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Encyclopedia > Partial birth abortion

The phrase partial-birth abortion is a controversial one used primarily by abortion opponents in the United States. While those who use the phrase say it refers to a specific type of late-term abortion, pro-choice critics of the term charge that it is ill-defined political rhetoric with no medical basis and that the definition could include even first-trimester abortions.

The term has been very recently coined. According to a Lexis Nexus search, the phrase was first seen in a major newspaper on June 4, 1995 [1] (http://mediamatters.org/items/200412130002) as the result of several events all stemming from the efforts of the pro-life Christian Coalition to begin a campaign designed to outlaw abortion. It is neither a medical nor scientific term.

This procedure is a source of considerable controversy, especially within the United States, as both pro-choice and pro-life advocates see the partial-birth abortion debate as a central battleground in the more general abortion debate. The legislation written to regulate the procedure has, to date, only sometimes included exceptions for the life of the mother, but usually not non-life-threatening health issues, and has been struck down by both state and federal courts around the United States. "Health" exceptions in abortion legislation have previously been interpreted to include "psychological health", which abortion opponents contend is so vague that it renders any attempt at prohibiting abortions toothless.

Late-term abortions in general, especially beyond the point in pregnancy where the fetus is viable, are also extremely controversial. The 1973 Supreme Court decision Roe v. Wade allows states to impose increasing restrictions on second- and third-trimester abortions. The companion ruling, Doe v. Bolton, however, required that states restrictions on late-term abortions must provide an exception for the health of the mother, and defined health to include mental as well as physical health. While some state laws allow late-term abortions (comprising approximately one percent of all abortions) in only the most dire of cases under state laws — for example, where the fetus is severely malformed and is dead or dying — many of these restrictions are constitutionally invalid. As of February, 2005, 17 states had bans on post-viability abortions that do not meet SCOTUS requirements: three states allow late-term abortions only when the mother's life is in danger, four other states allow late-term abortions only when the mothers physical (but not mental) health is in jeopardy, and 13 states ban all abortions performed after a certain point in pregnancy. Nineteen (plus the District of Columbia) allow them when necessary to preserve the woman's life, physical health, or mental health. 14 do not restrict post-viability abortions. [2] (http://www.guttmacher.org/statecenter/spibs/spib_RPA.pdf)

The late-term abortion avoids the grieving woman from having to undergo child birth or abdominal and uterine incisions of a caesarian section (c-section) when the child would not survive. Late-term abortions are a target of pro-life advocates because they believe the procedure most clearly illustrates their view as to why abortions, and especially late-term abortions, are immoral. Pro-choice advocates point out that a late-term abortion clearly cannot be an optional procedure and in practice, involves a tragic situation in which the government should not intervene to cause more suffering to the woman by requiring painful labor and delivery or abdominal surgery.

The use of the term partial-birth abortion is a central part of the debate: pro-choice advocates frequently counter that the "non-medical" phrase is only propaganda, while pro-life groups point out that "intact dilation & extraction" (IDX)(see below), was coined by two physicians just over a decade ago and claim that it appears in no peer-reviewed journals or medical texts. They also contend that the term IDX is a bland euphemism for an otherwise gruesome procedure. However, the medical procedure most likely affected is the dilation and evacuation method (called D & E, preferred by most obstetricians and gynecologists as safest and most likely to preserve the fertility of the woman for future pregnancies.

Opponents of laws attempting to prohibit partial-birth abortion point out that the central definition of such a ban is so vague that the law would have a chilling effect on physicians performing any abortion or other gynecological procedures such as D & C (dilation and curettage), used for various conditions of the uterus. Pro-life activists have argued that the ban would prevent only a few thousand abortions a year, while pro-choice activists have argued that it could be construed to ban many regularly used abortion methods and possibly all abortions even in the first trimester in which the embryo and uterine tissue are removed though the vaginal cavity.

Proponents of a ban on partial-birth abortion call the procedure immoral, saying it kills an otherwise viable baby. This claim appears inherently contradictory in view of the fact that none of the proposed bans have contained exceptions for cases in which the fetus is dying or already dead. Some opponents of the ban in the United States say that the proponents' argument is based on religious objections to the procedure and that to create legislation based on these religion objections violates that country's well-establised principle of separation of church and state.


Surgical Procedure

Since the nature and even the name of the procedure is so widely disputed, both opposing views will be listed and no editorialization or, or commentary on, the two descriptions will be provided. These descriptions represently only the point-of-view of the author and the organization which provided them.

No attempt has been made to independently verify the accuracy of either descripion. No attempt has been made to modify the strongly partisan language. They are both provided "as is".

Note that the procedures are listed in alphabetical order based on the name of the position they represent in order to assure that neither position is given precendence over the other.

(Pro-Choice Position) Planned Parenthood Description

Dilation and Evacuation
Dilation and evacuation (D&E) is performed in two steps.
The first step of a D&E involves cervical preparation (softening and dilation).
The vagina is washed with an antiseptic.
Absorbent dilators may be put into the cervix, where they remain for several hours, sometimes overnight. Misoprostol may also be used to facilitate dilation of the cervix.
During the second step of a D&E
The woman may be given medication to ease pain and/or prevent infection.
A local anesthetic is injected into or near the cervix. General anesthesia can also be used.
The dilators are removed from the cervix.
The fetus and other products of conception are removed from the uterus with surgical instruments and suction curettage. This procedure takes about 10-20 minutes.

(Pro-Life Position) National Right to Life Description

Partial-Birth Abortion
Abortionists sometimes refer to these or similar types of abortions using obscure, clinical-sounding euphemisms such as "Dilation and Extraction" (D&X), or "intact D&E" (IDE) which mask the realities of how the abortions are actually performed.
This procedure is used to abort women who are 20 to 32 weeks pregnant -- or even later into pregnancy. Guided by ultrasound, the abortionist reaches into the uterus, grabs the unborn baby’s leg with forceps, and pulls the baby into the birth canal, except for the head, which is deliberately kept just inside the womb. (At this point in a partial-birth abortion, the baby is alive.) Then the abortionist jams scissors into the back of the baby’s skull and spreads the tips of the scissors apart to enlarge the wound. After removing the scissors, a suction catheter is inserted into the skull and the baby’s brains are sucked out. The collapsed head is then removed from the uterus.

Distinction from "intact dilation and extraction"

The term is sometimes used interchangeably with the more medical sounding intact dilation and extraction (ID&X), and some claim this usage is misleading or erroneous. "Intact dilation and extraction" specifically covers a range of procedures beyond those defined by legal definitions of "partial-birth abortion." (See HR 1833 below.)

Pro-choice and pro-life groups have debated the ethical and legal aspects of the procedure since the early 1990s. Pro-choice advocates object to the misleading and vague term "partial-birth abortion," while pro-life advocates prefer it to more clinical terms.

Controversy over Life and Health

Proponents of the ban on partial-birth abortions have consistently omitted "life and health" exceptions when proposing such bans. Opponents of these laws question their constitutionality without these exceptions. During his term, President Clinton twice vetoed partial-birth bans because he felt they did not adequately address this issue. The Supreme Court likewise struck down as unconstitutional a Nebraska state law in Stenberg v. Carhart that did not include a health exception. Anti-abortion advocates were staunchly against including a health exception because they believed that under the current legal definition of "health," mental or psychological health could be included, essentially nullifying the law. They believed that they adequately addressed this in the findings section of the most recent version of the legislation (cited below), because they have included with the legislation a large amount of supporting documentation -- including a statement by the American Medical Association -- which they argue demonstrates that there is no medical situation under which this procedure could be used to preserve the physical health of the mother. However, federal courts in 2004 in San Francisco, Nebraska and New York have already rejected the Congressional findings as not being accurate.

Law in the United States

On November 5, 2003, President George W. Bush signed the Partial-Birth Abortion Ban Act (HR 760, S 3), which defined partial-birth abortions as:

. . . [A]n abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.

Note that this definition of "partial-birth abortion" is not equivalent to "intact dilation & extraction," and covers a different range of procedures. However, this definition could include even the first-trimester vacuum aspiration of embryos through the vaginal canal and the late-term "dilation and evacuation" (D & E)

The Act did not include a provision allowing for such abortions to take place when the health of the mother was endangered. This ran directly counter to Justice Sandra Day O'Connor's deciding opinion in Stenberg v. Carhart, in which the Supreme Court struck down the Nebraska law. O'Connor explicitly stated that any ban would have to include an exception should the life or health of the mother be endangered.

As a result, federal judges in San Francisco, New York and Lincoln, Nebraska tentatively blocked the implementation of the law while court cases were being argued. On June 1, 2004, Judge Phyllis Harmon struck down the law in the San Francisco case, stating that the "The act poses an undue burden on a woman's right to choose an abortion." The New York and Lincoln cases are ongoing. Whatever the outcome is, the three cases seem likely to be appealed to the Supreme Court eventually.

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