Late term abortion is often the sticking point, even for people who consider themselves pro-choice. Some people think that it's only reasonable to limit abortion beyond the point of viability, and on the surface maybe that even seems fair. After all, if the fetus is viable, why not simply give birth to it and put it up for adoption?
I think we need to take this question out of the neat, simple context of the abstract and move it into the messy, complicated and nuanced world of real life. First of all, why on earth would a woman even want a late term abortion? Why would she put herself through a procedure which is costly, difficult to obtain, psychologically traumatic, possibly damaging to her fertility, and certainly not accepted by society?
Don't believe that late term abortion is all those things?
Tiffany Reed, president of the DC Abortion Fund, was interviewed in 2009 after the shooting of Dr. George Tiller. "The cost of an abortion, which Reed says is about $400 to $500 before the 12th week of a pregnancy, increases about $100 a week or more thereafter. 'Women are not waiting because they want to; a lot of times they are chasing the cost,' she said."
So, some women are financially forced to wait longer for their abortions than they would have liked because of money. We could virtually eliminate this aspect of the problem by making private insurance and Medicaid programs pick up the bill for abortions, but the anti-choice lobby has made certain that that's a thing of the past!
An abortion after 14 weeks is no longer a dilation and curettage (D&C,) but is now a dilation and evacuation (D&E.) By design, a D&E is more physically traumatic for the same reasons a second trimester miscarriage is more physically traumatic than a first trimester one: the fetus is bigger. Because of this, the cervix must be dilated and often vacuum aspiration alone is not enough. While still considered generally safe as a whole, the D&E is a more involved procedure with higher risks of complications, including risks to the woman's future fertility.
Late term abortion is psychologically traumatic for the same reasons it's not socially acceptable. It's highly unlikely a woman will make it so far into her pregnancy that her abortion would be considered late term without showing or letting her friends and family know in some way that she is pregnant. There is a well-understood social stigma against abortion of any kind, which is why although about one in three women will have an abortion in their lifetime, hardly anyone talks about it. It's a taboo subject. And late term abortion is even more so. A woman needing such an abortion is no longer able to have the abortion in secret. Now she will either have to tell her friends and family she aborted, or lie to them and tell them she miscarried naturally. Certainly the latter will be her more likely story, but that, too, carries baggage. Now her loved ones will try to "mourn" with her, not truly understanding the situation.
Again, why would she want to do this?
As I stated before, some are waiting to afford the procedure. Some did not know they were pregnant or that their pregnancy was so advanced. This situation is common in women with severe substance abuse issues because they often have amenorrhea, or no period, and therefore they miss the first, most obvious sign that a pregnancy has begun. Do we really want to force women who have been continually exposing a fetus to substances such as meth, heroin, or excessive alcohol to carry a pregnancy to term? I know I don't.
How about the women who find out later in their pregnancies that their much-wanted baby has a severe deformity or disability that will limit their life or quality of life? It's awful that these women have to face the scorn and hatred of the anti-choice movement because they have chosen not to continue a pregnancy that will either result in a stillbirth, a baby who will live only a few days/weeks/months/years in pain, or a child with a severe disability that requires constant care. I have personally chosen to be a parent, but choosing parenthood does not mean signing up for feeding tubes, diapers into adulthood or changing colostomy bags, dealing with a child who will never mentally become an adult, and medical bills that will prevent you from ever having a meaningful retirement. Parents who raise a special-needs child are admirable, strong people indeed. But actively choosing not to raise a special needs child is neither weak nor cowardly. It's a hard, but realistic decision that most parents, in fact 92% who know they are going to have a child with Down's syndrome, make.
Keep in mind that the discovery of these disorders and malformations often happen later in the pregnancy. Spina bifida, and other nueral tube defects, tend to be found later in the pregnancy, often into the second trimester. Our medical testing is getting better, and we are moving to find out about problems with the fetus earlier and earlier in pregnancy, but we still cannot detect all problems before the 14th week, thereby meaning that we need to keep late term abortion legal and protected for these poor women.
The worst case scenario, and the one which breaks my heart the most, is the one in which continuing a particular pregnancy means that the woman's life and/or future fertility will be endangered, and she therefore must choose to abort to save her life or her reproductive future. These situations are rare, but they come up. Women who thought they could trust their doctors to save them are instead met with anti-choice red tape that makes an already terrible situation MUCH worse. These pregnancies are often wanted pregnancies, and sometimes the fetus is malformed or disabled. I often hear the argument that the woman's life is always top priority in these situations, and so, of course, she'll be saved at this point. I wish it were that simple. First of all, she needs to find a doctor who will do it. Those are exceedingly scarce now, and, if she's rushed into the emergency room, she's not likely to find someone who will do what needs to be done there. Precious time is lost in locating a doctor to perform a late term abortion, while a woman's life is on the line! And further, there are NO provisions anywhere that make exceptions for preserving a woman's future fertility, as well as her life. I other words, if she loses her uterus, but lives, the anti-choice movement sees no reason why an abortion intervention was necessary.
I propose that every emergency room in America needs a doctor, on staff or on call, willing to perform emergency late term abortions, at all times. Every ER needs one. Otherwise we are not truly working toward saving women's lives. We are just serving an anti-choice agenda that does see abortion as a possible life-saving intervention.
These blanket-statement laws that just say, "Nothing after 20 weeks, except to save the mother's life," do not cover the complexities and rarities of real life. They keep women from being safe. Moreover, I trust doctors, not lawmakers, to decide how late is too late for a woman to abort. The doctor will be honest with the woman about her odds of complications, and from there it should be her choice, no one else's. After all, we have no idea what her individual situation is, and she, not we, has to live with the consequences.