The Dark Truth: Abortion Laws And Late-Term Pregnancy

The topic of aborting a baby at 9 months is highly controversial and subject to different laws and interpretations in different countries and states. In the US, for example, the issue of abortion has been left to individual states since the Supreme Court overturned Roe v. Wade in 2022, with 14 states banning abortion at any stage of pregnancy and 11 others imposing gestational limits. In Europe, the Netherlands permits late-term abortions only in exceptional circumstances, such as when the unborn child has a serious disorder, and the procedure must be approved by an independent physician. While the debate around abortion continues, it's important to note that abortions at or after 21 weeks are rare and often difficult to obtain, with only a small number of states or countries permitting such procedures.

Partial-birth abortion (PBA)

PBA is typically used during the middle and final months of pregnancy when dismembering the fetus becomes more challenging due to stronger bones and ligaments. The procedure involves two to three days of cervical dilation for the mother, increasing the risk of infection and subsequent preterm births. PBA allows the doctor to partially deliver the fetus "intact" in a matter of minutes before killing it and completing the delivery. This is in contrast to the more commonly used dismemberment method, where the mother's cervix is manually dilated only enough to remove the fetus's severed body parts, a process that takes longer to complete.

The Partial-Birth Abortion Ban Act of 2003 is a United States law that prohibits PBA, referred to in medical literature as intact dilation and extraction. The law defines PBA as:

> "An abortion in which the person performing the abortion, deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and performs the overt act, other than completion of delivery, that kills the partially delivered living fetus."

The act specifies that any physician who performs PBA and thereby kills a human fetus shall be subject to fines, imprisonment, or both. However, it is important to note that the law does not prevent a woman from obtaining an abortion but rather prohibits a specific method of abortion. Additionally, the law provides that a defendant accused of an offense under this act may seek a hearing before the State Medical Board to determine if the procedure was necessary to save the life of the mother.

The constitutionality of the Partial-Birth Abortion Ban Act has been the subject of legal challenges and Supreme Court cases, with varying rulings at the state and federal levels. While some courts have upheld the law, others have declared it unconstitutional, particularly due to its omission of an exception for the health of the woman. The Supreme Court's decision in Gonzales v. Carhart in 2007 ultimately upheld the constitutionality of the act.

Gestational limits of abortion

The gestational limits of abortion vary across different states and countries. In the United States, abortion laws have been in flux since the Supreme Court overturned Roe v. Wade in June 2022. As a result, many state legislatures have imposed new restrictions and bans on abortion, with varying gestational limits.

As of October 2024, 14 states have laws in effect that ban abortions starting at fertilization, while 28 states have abortion bans based on gestational duration. These bans can occur at different stages of pregnancy, with some states imposing earlier deadlines than others. For example, Florida, South Carolina, and Georgia ban abortions after six weeks, when cardiac activity is detected in the embryo. Nebraska and North Carolina ban abortions at the 12-week mark, while Arizona bans abortions at 15 weeks. Utah is the only state that currently bans abortion at 18 weeks of pregnancy.

Some states impose bans later in the pregnancy. Iowa bans abortion starting at 20 weeks post-fertilization, while Kansas and Ohio ban abortions at 22 weeks of pregnancy. Wisconsin also bans abortions at 20 or more weeks post-fertilization, which is equivalent to 22 weeks after the last menstrual period.

A small number of states impose bans in the third trimester of pregnancy. Virginia is the only state that prohibits abortions starting in the third trimester, which typically begins at around 25 weeks. Additionally, more than a dozen states ban abortions after the fetus is considered viable, which is generally between 24 and 26 weeks.

On the other hand, some states do not impose any term restrictions on abortions. Six states and Washington, D.C., fall into this category, allowing abortions without specifying a gestational limit.

Outside of the United States, the laws and gestational limits surrounding abortion vary by country. For example, in the Netherlands, the Dutch Termination of Pregnancy Act allows abortions to be carried out up to the 24th week of pregnancy, which is the point at which the fetus becomes viable outside the womb. Late-term abortions after the 24th week are considered under criminal law and are only permitted in exceptional circumstances, such as when the unborn child has a serious disorder with no prospect of improvement.

Viability

In the context of abortion laws, viability is often used as a benchmark to determine when abortions can no longer be performed. More than a dozen US states ban abortions after the fetus is considered viable. However, the specific definition of viability varies and some states leave it up to the abortion provider's "judgment" to determine whether a fetus is viable.

The Dutch Termination of Pregnancy Act, for example, sets the viability threshold at 24 weeks. Late-term abortions after this point are considered criminal acts and are only permitted in exceptional circumstances, such as when the unborn child has a serious disorder with no prospect of improvement.

In the United States, the concept of viability has been central to the abortion debate. Prior to the Dobbs v. Jackson Women's Health Organization decision, viability was the delineating factor established by Roe v. Wade and subsequent Supreme Court decisions. However, viability was never properly defined by the courts, and the lack of a clear definition has contributed to ongoing debates and legal challenges surrounding abortion laws.

While the majority of abortions occur before 15 weeks of gestation, a small percentage (approximately 1%) are performed at or after 21 weeks. These abortions are often difficult to obtain, expensive, and require travel and multiple days of treatment. They are subject to various state regulations, including viability bans, procedure bans, and a limited number of providers who are trained or willing to perform them.

Lethal fetal anomalies

The diagnosis of an LFA can have ethical and legal implications for management during pregnancy, delivery, and postnatally. For example, it may permit obstetric management focused on maternal well-being rather than fetal survival, termination of pregnancy (including late in pregnancy), or non-resuscitation at birth. However, the lack of a clear definition of LFAs can lead to inconsistent decision-making and miscommunication with families.

In the United States, the diagnosis of an LFA may permit termination of pregnancy, even at a gestational age when it would otherwise be prohibited. For example, the Texas Health and Safety Code allows for an exception to the prohibition of pregnancy termination after 20 weeks if "the fetus has a severe and irreversible abnormality", defined as "a life-threatening physical condition that ... regardless of the provision of life-saving medical treatment, is incompatible with life outside the womb". Similarly, the Columbian Penal Code permits termination when there are "serious malformations of the fetus that make the fetus not viable, as certified by a medical doctor".

The specific legalities and limits of abortion vary from state to state in the US. Some states have laws in effect banning abortions at certain gestational stages, while others have no restrictions at all. As of June 2024, Virginia is the only state that prohibits abortions starting in the third trimester, which starts at around 25 weeks.

The debate around abortion, especially in the context of LFAs, is complex and multifaceted. On the one hand, there are ethical considerations regarding the potential for misunderstanding and miscommunication when using the term 'lethal'. There are also concerns about the potential for concealed value judgments about the quality of life of surviving infants. On the other hand, there are legal and moral considerations, with some states creating specific exceptions for LFAs in their abortion laws.

Health exceptions

In the United States, abortion laws vary from state to state, with some states banning abortion entirely and others allowing abortions with certain restrictions. While abortion is generally legal until 24 weeks, some states allow abortions beyond this point for medical reasons. Here is an overview of the health exceptions that may apply in these cases:

General Health Exceptions:

Lethal Fetal Anomaly Exceptions:

Some states include exceptions for lethal fetal anomalies, which are fetal conditions likely to be fatal before or shortly after birth. These exceptions are often limited to anomalies that would result in the death of the baby at birth or soon after. However, the specific conditions that fall under this exception vary by state, and the criteria for determining lethality may differ.

Ectopic Pregnancies and Miscarriages:

Some state abortion laws specify that care for ectopic pregnancies and miscarriages is allowed and not considered criminal. However, there may be restrictions on when and how this care can be provided. For example, abortion may only be permitted for the removal of a dead fetus or embryo, and pregnant people who are actively miscarrying may be denied care if there is still detectable fetal cardiac activity.

Barriers to Accessing Health Exceptions:

While health exceptions are included in many state abortion bans, they are often narrow and vaguely defined, making it difficult for physicians to know when an abortion is legally permitted to protect a patient's health. Additionally, law enforcement involvement may be required to document rape or incest, creating further barriers for survivors seeking abortions under these exceptions. The lack of clarity and consistency in the exceptions can deter physicians from practicing in states with restrictive abortion laws, further limiting access to abortion care.

In conclusion, while health exceptions are included in many state abortion bans, they are often limited in scope and challenging to navigate. The specific exceptions and restrictions can vary significantly from state to state, and it is important for individuals seeking abortions to understand the laws in their state.

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