lives, but it's also closer to "don't rut in public" and "don't pull your pud in the street" than a sin against God or a major affront to society. Abortion or unwanted pregnancy as a sign of infidelity is likely the major remaining shame, and 1) as it gets safer and simpler to deal with before discovery, and 2) since pregnancy - especially one easily not brought to term - is no longer a life-changing event unless you want it to be, even the negative connotations and the somewhat regressive attitudes of owning someone else's body will change somewhat.

    I'd expect in 20 years a somewhat evolved attitude on all this, but I wouldn't walk into a general presidential debate spouting actual facts and figures this year - I don't think intellectually and emotionally a majority are able to handle this quite yet. Any society that can have a Trump or Carson taken as seriously as they've been is pretty stunted. Leave it for the kids (irony intended). Just as the biggest danger from marijuana is police incarceration, not medical harm,the biggest danger from sex and pregnancy is now Republicans, not abortion or miscarriage. So I'll leave you with some stats.


    • Half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.[1]

    •Twenty-one percent of all pregnancies (excluding miscarriages) end in abortion.[2]

    • In 2011, 1.06 million abortions were performed, down 13% from 1.21 million in 2008. From 1973 through 2011, nearly 53 million legal abortions occurred.[2]

    • Each year, 1.7% of women aged 15–44 have an abortion [2]. Half have had at least one previous abortion.[3]

    • At least half of American women will experience an unintended pregnancy by age 45, and at 2008 abortion rates, one in 10 women will have an abortion by age 20, one in four by age 30 and three in 10 by age 45.[4,5]

    Abortion Drone carrying Mifepristone into Poland


    Interesting post. Dr. Ben Carson is fascinating. For Carson abortion, like everything he dislikes, is like Slavery. During Slavery, a slave women had no choice in having a baby. The slave owner decided if she was going to have a child. It did not matter if the child was the result of rape by the slave owner, the woman had no choice. Dr. Carson believes that abortion is like Slavery because he says it is. Dr. Carson feels that if a woman is raped today and becomes pregnant, she has no choice in the matter. The woman must give birth to the child. Dr. Carson's slave woman had no say in pregnancy. Dr. Carson wants to continue the inability of women to choose by making abortion illegal. I think Dr.Carson does not view women as anything by baby delivery devices. Dr.Carson would have instructed his slave woman to have the child resulting from the rape by her white master. Dr.Carson has the same message for women today.

    I guess it's simpler - it's all God's will - slavery, rape, pregnancy, birth, exploitation, death, and the cycle repeats. Don't know if he gets this from his particular branch of Christianity or he added his own special sauce, but the Old Testament cruelty and powerlessness and hopelessness surprisingly appeals to a lot of supposed New Testament believers.

    I think I mentioned my last trip to the south with the billboard on the highway exclaiming: "Obey God! Understanding can wait". Sure it can. Jump in the river and you'll be cleansed, the most permanent form of baptism.

    Maybe in Django II Samuel L. Jackson can play a slave plantation Dr. Carson character.

    "What you doing? Why you don't want that master's baby girl?"

    I thought that his portrayal of Stephen in Django Unchained was pretty spot on for Dr Carson.

    Yes. Mr. Jackson is frankly one of the best actors around today, outstanding acting, in so many different roles in a variety of different types of movies.

    I hear Mr. Jackson gave Ben Carson $10 to teach him how to act, which he did magnificently, teaching him Ezekiel 25:17, until Carson tried to stab him in his belt buckle and shove him in a grain pyramid until the riots had subsided. If it weren't for taking Mannatech, Samuel Jackson would've never gotten out, and Pulp Fiction would have never seen the light of day.

    When I hear Conservatives rattle off statistics like that, I immediately want to flip them around and confront them with the other meaning behind their statistics.  It's no use arguing with them about how safe and / or convenient abortion has become, since, for them, every argument about abortion, is trumped by their belief that Life begins at conception, and not at viability or at actual birth.  Arguments over abortion will always end with, "What about the Life of the baby?"  The more you show statistics to them to prove that abortions are safe, the more they retreat to their fallback position that ALL abortion is a sin since Life begins at conception.

    I want, for the sake of argument, to concede their statistic and then  ask what they propose to do with 121 babies per hour that would be born if abortion were made illegal.   That's slightly more than 2900 babies per day.  Who is going to take care of all those unwanted babies?   What social services are you going to provide for mothers of those babies? Will they be given any kind of government assistance to raise the child of their rapist?  2900 babies, every day.. Over 87,000 every month and 1,045,440 every year.   Where are you going to house all these babies?   How many more public schools will need to be built?   How do you replace all the women that are going to be forced to retire from the workforce, since with that many more babies being born, a greater percentage of women will be unable to sustain business careers and will inevitably have to stay home and raise all those babies ... etc. etc.   What are the ramifications of their intentions?  That is where, in my opinion, we might be able to make some headway.   But I think, at this point, arguing over abortion is pointless, since Conservatives will always end up retreating to their fallback position.  I think we might have greater success if we argue over the ramifications of the policies they are promoting rather than insisting they change their views on abortions.  Just a thought.

    If people believe that abortion is killing children, they won't be impressed by the "who will take care of the babies" argument for abortion..  You may as well(in their eyes) use the same query to justify killing newborn babies, since they view both the fetus and the newborn as human beings.

    Yes, I agree with you Aaron, but my thought was not to use "Who will take care of the babies" argument to try to justify abortion to the 'Right to Life' people, but rather to shift the conversation away from the rightness or wrongness of getting an abortion, to the ramifications of making abortion illegal. 

    Put them to work at Bleak House or helping Bill Sykes. If they can't steal, they'll soon learn or 'else

    More gruel please...

    So should abortion be "rare"? I'm just one opinion, but as I think about the evolving facts and methods around abortion in writing this piece, I've come to not think so, though as I can't experience pregnancy, I'm sure I'm not quite clued in on all the feelings it entails.

    It's an interesting question to think about outside of soundbites and political speak.  On one hand my take is that the frequency of abortions should be basically tied to the needs and desires of people who may be pregnant.

    It should be rare in that sex shouldn't be forced or coerced.  it should be rare in that people should have reliable and easy access to contraception. It should be rare because people should not have to go through it because they were denied the pill or denied information about birth control, of course.

    But, as you say, the science is evolving.  I can't see any cause to even make a moral distinction between somebody who takes the pill weeks before or a morning after pill, well, the morning after.

    I'm looking at it from the perspective of negative psychological and physical side-effects (and primary effects) ofnthe pill that people often don't talk about, especially for long periods of usen. Daily continual use of the pill and its major hormone changes for 10 years is probably much harder on the body than 3-4 medical abortions, maybe even 10 medical abortions. Though the sex and feeling of protection may be better with the pill. Probably other considerations.

    It's all complicated and full of trade-offs.  Humans do not just have sex for procreation, while in many ways, procreation is all nature asks us for (in terms of gene transference and species survival).  Still, I doubt we'd get very far as a species if we could not exert some control over our procreation.  Think of a strife of a world without sex without consequences!

    Beyond, "Inform people and let them choose," I don't see many other viable options for policy.

    Great piece, by the way.

    If it weren't clear, I'm assuming 99.9% of sex is *not* for procreation, and with 50% of pregnancy accidents, probably a lot of people would prefer not to "luck" into kids and instead choose the right time and conditions. Even a "practice" pregnancy aborted & then new pregnancy a few months later might give the couple or at least the woman much more time to be prepared, rather than the frequent "oh my, it's a baby - I guess we'll keep it (sigh)".

    If there weren't this heavy stigma of "you selfish bitch, you're killing a live human being (and replication of Christ!!!)" when it's not a child yet, nothing with discernible body parts or nervous system or brain or organs, then it's much easier to focus on the total picture tied in with women's health and well-being and preferences - being pro-life means setting the best conditions for bringing a child into the world and raising it once it's here, not just whelping because nature said to, and women are by-and-large the ones who carry this burden and pleasure. Even this Pope seems to grok this, pleasantly enough.

    So I guess I'm leaning towards a "yeah, medical abortion *is* a good contraception", not as ugly as standard abortion and acceptable once you work through the unneeded stigmas.

    However, since I myself have never taken the time to think through this in this kind of detail, I'd imagine not everyone would hop on the same conclusions. But it's nice that we're moving to a point in time when we don't have all this as hard choices - what a development.

    I just want to say, I love you guys.  I honestly do.  

    Thank you, PP.

    It's not exactly comparable: contraceptives vs abortion as means to determine female autonomy.

    Contraceptives come in many forms, some more effective than others, and certainly some safer over time - all choices that should be determined as best by the woman and her doctor.

    Pregnancy does, indeed, change a woman's hormones. Even in early stages, her life is affected - regardless of whether it's "noticeable" to others - both biologically and psychologically. The mental stress, the guilt, can be life changing if she ultimately decides to abort. Afterwards, it's seldom a "relief" without heartbreak. Have you spoken to a woman, personally, who told you it was? If so ... she lied.

    The most common (I think) contraceptive messes with women's hormones drastically, and typically that means over the course of years taking them - not as a 1-shot to abort pregnancy. Yes, you can choose condoms, but they're also much less reliable/more risky. IUDs have some danger of uterus puncture, not sure what else.

    Pregnancy of course changes hormones furiously over the course of 9 months (plus after, including post-partum depression for many), and medical abortions function by reversing some of those hormones, though obviously a much shorter timespan.

    The mental stress and guilt re: abortion is certainly there - how much of it is related to society's message that you've just done something very horrible, vs. a natural inner feeling, I can't say, but without coat hangers or vacuum pumps or waiting periods & state-ordered lectures on pregnancy or lines of shouters & sign-holders outside abortion clinics or presidential candidates reciting Old Testament admonitions, I think I can safely presume that the feelings of guilt, mental stress and heartbreak would be significantly less - i.e. much about that guilt is external societal pressure, not a natural feeling. What remains? you tell me.

    What remains? Perhaps everything you've tossed aside in the name of logic, science and general assumption.

    Certainly we're beyond coat hangers and vacuum pumps (though, well, Republicans), but using those examples of why women don't hurt as much is disingenuous. What women go through in a very personal way isn't caused by outside interference - that ignorance just elevates it.

    When a woman makes that kind of a decision, she's not choosing between methods of birth control. If you, or anyone else assumes so, you're not only misunderstanding the difference between prevention and dealing with reality, you're also downplaying the humanity involved.

    "What women go through in a very personal way isn't caused by outside interference - that ignorance just elevates it." - well, we're saying much the same thing, though I don't know if "ignorance" is all-apt for the outside part.

    A surgical abortion involves "a small suction tube", and this is involved in 3/4(?) of US abortions, so not "beyond" that, though the vacuums are probably a ton better and quieter from 20-30 years ago, while the other apparatus and procedure involved aren't that fun. We are beyond coat hangers in practice, though I think it's still part of the ethos and bad memories and scare around the topic. I suspect medical abortion is a game changer in that regard.

    Just as I've known women who are strippers, hang themselves from hooks, who are rather psychologically complicated and frigid about sex, some who were strict interpreters of the Bible, and more who fit possibly a perceived "standard" degree of sexual attitude and activity, I don't pretend to know what the "personal" effect of abortion is and how extensive - I knew a girl who drank heavily up to the day of her abortion and after too, didn't seem to give it a thought, and a woman who was rather upset at the prospect of her 3rd abortion with a boyfriend who was ignoring her/maybe fucking around, and a bisexual younger activist who seemed to more or less accept her 3 or 4 abortions as a natural result of being quite active. I also don't presume I knew all of their feelings just from what they told or showed me.

    I didn't say women are "choosing" between methods of birth control when they decide - the woman in the Vice article I quoted knew within 3 seconds she wasn't keeping the baby, so the method wasn't part of the decision. But the ease and comfort of the method *likely* plays a part in how traumatic the whole experience is - lying exposed in stirrups with a vacuum tube is *likely* more distressing than a pill or 2 or a shot, no? Especially if there are complications. And if someone tells me they're going through the former, my reaction is "oh you poor dear" and a shudder, while the latter is, oh, okay - kinda like B-complex supplements aside from the *personal* side which I think can vary tremendously.

    And politically, the GOP would have gotten little traction off a video of a woman taking a pill or getting a shot and going to the toilet to have her induced miscarriage. The shock and awe and slut-shaming is what they live for.


    You have synthesized this very well.  There is much in this world that is ugly.  Frankly, an abortion is not any uglier than a shoulder replacement; the latter having a much longer recovery time (I can vouch for that).

    But this whole thing about guilt and morality regarding a multi-celled, undifferentiated blob of tissue has become ridiculous.  What is wrong with us?  This is a legal medical procedure.  Do we have discussions about the "guilt" of having one's tubes tied?  Vasectomies?  Boob jobs?  

    Oh, I am getting tired.  PP:  You are doing this very well.  I will leave it up to you to finish.  

    Sorry to throw the reverse wrench in (spanner for the Brits in the room) but lobotomies used to be legal and much more common, and we evolved from that awful state. Of course an embryo evolves into a foetus up to birth, and at some point in that scale we are talking about a real human being, but one inside another human being - drowning a newborn in a gunny sack wouldn't be kosher, so then it is a question of when in that process it's not kosher, depending especially on the health of the mother (physically and psychologically ) as well as tough decisions re carrying a disabled embryo to term. I think we've found a pretty effective compromise of 13 weeks unless complications - the foetus seems capable of feelings after 28 weeks but thats not the only physical or moral issue - and from the info on why abortions are delayed, medical abortions make that 13 week deadline much easier to meet.

    Yes, my friend of 50 years had an abortion.  Prior to that she had a baby and gave him up for adoption.  Her only regret is that she didn't have two abortions.

    How dare you say that everyone who has an abortion lies if they say that it was a relief?  

    I am a loving mother to three adopted children, and I am aware of what a generous gift I was given by their birth mothers.  My twin boys just turned 26 and my daughter turned 30 last week.  I cannot say how these wonderful people have made my life better in every way.  But I will never judge women who make the choice to end a pregnancy early.  

    Maybe I should also mention that as a nurse I worked for 8 years in an Infertility Practice -- IVF and all that.  If anyone realizes the desire and need to have a child, it is someone who adopted 3, and then worked with couples who chose IVF.   The overwhelming majority of our IVF patients chose not to adopt because of wanting their own DNA, or to experience pregnancy and birth; things that I personally didn't care about, but I realize that people have different needs and expectations.  

    An early abortion is not the same as killing a child, and if it is heartbreaking, it is likely because of people giving guilt-trips that are inappropriate.


    I'm sorry if I mangled my words badly enough to give you the wrong impression, C'ville. Without going into my own or others personal history, I'll leave it that I am now and always have been strongly pro-choice.

    I sympathize with your opinion, and I think Hillary gave voice to the fact that abortion and unwanted pregnancy is often a markedly psychologically painful and twisting experience for many, and the "rare" was to signal that these weren't just running out, having irresponsible sex and then getting abortions,but in their universe they still had difficult situations to navigate so that making these tough abortion choices rarer through better contraception, fiancial supports, more responsible men, et al would be preferable. There is room for multiple attitudes and experience - that's why we talk about "choice"

    Oh, that's OK.  It is a very touchy subject.

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