Pro Life-Choice

To all whom it may concern,


I want to begin this letter as forthcoming as I can be, providing you with a label for the stance I am to take throughout; since packaging seems to be more important these days than what’s inside the box, as if we all forgot the old adage, “don’t judge a book by its’ cover”, but alas we don’t read books any more do we? We read from our computer screens more often than not, a true travesty, but as to not distract from my purpose in this opening, you can call this the Pro Life-Choice perspective. As I believe strongly in the preservation of what we hold most dear, “Life, Liberty, and the Pursuit of Happiness.” That last part, apparently, originally to do with property ownership, for having ownership of nothing is indeed a place where one cannot pursue happiness… but again, I digress. Within this Pro Life-Choice movement, of my own making, I will discuss what is trending in ways of other federal governments around the world, U.S. statistics for abortion over the last three decades, and access to health care. In conclusion I will provide you with my suggestions as to how we might move forward together on this ever more controversial issue; accommodating our need to preserve and protect human life, as well as ensuring a quality of life for both mothers and their children.

Before diving into these topics I would like to address the fact that abortion is not a new practice coming out of some age of enlightenment. Abortion has been practiced throughout history by diverse groups of peoples to ensure the safety of both mother and child, but also community. In a paper called Psychiatric aspects of induced abortion it states “approximately one third of the women in the United States have an abortion during their lives.” So neither is it rare among women, but it is also, according to an article published January 29th of 2011 in The Lancet called Abortion in the USA, one of the most frequently practiced surgical procedures done in the United states. Now there are reasons we want to ensure protections for a fetus and in my opinion it is fair to have limits prior to viability except in those extenuating circumstances such as rape, incest, mother’s health, ect., but “evidence indicates that the legal status of abortion has little influence on abortion levels” and is instead, “associated with the safety of the procedure.” (Legal Abortion Worldwide in 2008: Levels and Recent Trends) Thus, it is my opinion that, since this is a liberty as women at least a third of us hold to be an inalienable right, we must provide the accommodation of safety.


World Trends:

Many of us should be familiar with the recent decision by the Supreme Court of Mexico acknowledging this right of “safe, legal and free abortion services” (Center for Reproductive Rights), but what you may have missed, because I certainly did, was that the limits on abortions were still to be determined by the states. So basically Mexico looks a lot like we do right now, except that where it was illegal, most places outside of Mexico City, they are now liberalizing to accommodate the federal ruling. This does not mean there have been gestational limits set by the Supreme Court, only that states must allow a period of time for the woman to act before it would be deemed illegal for them, or someone assisting them, to perform the act.

What stood out most to me initially poking around on the world interactive map at reproductiverights.org was that even Russia has legalized abortion up until 12 weeks and upon further reading indicates “Artificial termination of pregnancy for social reasons shall be carried out at a gestation period of up to twenty-two weeks, and in the presence of medical indication, regardless of the gestational age.” Now granted, the Russian Federation determines these ‘social reasons’ and ‘medical indications’, but considering our lack of current protections I find this incredibly progressive.

Hopping over to China we again see no limits on gestational periods, but instead limits on what circumstances a mother may terminate their pregnancy. And yes I understand I am being argumentative, selecting these two countries to discuss first, but is it not who we like to compare ourselves to first when discussing social progress?

Heading down to South Africa we see a 12 week gestational limit, “Recognising that the State has the responsibility to provide reproductive health to all, and also to provide safe conditions under which the right of choice can be exercised without fear or harm…and promotes reproductive rights and extends freedom of choice by affording every woman the right to choose whether to have an early, safe and legal termination of pregnancy according to her individual beliefs.” They discuss exceptions for weeks 13-20 such as physical and mental health of the mother, risk of health to the child, rape and incest, as well as the “significant affect the social or economic circumstances [may be for that] woman”.

In India we also see permission given in cases of rape and fetal diagnosis. The most recent amendment ensures the right to terminate up to but not exceeding 20 weeks without consent from additional medical practitioners and then only up to 24 weeks.

Portugal has a 10 week limit. Finland, Ireland, Mozambique, Norway, & Ukraine have a 12 week limit. Argentina, Germany, Romania, & Spain have a 14 week limit. France has a 16 week limit. Sweden has an 18 week limit. Columbia has a 24 week limit.
Tunisia and Italy have 90 days or three month limits.

Reading over Abortion and Abortion Care Guidelines from the World Health Organization 12 weeks seems to be the suggested limit with some exceptions and offers arguments for not denying women who present after 20 weeks depending on their circumstances.

So unless we are trying to live up the standards set by Iraq, Iran, Afghanistan, Egypt, Nicaragua, or Madagascar where it is strictly prohibited or only permitted in the case of saving the mother’s life, it certainly appears to me that we need something on the federal level that provides women the right to choose, early and safe terminations of pregnancy.


U.S Statistics:

The National Library of Medicine has various analyses on abortion taking place over the last three decades under a common name Abortion Surveillance, often indicated by ‘United States’ and the year of analysis. This data began to be collected by the CDC in the late 1960s. The information collected varies by year, or rather the grouping of that data adjusts over time, but what we know is that since the late 80s a majority of abortions given in the United States occur by the 13th week up to plus 6 days. And by 2007 that percentage had risen from ~85% to over 91%, most recently in 2021 reaching 93.5% of abortions taking place by week 13. There is data to suggest that as our methods of abortion have moved from surgical to non-surgical, more women have been able to terminate within 6-9 weeks gestation and that most of the women who do attempt to obtain an abortion later in their pregnancy are younger than 25. In another article found on NLM called Abortion surveillance at CDC: creating public health light out of political heat it is again reiterated that, “Today, more is known about the epidemiology of abortion than any other operation in the history of medicine.” Meaning we know a lot about abortion. The risks, the related issues, and the methodology.

Today it is most common for a woman seeking an abortion in the first 6 to 8 weeks to receive a pill to induce the termination of a pregnancy. Mifepristone has been in the news lately, but there is also misoprostol, and these can be used together. Mifepristone was approved by the FDA in 2000 with the intent to make abortion services more available to women earlier in their pregnancy. Mifepristone can only be obtained through a licensed physician in the United States. Trends in use of medical abortion in the United States: reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001-2008 supports the efficacy of the use of non-surgical abortion in that “existing data suggests that the number of abortions provided in physician’s offices and small-caseload facilities decreased from 2005-2008”. “It was [also] anticipated that the use of telemedicine and the provision of early medical abortion by advanced practice clinicians would increase the availability of abortion services in remote areas with relatively few physicians and surgical facilities.” So, the intent here was to put the power in the hands of the people and lessen the caseload on local medical staff to have to perform invasive surgeries of which they may or may not be opposed.

There is an article found at Clinical Obstetrics and Gynecology called Abortion Care Beyond 13 Weeks’ Gestation: A Global Perspective that explains it is abortions occurring later in gestation that account for higher rates of death and disease. That it is the already more disadvantaged who can not easily obtain early care that are most adversely affected. Additionally, I would like to address the concern of people using abortion as a form of contraception. In an article called Subsequent Unintended Pregnancy Among US Women Who Receive or are Denied a Wanted Abortion it reports there is no evidence to support that if a woman has an abortion or seeks an abortion that it will increase the probability they will find themselves with future unintended pregnancies.

What we want is the right to care for our health as we see appropriate, in line with our personal beliefs, our goals, and our present circumstances. We do not want to end the life of an unborn child, we want to ensure the quality of our own lives as well as that of our potential children.


Access to Health Care:

Let me pick up again at access to healthcare. Over the last 20 years there has been an attempt to limit the reliance on facilities and healthcare workers by increasing access to ‘self-managed’ abortion. “People who self-manage abortions with medication may get drugs from pharmacies, drug sellers or through online services or other outlets. They can receive information on how to end a pregnancy with pills and what to expect through the process from friends, family, and community groups, hotlines, pharmacists and medicine sellers, or the internet. For some people abortion outside the formal health setting may be preferable to in-clinic abortion, particularly for groups who face systematic discrimination and lack accessible and acceptable formal health care.” (Policy surveillance for global analysis of national abortion laws) The CDC has collected statistics regarding legally induced abortion death rates, as well as gestational limits, and I averaged 7.3 deaths occurring annually since 1984. Now, every life matters and as stated previously most deaths and disease occur in later term abortions, so this is not to say we accept 7.3 deaths a year, but that we can help improve these statistics by continuing to provide early access to abortion services.

We also discussed earlier that only a licensed physician can prescribe mifepristone in the United States. Which may or may not be putting an undue burden on doctors as facilities in certain states have had to close due to restrictions leading up to and since the overturning of Roe vs Wade. If midlevel providers, pharmacists or lay health workers are unable to assist women with the most common operation occurring in medical practice today, while doctors are “regulated by the penal code” prohibiting or restricting abortion after an ever diminishing time frame of gestation it does seem to me a recipe for increased health safety concerns for both mother and child knowing that the later someone receives abortion assistance they are more likely to be affected adversely even in the best hands of our healthcare workers. It appears to me that, the more restrictions you place on our access to early care the higher risk of burden you place on the health and well being of your patients. There is a study called Abortion Incidence and Service Availability in the United States, 2014 which “estimated that as many as 100,000 women aged 18-49 residing in Texas had ever attempted to end a pregnancy on their own, and a media analysis found that interest in self-induced abortion - as measured via Google searches - was higher in states with restrictive abortion laws than in states without them.” That to me is a very uncomfortable number.

In this same study they discuss four types of facilities providing abortion services: hospitals, abortion clinics, physicians’ offices, and non-specialized clinics.

“Abortion clinics are defined as non-hospital facilities in which half or more of patient visits are for abortion services, regardless of annual abortion caseload.”

“Physicians’ offices are defined as facilities that provide fewer than 400 abortions per year and have names suggesting that they are private practices.”

“Non-specialized clinics are non-hospital sites in which fewer than half of patient visits are for abortion services.”

“Physicians’ offices that provide 400 or more abortions per year were categorized as non-specialized clinics; because of their relatively large caseload, we assume that their service provision more closely mirrors that of a non-specialized clinic.”

During the year in scope, 2014, abortion clinics accounted for 59% of all abortions while non-specialized clinics accounted for another 31%. This indicates to me that, the number of medical workers who may encounter circumstances in which they are opposed to providing such services as abortion assistance, but in the situation to, would be diminished exponentially if only these types of clinics were still available to the public for use. Creating obstacles for those seeking abortion assistance at designated abortion clinics appears to me to also be shifting responsibility to hospital facilities who may have a greater number of healthcare workers who hold beliefs that may negatively affect the outcome of the healthcare being sought and thus provided. Let me mention this final statistic from the same study, “Twelve percent of non-hospital facilities reported treating at least one patient who had attempted to end her pregnancy on her own...” and “The proportion of facilities that had treated such patients was higher in the South and the Midwest (21% and 16% respectively) than in the West (10%) and the Northeast (8%).”

According to Abortion in the USA it can cost somewhere between $400 to $600 dollars for an abortion procedure. When you add that to any additional travel expenses to reach a facility that may help and then estimate the time it may take any individual to obtain such funds working minimum wage and having their regular everyday expenses for food housing and transportation, let alone finding the time off said minimum wage job, I can start to see how it may become increasingly difficult to meet a 6 week maximum restriction especially if you don’t realize you’re pregnant until week 3 or 4.

The World Health Organization outlines the “core components of the right to health” as being Availability, Accessibility, Acceptability, and Quality. Removing access to a facility that “[appreciates] the validity and worth of [a] different value [system] and [in accordance] to each person…” not only appears to violate a standard based on common sense, but also the very oath to which doctors are expected to hold themselves. The conflicts of interest here continue to concern me a great deal.


Conclusion:

I promised I would provide you suggestions on how we might move forward together. I believe that Pro-Choice advocates too find life to be invaluable as do our Pro-Life advocates. Where I see we are struggling to come together is in the imposition of how we achieve our goals. There is not merely one way to express the value of human life and our forefathers knew that we could not impose our religious beliefs upon each other without falling short of our ideal of liberty. Therefore, we must accept alternative choices to our own even when we do not agree, as long as they do not infringe upon our own liberties. Providing access to abortion clinics whose primary role is to accommodate those who seek to responsibility terminate an unintended pregnancy, or one which may lead to health or exceptional economic burdens, seems appropriate. Additionally, so to, not only encourage early detection and termination within 6-9 weeks, but to ensure the safety of the termination for both the mother and fetus, make mifepristone and misoprostol available to those who need it without undue obstacles. And finally, let us protect those who did not have a choice to begin with. People do not chose to be raped, trafficked, survivors of incest; most people do not choose to be poor without there being other mental health factors at play. It is our job to protect them. To ensure their quality of life after the fact when preventative measures have failed.

Let us agree to disagree, but let us agree on access to liberty, let us agree on ensuring safety for both mother and child by making available safe clinics, methods, and personnel to provide such services as are in demand by at least a third of women in the United States at some point in their lives; and let us uplift the quality of life for those most disadvantaged.