 Chapter
5: About the Issues
Abortion
GLOSSARY
Abortion In
public policy debate, “abortion” has come to mean a pregnancy's
termination by deliberately expelling or removing a fetus from the
uterus; also called “induced abortion.”
Viability The point at which
a fetus/child can live a sustained life outside the mother's uterus.
BACKGROUND
[APRIL 1, 2002] According to the federal Centers for
Disease Control and Prevention (CDC), an estimated 1.33 million
abortions were performed in the United States in 1997 (latest available
national data); this is down from the peak of 1.6 million in 1990.
The 1997 national rates were
- 22.2 per 1,000 women aged 15–44, down from 27.4
in 1990; and
- 27.5 per 1,000 woman aged 15–19, down from 40.3
in 1990.
Michigan Data
The latest data available from the Michigan Department
of Community Health show that 26,807 abortions were performed in
Michigan in 2000, an increase of 2.3 percent from the previous year
but a 45.4 percent decrease since 1987, the year with the highest
number of reported abortions. The rate is 12.2 per 1,000 for Michigan
women aged 15–44. Data from the state may not reflect the true prevalence
of abortion because, while reporting is required, abortion providers
may not report all the procedures they perform.
The reasons for the abortion decline are intensely
debated by pro-life and pro-choice advocates. The following reasons
are most frequently cited, but the decrease probably is attributable
to a combination of factors rather than a single one:
- Wider and more effective contraception use
- Changing attitudes toward premarital sexual activity
- Diminished access to abortion because of the ban
on paying for abortions with Medicaid funds
- Enactment of parental and informed-consent laws
- A decrease in the number of abortion providers
- Increased teaching of abstinence and/or sex education
in schools
- Changing age distribution of females in their reproductive
years
Of the abortions reported in Michigan in 2000,
- 87 percent occurred during the first 12 weeks of
pregnancy;
- 98 percent occurred within the first 20 weeks of
pregnancy;
- women aged under 20 accounted for 19 percent (down
from 31 percent in 1980);
- women aged 20–24 accounted for 32 percent;
- women aged 25–29 accounted for 23 percent;
- women aged 30 and older accounted for 25 percent;
- unmarried women accounted for 84 percent; and
- among those who had an abortion that year, 48 percent
had previously had one.
In 2000, physical complications—most frequently, shock—immediately
following an abortion were reported in 26 cases, or about one in
1,000 procedures. Information on subsequent complications (within
seven days) was collected for the first time in 2000. Any physician
providing care to a woman suffering from such a complication must
report it to the state. Seven incidents of subsequent complications
were reported.
In 2000, 76 percent of reported abortions were performed
in a physician's office, 23 percent in a freestanding, outpatient
surgical facility, and the remainder in a hospital or satellite
clinic.
Since 1988 Michigan has prohibited payment for abortions
through the Medicaid program unless the procedure is necessary to
save a woman's life. (In 1987 about 18,000 Medicaid-funded abortions
had been performed in the state.) The federal government subsequently
(in 1994) required states also to pay for abortions desired by Medicaid
recipients to terminate a pregnancy resulting from rape or incest.
Information on the source of payment for non-Medicaid abortions
was collected for the first time in 2000; where source of payment
was reported, self-pay was most frequently indicated.
Legal History
In 1973 the U.S. Supreme Court, in Roe v. Wade,
ruled that the Constitutional right to privacy extends to a woman's
decision, in consultation with her physician, to terminate her pregnancy.
The same ruling says that states may prohibit abortion in the third
trimester unless a woman's life or health is endangered (“health”
has not been defined precisely). In 1989, in Webster v. Reproductive
Health Services, the Court reopened the door to state regulation
of pre-third-trimester abortion by upholding Missouri's 1986 law
(1) declaring that life begins at conception and (2) prohibiting
public facilities from being used for abortions not necessary to
save a woman's life. The Court allowed the declaration that life
begins at conception because it believed there was insufficient
evidence that the declaration would restrict protected activities
such as abortion.
Following Webster, many state legislatures
imposed new restrictions on abortion. In fact, while debate continues
as to whether abortion should be permitted at all or only in very
limited circumstances, most recent judicial decisions and legislative
activity have focused on restrictions to abortion (or access to
abortion providers) that fall short of an outright ban.
DISCUSSION
Few issues engender more controversy than abortion.
The main and opposing camps on the issue are “pro-life,” which includes
people who oppose abortion in all (or almost all) circumstances,
and “pro-choice,” which includes people who believe a woman has
the right to choose whether she will have an abortion in all (or
almost all) circumstances. These camps disagree on most aspects
of the issue, including how they refer to themselves and the others.
- Pro-life advocates often call pro-choice advocates
“pro-abortion.” But pro-choice supporters argue that they do not
prefer abortion to childbirth or adoption, but they do favor a
woman's right to choose for herself, which is why they call themselves
pro-choice.
- Pro-choice supporters often call pro-life supporters
“anti-abortion.” This reflects the pro-choice belief that life
does not begin at conception. But pro-life advocates counter that
it does, and therefore “pro-life” is more accurate than “anti-abortion.”
(In this piece, we use “pro-choice” and “pro-life.”)
To cite just one more example of the many disagreements
between the two camps, pro-choice advocates call a “fetus” that
which pro-life advocates call an “unborn child” or “baby.”
Many see abortion as a black-and-white issue—that
is, one either favors a woman's right to choose to terminate her
pregnancy, or one does not—but the issue's complexity allows for
shades of gray. Some believe that abortion should not be allowed
under any circumstance, while others would permit it to save the
mother's life or in cases when the pregnant woman is a rape or incest
victim. In addition, some believe that abortion should not be permitted
after viability (that is, the point at which the fetus/unborn child
can live a sustained life outside the mother's uterus). Pro-choice
advocates view this as restricting a woman's legal right to abortion;
pro-life advocates view it as saving lives. The debate about viability
is complicated because advances in medical science may continue
to reduce the number of weeks of pregnancy before viability is achieved.
“Partial-Birth ” or “Dilation
and Extraction” Abortion
Related to the viability debate is the ongoing battle
over “partial-birth” abortion. Again, the nomenclature itself is
controversial. Pro-life supporters define the procedure as partial
birth because the fetus/unborn child is partially delivered, usually
feet-first, through the vagina before the abortion is performed.
Such abortions usually are performed after 20 weeks gestation, and
pro-life advocates contend that these abortions are particularly
objectionable because the fetus/unborn child is viable; they add
that such a procedure rarely is needed to save the mother's life
or even preserve her health.
Pro-choice supporters respond by defining this procedure
as “dilation and extraction” abortion, arguing that partial birth
is a political construct and misnomer with no equivalent in real-world
medical practice; that is, the fetus is not partially born. They
further contend that these abortions rarely are performed, and when
they are, it is only to save a woman's life when no other method
will suffice.
A 1996 Michigan law, Public Act 273, bans partial-birth
abortions, allowing an exception when the mother's life is in danger.
The law, which subsequently was permanently enjoined (prohibited
from being in effect) by federal court, defines the procedure broadly
and refers to a vaginally delivered “living fetus,” which is defined
vaguely and may mean from the moment of conception.
In 1999 two partial-birth abortion laws were enacted
in Michigan, but the U.S. District Court permanently enjoined the
first and temporarily enjoined the other.
- P.A. 107 of 1999 added the Infant Protection Act
to the Michigan Penal Code. Pro-life supporters say the measure
bans partial-birth abortions; pro-choice supporters say it could
ban all abortions.
- P.A. 192 of 1999 amended the Michigan Code of Criminal
Procedure, imposing a maximum sentence of life imprisonment for
performing a procedure on a live infant with intent to cause death.
The State of Michigan is not appealing the decisions
to enjoin, which were based on rulings by the U.S. Supreme Court
in Stenberg v. Carhart, 2000. The Court (1) upheld
a lower court decision invalidating Nebraska's ban on “partial-birth”
abortion, (2) ruled that the language in the Nebraska law covered
a broad range of abortion procedures, thus resulting in an undue
burden on a woman's right to make an abortion decision, and (3)
ruled that every abortion regulation must provide for an exception
when necessary to preserve the mother's life or health.
Access to Abortion
Three major Michigan laws enacted in the last decade
relate to a woman's access to abortion; one pertains to parental
consent and two to informed consent. The 1992 U.S. Supreme Court
ruling in Planned Parenthood of Southeastern Pennsylvania
v. Casey was a key factor in the implementation of the first
measure and the genesis of the second and third. The Court upheld
a Pennsylvania law's provisions requiring a woman to wait 24 hours
before an abortion, read state-authored materials about abortion
and fetal development, and, if a minor, obtain parental consent
or a judicial waiver. The Court reaffirmed the right of a woman
to an abortion under Roe v. Wade but revoked the definition
of that right as “fundamental.” The Court instead offers a standard
of review that allows restrictions on abortion prior to viability
if the restrictions do not constitute an undue burden on the woman.
The Court held that the Pennsylvania law's provisions are not unduly
burdensome merely because they attempt to discourage a woman from
obtaining an abortion.
Parental Consent
Michigan P.A. 211 of 1990 requires parental consent
to abortion for minors (aged 17 and younger) unless the minor obtains
a waiver from a judge. This law has been in effect since 1993.
Pro-life supporters argue that the law restores parental
and familial rights. They argue that many other less momentous procedures
(e.g., ear piercing) require parental consent.
Pro-choice supporters believe that the law violates
a female's right to decide for herself about childbearing options;
they further contend that the judicial waiver may be an undue burden
for females who may not be able to prove (or dare not try) that
they have been a victim of abuse or incest in their own home.
Informed Consent
Public Act 133 of 1993 requires any woman seeking
an abortion to (1) be given state-prepared information about the
procedure, (2) wait 24 hours before undergoing the procedure, and
(3) sign a state-prepared informed-consent form immediately prior
to the abortion. The information includes depictions of the fetus
at the stage corresponding to the woman's pregnancy, a description
of the abortion procedure, information on the risks and complications
of abortion and live birth, information on pregnancy-related services,
and a prenatal care and parenting information pamphlet. The law
was temporarily enjoined and then implemented in 1999.
P. A. 345 of 2000 amends the above law and imposes
limits on how a woman may receive the required information; it specifies
that she may obtain it only in person, by registered mail, by fax,
or from a state government Web site. The effective date of the law
was delayed while the state completed court-directed changes in
the Web site; the site was posted in March 2002, and the law may
take effect on May 1, 2002. On March 4, 2002, the federal district
court in Detroit struck down the provision in the law that prohibits
a physician from obtaining payment for “abortion related” services
until the 24-hour waiting period expires.
Pro-choice advocates claim that informed-consent laws
are unnecessary at best and, at worst, prevent women from exercising
their right to make private decisions about reproductive choices.
They argue that evidence demonstrates that women already carefully
consider their options before choosing abortion, adding that established
medical standards ensure that women are given accurate and unbiased
information about their health care options. Moreover, they note,
clinics routinely refer women who are ambivalent about their decision
for additional counseling.
Pro-life advocates counter that such legislation enables
women to make informed choices about abortion. They believe that
the information on fetal development balances what they consider
biased information already offered to women considering abortion.
More recent legislation pertaining to access includes
language in the budget for community colleges that prohibits the
schools from providing insurance to their employees that covers
abortion services (P.A. 52 of 2001). There also is a requirement
that a physician's office in which abortions are annually performed
on 50 percent or more patients must be licensed to operate as a
freestanding, surgical, outpatient facility (P.A. 206 of 1999);
pro-choice advocates maintain that the additional money and time
needed to obtain licensure will discourage providers from offering
abortion services, thus making it harder for women to obtain them.
Family Planning
Controversy about abortion extends to federal support
for family planning services, which are funded largely through Title
X of the Social Security Act. Title X provides subsidized, affordable
contraceptives and other reproductive health services (Pap smears,
breast exams, HIV testing, and screening and treatment for sexually
transmitted diseases) to more than four million low-income women
each year.
While Title X funds cannot be used for abortions themselves,
clinics receiving the funds must offer “nondirective counseling”
on women's options, which include carrying a child to term, adoption,
and abortion. Pro-life proponents argue that the clear purpose of
Title X, enacted in 1970, is to provide pre-pregnancy services.
The title's authorizing language states that funds shall not be
used in programs in which abortion is a method of family planning.
Pro-choice proponents counter that denying a woman information about
the full range of options violates the principle of informed consent
and her right to reproductive choice. Arguing that pro-life advocates
wish to eliminate or cut funding for Title X, pro-choice advocates
add that the program does not fund abortions but rather, by providing
contraceptives and pre-pregnancy counseling, prevents unwanted pregnancies
and abortions.
In Michigan, pregnancy prevention programs funded
by state dollars are precluded from counseling women about abortion.
House Bill 4655, under consideration by the legislature at this
writing, would give family-planning or reproductive-health services
funding priority to entities that do not (1) perform elective abortions,
(2) refer women to abortion providers, (3) advocate for the legality
or accessibility of elective abortion, or (4) have a written policy
that abortion is part of a continuum of family planning or reproductive
health services. Pro-choice supporters contend that enacting the
measure will preclude Planned Parenthood Affiliates of Michigan
from receiving state and federal funding for family-planning and
reproductive-health programs and result in an increase in unwanted
pregnancies and abortions. Pro-life supporters counter that Planned
Parenthood Affiliates of Michigan will lose funds only if another
agency is available to provide the services being funded.
Other Matters of Controversy
The “morning after” contraceptive pill, if taken within
72 hours after unprotected intercourse, can prevent a fertilized
egg from becoming implanted on the uterus wall. Some pro-life supporters
oppose the drug's use on the ground that it is a form of abortion.
Pro-choice supporters see the drug as a means to prevent unwanted
pregnancies and an alternative to abortion.
More controversial still are abortifacients,
drugs that induce abortion weeks into pregnancy. The U.S. Food and
Drug Administration (FDA) has approved mifepristone—the generic
name for RU-486, the French brand name—for use as an abortifacient
for use in pregnancies of 49 days or less duration. Pro-life supporters
contend that using mifepristone, in addition to inducing abortion,
leads to such complications as prolonged bleeding, severe cramping,
and nausea, and its long-term effects are unknown. Pro-choice supporters
point out that mifepristone was rigorously tested and thoroughly
reviewed before receiving FDA approval, and, while there are some
side effects, it offers women a safe and effective non-surgical,
private option.
Since FDA approval of mifepristone, bills restricting
access to the drug have been introduced in Congress and several
state legislatures.
New Reproductive Technology
The rapid advances in reproductive technology and
medical research are raising new legal, moral, and ethical questions
for policymakers and courts. Emerging issues related to assisted
reproductive technologies—including in vitro fertilization;
donation and storage of sperm, eggs and embryos; posthumous fertilization;
and surrogate parenting arrangements—are forcing courts to rule,
often in the absence of guiding legislation, on the rights of mothers,
fathers, and fetuses.
Another emerging issue fraught with controversy is
stem cell research, which involves human embryos and fetal tissue.
The research raises hope for development of ways to treat such diseases
as diabetes, but it also intensifies debate about the point at which
life begins.
See also Genetic Cloning, Testing, and Research.
FOR ADDITIONAL INFORMATION
Alan Guttmacher Institute
1120 Connecticut Avenue, N.W., Suite 460
Washington, DC 20036
(202) 296-4012
(202) 223-5756 FAX
http://www.agi-usa.org
Data Development Section
Michigan Department of Community Health
P.O. Box 30195
Lansing, MI 48909
(517) 335-8705
(517) 335-8711 FAX
www.michigan.gov/mdch
Planned Parenthood Affiliates of Michigan
P.O. Box 19104
Lansing, MI 48901
(517) 482-1080
(517) 482-4876 FAX
http://www.miplannedparenthood.org
Right to Life of Michigan
2340 Porter Street, S.W.
P.O. Box 901
Grand Rapids, MI 49509
(616) 532-2300
(616) 532-3461 FAX
http://www.rtl.org
CONTENT CURRENT AS OF APRIL 1,
2002
© 2002 Public
Sector Consultants, Inc.
Sponsored by the Michigan Nonprofit Association and the Council
of Michigan Foundations
www.michiganinbrief.org
 
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