Is a 15-week limit on abortion an acceptable compromise?

A recent opinion piece by George F. Will, “Ambivalent about abortion, the American middle begins to find its voice” in the Washington Post made the startling claim that the overturning of Roe v. Wade (Dobbs v. Jackson Women’s Health Organization, 2022) has resulted in “a partial healing of the nation’s civic culture.” One might think exactly the reverse. The Dobbs decision energized voters, especially women and young people, resulting in numerous Republican electoral defeats across the country. However, Will argues that the return of abortion policy to the states gives voters the opportunity of choosing moderate restrictions on abortion. Since most Americans support early abortion while opposing late-gestation abortion, Will thinks that a 15-week ban on abortion would be an acceptable compromise.

Why 15 weeks? Two reasons can be given. Almost all abortions in the US—93%—occur within the first 15 weeks of pregnancy. For this reason, making abortion illegal after 15 weeks would not, it would seem, impose serious burdens on most people seeking abortions. 

Another reason is that several European countries limit abortion on request to the first trimester, leading some US lawmakers to suggest that a 15-week ban would bring our abortion law in line with theirs. This is disingenuous, to say the least. While elective abortion is limited in some European countries, it is not banned afterwards, but is allowed on other grounds, including economic or social reasons, or a threat to the woman’s physical or mental health. Moreover, in most European countries, patients do not have to pay for abortion; it is covered under universal health coverage. The fact is that the trend in Europe has not been to limit abortion, but to expand access to it. Countries in Europe “… have removed bans, increased abortion’s legality and taken steps to ensure laws and policies on abortion are guided by public health evidence and clinical best practices.”

Were states to guarantee access to abortion prior to 15 weeks, a 15-week ban might be acceptable. However, even before Dobbs, many women in the US lacked access to abortion, due to a dearth of providers, especially in rural areas. They often had to travel many miles to find an abortion clinic, which meant that they had to arrange childcare if they have other children or take time off work. Delay is also caused by the need to raise money for an abortion, which is not paid for by Medicaid in most states, except in cases of rape, incest, or a life-threatening condition. To be sure, even if there were none of these roadblocks, some women would still not be able to have early abortions because they do not know that they are pregnant, due to youth, being menopausal, chronic obesity, or a lack of pregnancy symptoms. Any time limits will pose hardships for some people. But if access to early abortions were guaranteed, a compromise on a 15-week limit might be worth it.

I suspect that time-limit advocates are not particularly interested in making sure that women who have abortions get them early in pregnancy. They want to place roadblocks in the way of getting abortions, full stop. That these roadblocks increase the numbers of late abortions is of little concern to them, however much they wring their hands over late abortions. Abortion can be reduced by reducing the number of unwanted pregnancies, something that has been shown to be achieved by access to contraceptives and science-based sex education in the schools. Remember when pro-lifers emphasized those methods? Me neither. 

My second concern is with abortions sought after 15 weeks. The reason for a late abortion may be that the woman has a medical condition that has not developed, or has not been detected, until later in pregnancy. In such cases, the pregnancy is almost always a wanted pregnancy, and the decision to terminate imposes a tragic choice.

It may be responded that all states allow abortions to be performed when this is necessary to save the pregnant woman’s life, and many allow for abortions to protect her from a serious health risk. The problem is that these exceptions conflict with standard medical care, especially in the case of miscarriage. Once the woman has begun to miscarry, the failure to remove the fetus is likely to cause her sepsis, which can be life-threatening. However, in states with restrictive abortion laws, doctors cannot perform an immediate abortion, which is the standard of care in such situations. They have to wait until her death is imminent and, in some states, they cannot remove the fetus until its heart stops. 

Ireland’s restrictive abortion law was repealed after a woman who was denied an abortion during a miscarriage died from septicemia. To the best of my knowledge, no woman in the US has died as a result of restrictive abortion laws, but some have come close. An OB-GYN in San Antonio had to wait until the fetal heartbeat stopped to treat a miscarrying patient who developed a dangerous womb infection. The delay caused complications which required her to have surgery, lose multiple liters of blood, and be put on a breathing machine. Texas law essentially requires doctors to commit malpractice.

Conservatives often portray those in the pro-choice camp as advocating abortion until the day of delivery, for trivial reasons. This is deeply unfair. If they want us to compromise on time limits, they should be willing to guarantee access to abortion before 15 weeks. They should be willing to compromise on pregnancy prevention through contraception and sex education. And they should agree to drop all restrictions on late-term abortions that make legislators, rather than doctors, in charge of deciding what is appropriate medical care for their patients.

_{Featured image: Gayatri Malhotra via Unsplash (public domain)}