By Charlene Sathi
On January 22, 2019, New York State Governor Andrew Cuomo passed the Reproductive Health Act which has brought the most significant change to New York abortion laws since the historic Roe v. Wade. In this case, 46 years ago, the Supreme Court ruled that a woman has a constitutional right to an abortion until the point of viability, roughly at the 24-week mark. Conversely, this new law allows women to obtain a legal abortion at any point in pregnancy until full-term.
The issue of late-term abortion evokes polarizing views from pro-life and pro-choice perspectives amid the current Republican and Democratic angst in America today. However, by using divisive terms and rhetoric, we are unable to see the larger moral contention at-hand. It is important to distill this issue from the political blood-bath in order to consider it in light of the facts.
In reproductive science, the gestational 24-week mark is critical because, at this point, a fetus can generally survive outside the womb with medical assistance, and have a prognosis for a healthy life. It is critical that we consider the ethical implications of moving this legal barrier further down the fetal development timeline.
Up until this point in history, it was entirely legal for a woman to terminate her pregnancy at any point in which her life was medically at risk. The new legislation opens up this limitation to extend protection for when a woman’s ‘health’ is at risk, as well as in the absence of fetal viability.
The term ‘health’ is broadly used to identify a range of factors relevant to the wellbeing of the mother, including psychological, emotional and familial aspects of her health. By using this vague terminology, the law effectively allows a woman to obtain an abortion at any time, for any reason.
It is widely accepted that undergoing an abortion is often one of the most difficult decisions a woman will make, however her reasoning is highly important as it is often the basis used to decide whether an abortion is justifiable. Significant also, is whether or not she is making an informed decision, for example, whether she has been presented with available alternatives and support, information about potential health risks, and so on.
Advocates of abortion argue that late-term abortions are rare and undertaken only when a woman’s life or health is at risk or where the unborn child suffers from a fatal condition. Yet, of the 15,000 late-term abortions that take place in the United States each year, a 2013 study undertaken as part of one of the largest studies on abortion in the US, suggests that only a very small proportion are for fetal anomaly or life endangerment.
A 2004 study from the Guttmacher Institute found that the most frequent reasons cited for having an abortion at all gestational ages included: “that having a child would interfere with a woman’s education, work or ability to care for dependents (74%); that she could not afford a baby now (73%); and that she did not want to be a single mother or was having relationship problems (48%)."
According to the 2013 study, other reasons women commonly sought an abortion later on in pregnancy included not knowing they were pregnant, not knowing where to go for an abortion, expense, insurance issues, travel considerations, indecision and disagreements with the father.
Such reasons are hard to square with the reality of late-term abortion.
Additionally, it should be noted that women who seek late-term abortions are often in vulnerable situations with a limited support system. The 2013 study described five profiles of such women: “They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and [experiencing their first pregnancy].”
A law as broad and extreme as New York’s, puts vulnerable women like this at even greater risk and does nothing to address the underlying issues that they are facing.
Furthermore, late-term abortions are complex and last several days. Women are at risk for severe hemorrhages, lacerations, and damage to their cervix which may give rise to future pregnancy complications. In addition to these physical risks, women also face the psychological risks attached to ending the life of their child.
This gives rise to the question of where we, as a just society respecting the rights of a woman and the rights of all humans, must draw the line as to when a fetus is worthy of human rights, ethical treatment and protection. Is it at conception? When there is evidence of a beating heart (5 weeks)? When there are detectable brain waves (8 weeks)? When a pregnant woman can start to feel her baby moving (16 weeks)? When a baby can feel pain (20 weeks)? When there is a reasonable chance of survival outside the womb (23/24 weeks)? When a baby is born?
Late-term abortions are at odds with advances in neonatal care, including in utero surgery in which the fetus is operated on inside the womb. In other words, when an unborn child is wanted, it is given care and protection, but when it is unwanted, it’s life is terminated. This speaks to how our society views the importance of lives – regardless of age – on the basis of desirability.
While the New York legislation raises a myriad of ethical issues in relation to both mother and child (which should have been properly addressed before it was passed), one thing is clear: both pro-lifers and pro-choicers, Republicans and Democrats, and everyone in between, are incredibly uncomfortable with a law that allows the unfettered abortion of unborn children.
Charlene Sathi has recently completed a Master of Science in Bioethics from Columbia University in New York City and currently works as a Clinical Research Coordinator at Columbia University Irving Medical Center.
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