Creating Space and Support for All Women Who Have Abortions

By Lydia Stuckey

Because of my work at the Reproductive Health Technologies Project (RHTP), I am often the one people turn to during happy hour or other social events when they want to talk about hot issues related to abortion and reproductive health -- I’m sure others who work in the pro-choice movement can relate. Recently, abortion has risen to the forefront of conversations again, in part due to the extensive media coverage of the murder of abortion provider Dr. George Tiller by an anti-choice extremist. That tragic event and the ensuing public discussion generated debates and dialogue about abortion itself and the women who seek abortions. It also, I hope, has created an opportunity for people to reconsider how they feel about abortions that occur after the first trimester — such as those Dr. Tiller performed.

After Dr. Tiller’s murder in May, one of the most frequent public discussions addressed one specific segment of the women he had served as a provider — women who decided to terminate a wanted pregnancy after learning about a fetal illness or other severe anomaly that threatened the woman’s health or that of the fetus. These stories, told by women, men, bloggers, and columnists, were often agonizing and heart-breaking. They described personal experiences with abortion late in the second and into the third trimester that were deeply moving and generated genuine sympathy. The response to these stories often resonated above the usual political hostility that exists on issues of choice. In fact, the outpouring of support and understanding for these women and their families was something that I have rarely seen, regardless of the issue.

Missing from the recent commentary, and from most discussions about choice, were the stories of women who seek an abortion after the first trimester for other reasons -- who are not experiencing a tragic health risk. There is a dearth of accounts about these women’s experiences in the media, although the stories are often incredibly compelling. These women deserve support and empathy too, although they often receive just the opposite from politicians, the media, and society in general. For example, one friend with whom I was talking about this issue passed judgment by saying, “Well, it’s their fault that they waited so long.” “That’s not necessarily true,” was my response.

The vast majority of U.S. abortions (89%) occur in the first 12 weeks of pregnancy, while just 11% occur after then.¹  While I believe that the small percentage of abortions that occur after the first trimester can cause legitimate and complex moral dilemmas for even the most ardent pro-choice supporters, we cannot ignore the women who have these abortions. It does these women a disservice to only discuss their experiences in private, or to demonize them in public. We should not leave these women unsupported and their voices excluded from conversations about reproductive health and choice. We should challenge ourselves to understand the realities of a woman who chooses to end her pregnancy instead of just debating: “How late is too late?” (I’m not saying it is a bad subject to debate, I just don’t think all of the public conversation should center on this.)

The Centers for Disease Control and Prevention’s (CDC) yearly abortion data from the early 1980s onward indicate that the proportion of abortion procedures performed after the first trimester has stayed relatively stable. What causes are behind these abortions that occur after the first trimester? The answer is fairly complex. Of course, before a woman can decide how to handle an unexpected pregnancy, she has to know she’s pregnant. One study found that young women under age 18 took longer than older women to acknowledge their pregnancy symptoms and take a pregnancy test to confirm their condition.¹  Delays in confirming a pregnancy can also be associated with obesity, abuse of drugs or alcohol, and fear of abortion.² 

Once a pregnancy is confirmed, women need time to consider the best course of action for their lives. In a 2004 study of women seeking second-trimester procedures, 50 percent of those interviewed said that a major reason they delayed the abortion was that “it took a long time to decide.” More specifically, the women who struggled with the decision cited cost, religious, and/or moral concerns.³  The same study also found that some of the pregnancies had been wanted originally, but the woman’s life circumstances had changed to the degree that she eventually decided that abortion was her best option.

Studies also highlight that some women originally sought abortion services in the first trimester, but faced barriers and challenges that pushed the timing of their procedure back. These impediments may include a lack of available transportation to the clinic, problems arranging child care, having received misinformation from a crisis pregnancy center, intimate partner violence, and the need to gather funds to pay for the procedure.

Women also face barriers that are specific to later abortion services. After the first trimester, abortions cost more; this can put women (particularly low-income women) into a vicious cycle of having to raise an increasing amount of money the longer their procedure is delayed due to lack of funds. And, fewer providers perform second trimester abortions than first trimester procedures, making it hard for women to schedule an appointment, much less travel what are often significant distances to reach the provider.

Public policy options can help address many of the factors that delay access to first trimester abortion and increase the procedure’s costs. Enhanced availability of effective family planning services can help all women prevent unwanted pregnancies in the first place. Improved sexual health education can aid young women in forging healthy relationships; sharpen their ability to make smart decisions regarding sex, communicate about birth control with their partners when they become sexually active, and help them understand their reproductive system -- including the signs of pregnancy.

Repealing Federal prohibitions against public funding for abortion services could prevent women who rely on public insurance from having to raise money for the procedure. The Federal funding bans affect low-income WOMEN who are covered by public insurance as well as women who work for the Federal government, serve in the military, use Indian Health Services, or are incarcerated. This one change could go a long way in helping women get the procedures they need as soon as they need them.

So where does this leave us? In a perfect world we wouldn’t have to explain all the many reasons women have later abortions, but the unfortunate reality stands that more often than not, anti-choice activists are the only ones publically telling these stories and are doing so by painting sensationalized pictures of both second and third trimester abortions and the women who have them. While it can be less morally ambiguous, and frankly less difficult, to focus on fetal anomaly and tragedy when talking about later abortions, the discussion can’t stop there. In my opinion, all women who seek abortion — whether in the first trimester or afterwards — have a unique story and deserve our support. Their choices certainly deserve to be received with less judgment and criticism then they currently do. I hope that in the future, conversations around abortion can mirror the ones that followed Dr. Tiller’s death (without being initiated for the same awful reason), but can also be taken a step further – by recognizing and telling the stories of all women who have abortions, whenever the procedure occurs.

Lydia Stuckey is a Senior Associate for Programs and Policy at the Reproductive Health Technologies Project.

References

1. Guttmacher Institute, Facts on Induced Abortion, New York: Guttmacher Institute, July 2008.
2. Foster DG, Jackson, RA, Cosby K et al., “Predictors of delay in each step leading to an abortion,” Contraception 2008;77(4):289-293.
3. Finer, LB, Frohwirth LF, and Dauphinee LA, et al., “Timing of steps and reasons for delays in obtaining abortions in the United States,” Contraception 2006;74(4):334-44.