Posted on 5.10.2012 by Amy
As Georgia, Arizona and other states have banned abortion at various points in later pregnancy, some pro-choicers have moved to confront medical misinformation embodied in the bans with...well, more medical misinformation.
As was the case with the hubbub over transvaginal ultrasounds in Virginia, some well-intentioned commentators fixated on what may have seemed the most salacious point in the Arizona ban -- that it appeared to define pregnancy as beginning on the first day of a woman's last menstrual period, or about two weeks before fertilization and implantation.
Amanda Marcotte slammed Arizona legislators for "arguing that you're 'pregnant' while you're actually getting your period." (Marcotte later nixed many parts of her article.) A Jezebel headline blared "Batshit Insane Lawmakers Attempting to Declare Women 'Pregnant' Two Weeks Before Conception." Even Stephen Colbert seized on the absurdity, saying legislators had moved beyond pro-life, becoming "pre-life."
There was only one problem. The medical community generally defines pregnancy based on a woman's last menstrual period, so in a sense all women, in the eyes of their doctor, are two weeks pregnant by the time a fertilized egg implants in the uterus. Health care practitioners use gestational age to measure pregnancy because unlike fertilization and implantation -- which are tough to pinpoint, since they don't necessarily occur on the same date as intercourse -- a woman's last menstrual period marks a fixed point in time when her body is beginning to prepare for a possible future pregnancy. Gestational age, in other words, wasn't invented by Republicans.*
In fact, the laws that use gestational age as a measure of pregnancy (yes, the ones that label you two weeks "pregnant" around the time you ovulate) are more medically accurate than those -- modeled on the Nebraska ban -- that redefine pregnancy as beginning at fertilization. Many fertilized eggs never implant in the uterus but are simply flushed from the body. Reproductive health advocates have noted that attempts to define life as beginning at fertilization could threaten birth control and in vitro fertilization.
The Arizona law is in fact stricter than the Georgia ban. (Interestingly, Marty notes this strictness may have been an accident resulting from medical ignorance, not necessarily an attempt to be the most fetus-loving.) Arizona moved to ban abortion at 20 weeks, as other states had done. But they specified that the ban was for pregnancies after 20 weeks gestational age -- or 18 weeks "postfertilization" -- two weeks earlier than Georgia.
(Several states now ban abortion at various stages in pregnancy, many of them based on the debunked assumption that a fetus can feel pain after 22 weeks gestational age. The Guttmacher Institute calls the Nebraska ban and several others like it 20-week bans. As Marty notes, these laws ban abortions at 20 weeks "postfertilization," also called fetal age, or 22 weeks gestational age).
The difference between Georgia and Arizona is two weeks. Which, as those of us who have worked in abortion care know, is a big difference. Here again I think pro-choicers missed an opportunity to refocus the dialogue on the women who will be affected by the bans. I recall certain patients for whom two weeks -- or even two days -- made all the difference in the world. The legislators may not be able to imagine an actual human being in place of the vague concept of a woman terminating a late-term pregnancy. But for me, there was the homeless woman so overwhelmed by the prospect of raising $75 for an ultrasound that she was 21 weeks and a few days by the time she began her abortion. There were the teenagers who -- out of sheer terror or denial -- concealed their pregnancies until they were well into their second trimesters, sometimes even surpassing the 22-week cutoff at the clinic where I worked. (In Arizona, many more of them would either need to travel out of state or prepare to give birth unwillingly.) There were women whose partners were abusive, women who were caring for dying parents, women who opted not to bear a child with disabilities, or women who had recently discovered medical problems that would make the pregnancy difficult or impossible. There were many, many people who couldn't afford the cost of an abortion, and found themselves racing the clock as the price increased and they moved closer to the cutoff. There were women who just simply did not want to be mamas right then, but who were grieving, agonizing, discussing...taking the time they needed.
The pro-choice movement often minimizes late-term pregnancies, noting that a tiny fraction of abortions take place after 20 weeks. Longtime reproductive rights activist Susan Yanow notes the problems with obscuring later abortions:
Too many conversations about second trimester abortion start defensively with the statement, "Of course, most abortions take place in the first trimester." However, approximately 55,000 women in the US obtain abortions at 16 weeks or later every year. This is not new; women have consistently needed access to later abortions...Who are these women? The women who seek later abortions are disproportionately young women, low-income women and women of color who often face numerous delays in obtaining services that contribute to the later gestational ages at which they present for care. Of the abortions provided to white women, 11.5 percent occur after 12 weeks compared to 13.1 percent of abortions to African Americans.
Each woman -- each fraction of a percent -- has her story. All are different, all are legitimate. But they are have one thing in common. None will benefit from any bans on abortion, regardless of when they take place.
*_If you've ever had an abortion, you've most likely been told the length of your pregnancy based on gestational age. This means your pregnancy was measured from your last menstrual period. Since a woman with a perfect 28-day cycle ovulates in the middle, that means about two weeks have been added from the day you actually became pregnant. So if I told you you were six weeks pregnant today (erm, sorry to break the news?) that means fertilization and implantation likely happened about four weeks ago. It's imprecise science, since Woman A might have a 25-day cycle, while Woman B has a 39-day cycle. But it's more scientifically accurate than calling a fertilized egg a human._