U.S. court upholds law on abortion information

SAN FRANCISCO – A federal appeals court has refused to block a new law requiring religiously sponsored antiabortion clinics known as "crisis pregnancy centers'' to notify patients that the state makes reproductive health services, including abortion, available at little or no cost.

The clinics argued that the law violates their freedom of speech. The state-mandated notices are "the equivalent of a referral for abortion,'' attorney Francis Manion of the American Center for Law and Justice, a conservative legal organization, said in a court filing this week.

But the 9th U.S. Circuit Court of Appeals in San Francisco denied a request by three Northern California clinics Wednesday for an injunction that would have blocked the law while they challenged its constitutionality. The panel of Judges Edward Leavy, Milan Smith and Sandra Ikuta, all Republican appointees, said the clinics were unlikely to prevail in their appeal of a federal judge's ruling allowing the law to take effect Friday.

Crisis pregnancy centers offer free counseling and services to pregnant women, including pregnancy tests and ultrasound examinations, but steer them away from abortions. There are about 2,500 centers nationwide and at least 228 in California, according to a legislative staff analysis of the new law.

The measure, introduced by Assemblyman David Chiu, D-San Francisco, requires state-licensed reproductive health centers, including crisis pregnancy centers that have a doctor on their staff, to notify clients of the full range of low-cost or free reproductive health services available under state law. Those services include contraception, prenatal care and abortion. The notices must list the phone number of the county social service center.

Clinics without a doctor are not licensed by the state and will have to tell clients they are unlicensed.

In a ruling Dec. 18 denying an injunction against the law, U.S. District Judge Jeffrey White of Oakland said the notices that the clinics will have to give their patients contain "only factual and incontrovertibly true information about the range of pregnancy-related public health services available.'' He said the state is not endorsing those services or preventing the clinics from speaking out against them.

Manion said Thursday that his clients will continue to challenge the law in the appeals court.
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Abortion Abortion

Introduction

An abortion is the medical process of ending a pregnancy so it does not result in the birth of a baby.

It is also sometimes known as a 'termination' or a 'termination of pregnancy'.

Depending on how many weeks you have been pregnant, the pregnancy is ended either by taking medication or by having a surgical procedure.

Read more about how an abortion is performed.

An abortion is not the same as a miscarriage, which is where the pregnancy is lost or ends naturally. The loss starts without medical intervention, although medical or surgical treatment may be needed after a miscarriage has started to help empty the womb.

Why an abortion may be needed

There are many reasons why a woman might decide to have an abortion, including:

    personal circumstances – including risk to the wellbeing of existing children
    a health risk to the mother
    a high chance the baby will have a serious abnormality – either genetic or physical

Read more about why an abortion may be necessary.

When an abortion can be carried out

Under UK law, an abortion can usually only be carried out during the first 24 weeks of pregnancy as long as certain criteria are met (see below).

The Abortion Act 1967 covers England, Scotland and Wales but not Northern Ireland, and states:

    abortions must be carried out in a hospital or a specialist licensed clinic
    two doctors must agree that an abortion would cause less damage to a woman's physical or mental health than continuing with the pregnancy

There are also a number of rarer situations when the law states an abortion may be carried out after 24 weeks. These include:

    if it's necessary to save the woman's life
    to prevent grave permanent injury to the physical or mental health of the pregnant woman
    if there is substantial risk that the child would be born with serious physical or mental disabilities

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before 9 weeks where possible.

Read more about when an abortion is carried out.

NHS abortions

If you want to have an abortion through the NHS, you'll usually need to be referred to a specialist service that deals with abortion.

You can ask your GP to refer you or you can go to your local family planning clinic or genito-urinary medicine (GUM) clinic. Use the post code search facility to find your nearest sexual health clinic.

The law states that any doctor with a moral objection doesn't have to certify a woman for an abortion. But they must recommend another doctor who is willing to help.

Before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled, and they must both sign the relevant certificate.

This will often – but not always – be your GP and the doctor at the clinic where the abortion will take place.

Although it's often very helpful to talk through the options with your GP or a family planning nurse before being referred, it's possible to refer yourself for an NHS abortion in some parts of the country.

You can self-refer for an NHS-funded abortion by contacting:

    the British Pregnancy Advisory Service (BPAS) on 03457 30 40 30 – or email them at info@bpas.org
    Marie Stopes UK on 0345 300 8090 (open 24 hours) or request a confidential call back via their online form
    the Pregnancy Advisory Service on 0845 359 6666 – alternatively, individual clinics also have their own local numbers you can call, or you can fill in a confidential enquiry form on the PAS website.

Please note that these telephone numbers are not necessarily free to call and can be particularly expensive if called from a mobile.

Funding of NHS abortion services differs in various parts of the country. The level of NHS provision ranges from more than 90% of local demand to less than 60%.

In some areas, the NHS will pay for abortions at private clinics, but in other areas you may need to pay to have an abortion at a private clinic.

Private abortions

You can contact a private abortion clinic without being referred by a doctor. However, the NHS will not usually pay for this, and the agreement of two doctors is still required. The clinic will make the arrangements.

Costs for abortions in private clinics vary and will depend on:

    the stage of pregnancy (earlier abortions are usually less expensive)
    whether an overnight stay is needed
    the method of abortion used

If you are considering having an abortion, it is important to talk to somebody about it as soon as possible.

Risks

No clinical procedure is entirely risk free, but abortion poses few risks to a woman's physical health, particularly when carried out as early as possible in the pregnancy (preferably during the first 12 weeks).

Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future.

The risk of problems occurring during an abortion is low. However, there are more likely to be problems if an abortion is carried out later in a pregnancy.

The risks associated with abortions are:

    haemorrhage (excessive bleeding) – occurs in about one in every 1,000 abortions
    damage to the cervix (the entrance of the womb) – occurs in no more than 10 in every 1,000 abortions
    damage to the womb – occurs in up to four in every 1,000 abortions during surgical abortion, and less than one in 1,000 medical abortions that are carried out at 12-24 weeks

Read more about the risks of abortion.

 There are many reasons why a woman might decide to have an abortion, including personal circumstances or a health risk to the mother or baby 
Post-abortion counselling

Women vary greatly in their emotional response to having an abortion. You may experience a number of different feelings and emotions.

If you need to discuss how you are feeling, you can contact a post-abortion counselling service such as the British Pregnancy Advisory Service (BPAS), Marie Stopes UK, or find NHS counselling services near you.
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Termination of Pregnancy

Epidemiology

Incidence

In Europe, 30% of all pregnancies are terminated.[2] In 2011, according to Department of Health statistics:[3]

    The total number of abortions was 189,931.
    The age-standardised abortion rate was 17.5 per 1,000 resident women aged 15-44.
    The abortion rate was highest at 33 per 1,000, for women age 20.
    The under-16 abortion rate was 3.4 and the under-18 rate was 15.0 per 1,000 women.
    96% of abortions were funded by the NHS; of these, over 61% were in the independent sector under NHS contract.
    91% of abortions were carried out at under 13 weeks of gestation; 78% were at under 10 weeks.
    Medical abortions accounted for 47% of the total.
    2,307 abortions (1%) were under ground E - risk that the child would be born handicapped.

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Legal requirements

The 1967 Abortion Act allows termination before 24 weeks of gestation if it:

    reduces the risk to a woman's life; or
    reduces the risk to her physical or mental health; or
    reduces the risk to physical or mental health of her existing children; or
    if the baby is at substantial risk of being seriously mentally or physically handicapped.

Most terminations are performed under the second of these criteria. There is a general debate in political and public circles currently that the upper gestational age limit ought to be reduced from 24 weeks to 22 or 20. This is due to the realisation that advances in neonatal care are improving the survival rates of some premature infants born around this time, setting up an environment of moral concern that babies that could survive are having their lives ended. 4-dimensional ultrasound also appears to show 20-week gestation fetuses displaying complex behaviours, prompting a call for a shift from viability as the main criterion, towards sentience.[4] Currently, the British Medical Association (BMA) does not favour a reduction in the gestational age limit for TOP.[5]

There is no upper limit on gestational time if there is:

    Risk to the mother's life.
    Risk of grave, permanent injury to the mother's physical/mental health (allowing for reasonably foreseeable circumstances).
    Substantial risk that, if the child were born, it would suffer such physical or mental abnormalities as to be seriously handicapped. Such TOPs must be conducted in an NHS hospital.

<1% of TOPs are performed after 20 weeks. This is usually following amniocentesis, or in very young girls who have concealed or not recognised the pregnancy

Abortion in girls under 16 years

In girls aged under 16 years, form HSA1 must be signed by two doctors. GMC guidelines are that girls <16 years may be able to reach an informed decision depending on their capacity to comprehend everything involved in the procedure. However, in those cases where a competent underage girl refuses termination, it may be possible for a parent or guardian to authorise termination if it is in the girl's best interests - see separate article Consent to Treatment in Children (Mental Capacity and Mental Health Legislation). In Scotland, parental consent cannot be given if a competent girl has refused termination. In girls <16 years deemed unable to reach an informed decision, a parent or guardian may give consent to, or refuse, termination. However, you may ask a court to overrule if you believe that it is not in the child's best interests to consent to, or refuse, treatment.[1]
It is strongly recommended that you seek medico-legal advice from your medical indemnity organisation regarding your statutory and ethical duties, and the rights of patients and/or their parents, regarding TOP in girls aged <16 if you have any uncertainty.

Before termination

    Confirm the patient is pregnant.
    Counsel to help her reach the decision she will least regret.
    Ask her to consider the alternatives (eg, adoption); ask about her partner (but note that the partner cannot consent to, or refuse, termination).
    Ideally, allow time for her to consider and bring her decision to a further consultation. However, remember that the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines state that 'the earlier in pregnancy an abortion is performed, the lower the risk of complications. Services should therefore offer arrangements that minimise delay'.

If she chooses termination:

    Screen for chlamydia (25% postoperative salpingitis if untreated).
    Discuss future contraceptive needs (start the pill next day or insert an intrauterine contraceptive device (IUCD).
    Check rhesus (Rh) status - if negative, anti-D is needed.
    Offer follow-up - there may be problems around the time she would otherwise have delivered.

Royal College of Obstetricians and Gynaecologists guidelines[6]

    All women should have access to a clinical assessment.
    There should be a pathway to tertiary medical care for women with significant medical conditions.
    There should be arrangements to minimise delay - eg, direct access from referral sources other than GPs.
    Women who decide to continue their pregnancy should be referred for antenatal care immediately.
    All women should be offered an assessment appointment within five working days of referral.
    All women should undergo an abortion within five working days of the decision to proceed.
    No woman should wait longer than three weeks from initial referral to the time of her abortion.

Blood tests

Pre-abortion assessment should include:

    Measurement of haemoglobin level.
    Determination of ABO and Rh blood groups.
    Screening for other conditions as clinically indicated - eg, haemoglobinopathies, hepatitis B virus, HIV.
    Cervical screening.

Ultrasound scanning

All services must have access to scanning, as it can be a necessary part of pre-abortion assessment, particularly where gestation is in doubt or where extrauterine pregnancy is suspected. When ultrasound scanning is undertaken, it should be in a setting and manner sensitive to the woman's situation. It is inappropriate for pre-abortion scanning to be undertaken in an antenatal department alongside women with wanted pregnancies.

However, ultrasound scanning is no longer considered to be an essential prerequisite of abortion in all cases.[6] This is because medical TOP is now used at all gestations, so accurate dating of the pregnancy within the first trimester is no longer essential.

The abortion procedure

Ideally, services should offer a choice of methods for the relevant gestational age.

Antibiotic prophylaxis and/or infection screening with treatment should be offered. Regimens include metronidazole 1 g rectally at the time of abortion, plus doxycycline 100 mg bd for seven days starting post-abortion, or metronidazole 1 g rectally at the time of abortion plus azithromycin 1 g orally on the day of abortion.[6]

At under 7 weeks of gestation

    Avoid conventional suction termination.
    Medical abortion using mifepristone plus prostaglandin is appropriate - eg, mifepristone 200 mg orally followed 36-48 hours later by misoprostol 800 micrograms vaginally buccally or sublingually.
    A further dose of misoprostol (the dose varies with gestation) may be given, if required, after four hours.
    This has been found to be safe, effective and with no adverse outcomes for subsequent pregnancies.[7]
    Early surgical abortion using rigorous published protocol (to include visual inspection of tissue) may be appropriate.

At 7-15 weeks of gestation

    Medical abortion is now considered appropriate at any gestation. The regime is initially as outlined above. Repeat doses of misoprostol (400 micrograms) are given, if required at 3- to 4-hourly intervals.
    Conventional suction termination is appropriate at 7-15 weeks, although medical abortion may be preferable above 12 weeks.
    The uterus should only be emptied with suction cannula and blunt forceps.
    Local anaesthesia for suction termination may be safer than general anaesthesia.
    Cervical priming should be considered in all cases having surgical procedure, but should be routinely used where gestation is >10 weeks or the woman is under 18 years of age. Mifepristone can be used, but osmotic dilators are superior after 14 weeks of gestation.
    Surgical evacuation of the uterus is only necessary if there is clinical evidence of incomplete abortion.

Terminations at greater than 15 weeks of gestation

    Dilatation and evacuation, preceded by preparation, are safe and effective when undertaken by expert hands.
    Medical abortion may be a preferable alternative using mifepristone 200 mg orally followed 36-48 hours later by misoprostol 800 micrograms vaginally every three hours to maximum of four further doses.
    Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation.

Aftercare

Medical

Anti-D IgG to all non-sensitised RhD-negative women. Discuss contraception and supply if accepted.

Written

Provide a list of possible symptoms, highlighting those that need urgent medical attention, with a 24-hour number where it can be obtained. Also, a letter with enough details to allow another doctor to be able to deal with any complications. Arrange a follow-up appointment for within two weeks and further counselling for the small number of women who experience long-term distress.

Complications of abortion

The most common complications are:

    Infection: up to 10% of terminations are reduced by prophylactic antibiotics or pre-procedure screening for infection.
    Cervical trauma: 1%, lower when termination is performed early.

Uncommon complications are:[6]

    Haemorrhage (severe requiring transfusion) - 1/1,000 (1st trimester) - 4/1,000 (beyond 20 weeks).
    Perforation of uterus - 1-4/1,000.
    Failed termination - 2.3/1,000 surgical, 6/1,000 medical.

There is no clear evidence to link abortion and breast cancer, preterm delivery or subsequent infertility.
Psychological effects

Only a small proportion of women experience long-term adverse psychological sequelae. Although early distress is common, it is usually a continuation of the symptoms present before the abortion. There is also evidence of the negative effects on both the mother and the child where abortion has been denied.

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Barriers to abortion create stress, financial strain for Island women: advocates

Women take part in a protest as pro-choice demonstrators rally at the New Brunswick legislature in Fredericton on Thursday, April 17, 2014. Barriers to abortion are creating stress and financial strain for Prince Edward Island women according to advocates. THE CANADIAN PRESS/David Smith

It was when Sarah was getting instructions on finding the unit at the New Brunswick hospital where she would undergo an abortion that she realized the lengths women from P.E.I. have to go to obtain the procedure.

The young woman, who didn't want to use her real name, was on the phone for more than an hour as a nurse explained how to navigate the hospital's maze of hallways, and what would happen once she arrived.

She made the call discreetly, not wanting her boss to know she would take a day off to make the two-hour trip to the Moncton Hospital to end an unwanted pregnancy.

Upset and nervous, the 26-year-old secretly lined up a drive with a friend and arranged to stay in a hotel in Moncton so she would be on time for her 6 a.m. appointment.

"That's when it hit me what I was going through," she said in an interview.

"You feel isolated and shunned — it hurts your feelings and it just doesn't make sense in this day and age. It just seems like, why wouldn't you help women here?"

It is a ritual that plays out routinely for women in the only province in Canada that does not provide surgical abortions within its borders, and one that pro-choice advocates say remains fraught with challenges despite pledges by the provincial government to remove barriers to abortion access.

Liberal Premier Wade MacLaughlan announced soon after his election in May that women from P.E.I. would be able to get surgical abortions in Moncton without the need for a doctor's referral, a measure that received guarded praise from pro-choice advocates.

Under the arrangement, women who are less than 14 weeks pregnant can call a toll-free line for an appointment and have everything done in one day, when possible.

Previously, women needed a doctor's approval and had to have blood and diagnostic work done on the Island before travelling almost four hours to Halifax for the operation. Or they could go to a private clinic and pay upwards of $700 for the procedure.

Abortion rights advocates say both are costly and stressful options for women, who rely on volunteers to do everything from finding people to accompany them to the hospital to arranging childcare.

Becka Viau of the Abortion Rights Network helps women figure out requirements for bloodwork and pinpoint how far along they are in their pregnancy, as well as line up drivers, babysitters and meals while raising funds to cover things like the $45 bridge toll, phone cards and lost wages.

"The pressure on the community to carry the safety of Island woman is ridiculous," she said. "You can only look at the facts for so long to see the kind of harm that's being done to women in this province by not having access."

Still, for some MacLauchlan's announcement was a significant change for a province that has fought for decades to keep abortions out of its jurisdiction, with some seeing it as the beginning of the end of the restrictive policy.

Some say opposition to abortion access is quietly waning on the Island, where it is not uncommon to see pro-choice rallies and political candidates.

Colleen MacQuarrie, a psychology professor at the University of Prince Edward Island who has studied the issue for years, said the Moncton plan had been discussed with former premier Robert Ghiz and was considered a first step toward making abortions available in the province.

But a month after those discussions, Ghiz resigned. Reached at his home, he refused to comment on the talks but said everything was on the table.

"We've created the evidence and we've gotten community support," said MacQuarrie, who published a report in 2014 that chronicled the experiences of women who got abortions off Island.

"It has gotten better, but better is not enough. We need to have local access."

Rev. John Moses, a United Church minister in Charlottetown, published a sermon that condemned abortion opponents for not respecting a woman's right to control her health and called on politicians to "stop ducking the issue."

"To tell people that they can't or to make it as difficult as we possibly can for them to gain access to that service strikes me as a kind of patriarchal control of women's bodies," he said in an interview.

"It's a cheap form of righteousness."

Holly Pierlot, president of the P.E.I. Right to Life Association, says she's concerned about the easing of restrictions and plans to respond with education campaigns aimed specifically at youth.

"Politically, we've certainly got a bit of a problem," she said. "We were disappointed by the new policies brought in by the provincial government and we are concerned by the federal move to increase access to abortion."

Horizon Health in New Brunswick says the Moncton clinic saw 61 women from P.E.I. from July through to Nov. 30.

P.E.I. Health Minister Doug Currie did not agree to an interview, but a department spokeswoman says that from April to October the province covered 44 abortions in Halifax and 33 in Moncton.

"The government made a commitment to address the barriers to access and they acted very quickly on it," Jean Doherty said.

It's not clear whether that will be enough to satisfy the new federal Liberal government under Prime Minister Justin Trudeau, who told the Charlottetown Guardian in September that "it's important that every Canadian across this country has access to a full range of health services, including full reproductive services, in every province."

The party also passed a resolution in 2012 to financially penalize provinces that do not ensure access to abortion services.

In an interview, Federal Health Minister Jane Philpott would only say the issue is on her radar.

"This is something I am aware of, that I will be looking into and discussing with my team here and with my provincial and territorial counterparts," she said.

Successive provincial governments have argued that the small province cannot provide every medical service on the Island or that there are no doctors willing to perform abortions, something pro-choice activist Josie Baker says is untrue.

"We're tired of being given the run around when it comes to a really basic medical service that should have been solved 30 years ago," she said.

"The most vulnerable people in our society are the ones that are suffering the most from it. There's no reason for it other than lack of political will."
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Abortion in Tennessee Factsheet

Abortion stigma is a shared belief that abortion is morally wrong and/or socially unacceptable. Abortion stigma has disastrous consequences. People seeking abortions are bullied, shamed, marginalized, and sometimes even prevented by law or intimidation from seeking safe health care services. Abortion providers are harassed, dehumanized and targeted by regulation and anti-abortion advocates. Stigma leads to the social, medical, and legal marginalization of abortion care around the world and is a barrier to access to high quality, safe abortion care. http://seachangeprogram.org/whats-new

In 2011, 16,720 women obtained abortions in Tennessee, producing a rate of 13.1 abortions per 1,000 women of reproductive age. The rate decreased 15% since 2008, when it was 15.3 abortions per 1,000 women 15-44. Abortions in Tennessee represent 1.6% of all abortions in the United States. (Source: Guttmacher Institute)

In 2011, 113,900 TN women became pregnant; 70% of these pregnancies resulted in live births, 15% in induced abortion. This is below the national average which was 67% live births and 18% in abortions. (Source: Guttmacher Institute)

In Tennessee, the following restrictions on abortion were in effect prior to Amendment 1 as of November 1, 2014:

    Health plans offered in the state’s Affordable Care Act health exchange may not provide coverage for abortion.
    Public/government funding is available for abortion only in cases of life endangerment, rape or incest.
    The use of telemedicine or the remote prescription of abortion medication is prohibited, i.e. abortion must be performed in the physical presence of the woman.
    At least one parent of a minor must consent before an abortion is provided.
    Abortion facilities must clearly post signs in 40 point Ariel font indicating that a woman cannot be “pressured, forced or coerced” to have an abortion against her will (TN Freedom from Coercion Act, passed 2010) http://www.capitol.tn.gov/Bills/106/Bill/SB3812.pdf
    Only a physician licensed or certified by the state, not a nurse or physician’s assistant, may perform an abortion.
    The Life Defense Act of 2012 requires clinics to report detailed demographic data on doctors and patients to the TN state government. http://data.rhrealitycheck.org/law/tennessee-life-defense-act-of-2012-hb-3808/
    Life Defense Act of 2012 requires doctors performing abortions at clinics to have hospital admitting privileges no further than an adjacent county away.

As of Dec 1, 2015 there were 7 abortion clinics in Tenneessee:

    Planned Parenthood – Nashville
    The Women’s Center – Nashville
    Bristol Regional Women’s Center – Bristol, TN
    Knoxville Center for Reproductive Health – Knoxville, TN
    Planned Parenthood – Knoxville, TN*
    CHOICES Memphis Center for Reproductive Health – Memphis, TN
    Planned Parenthood – Memphis, TN

*The Knoxville Planned Parenthood doesn’t do surgical abortions, but they do offer induced/medical abortions i.e. abortion induced with medication, which is most effective for first trimester abortions (9 weeks or earlier).

3 of the 7 clinics are run by Planned Parenthood. The Bristol Regional Women’s Center and The Women’s Center in Nashville are run by the same provider and are not clinics, just doctors offices, which makes them more vulnerable to regulation. CHOICES is an independently run nonprofit.

The total number of abortion providers in TN is down from 14 in 2011. http://www.guttmacher.org/pubs/sfaa/pdf/tennessee.pdf

In 2011, 96% of Tennessee counties had no abortion clinic. 63% of Tennessee women lived in these counties. http://www.guttmacher.org/pubs/sfaa/pdf/tennessee.pdf

How to self induce an abortion with the abortion pill and what to expect, see: Women on Waves. This is not legal in Tennessee. If you self induce and you need to seek medical assistance due to complications from the procedure, do not tell anyone that you tried to induce an abortion or you could be subject to criminal charges of attempted murder or murder.

pregnancies are calculated from the date of your last period, meaning on average 2 weeks of pre-conception time (in which there was factually no pregnancy) are included in the count. Everyone needs to be advised to never give a health provider their LMP (last menstrual period) but rather an estimated conception date and vague references to periods being irregular. This buys vital time for those deciding whether to keep a pregnancy, and protects those who do want to carry to term from unnecessary induced labor.

Tennessee provides funding to pregnancy resource centers (also called “abortion alternatives” or “crisis pregnancy centers”) through a Choose Life specialty license plate program. A license plate supporting women’s right to choose is not available. http://www.tn.gov/revenue/vehicle/licenseplates/miscellaneous/miscellaneous.shtml and http://www.nytimes.com/2009/04/28/us/28bar.html and has been opposed by the TN legislature in the past.

If you are considering an abortion, do not visit a crisis pregnancy resource center. They will not give you accurate information about abortion services and will try to talk you into choosing another option. They may also lie to you about the risks of abortion in order to dissuade you from obtaining one. (Source: NARAL) Moreover, they will try and delay you.  Their delay tactics cost precious weeks of decision making. If you wait too long, you will not be able to access an abortion legally in TN because abortion is illegal after viability (20-24 weeks).

Pregnancies are calculated from the date of your last period, meaning on average 2 weeks of pre-conception time (in which there was factually no pregnancy) are included in the count. Everyone needs to be advised to never give a health provider their LMP (last menstrual period) but rather an estimated conception date and vague references to periods being irregular. This buys vital time for those deciding whether to keep a pregnancy, and protects those who do want to carry to term from unnecessary induced labor.

The risk of death associated with childbirth is approximately 14 times higher than that with abortion in the U.S. The pregnancy-associated mortality rate among women who delivered live babies was 8.8 deaths per 100,000 live births. The mortality rate related to induced abortion was 0.6 deaths per 100,000 abortions. (Source: US National Institutes of Health)

An abortion-related death is defined as a death resulting from a direct complication of an abortion (legal or illegal), an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychological effects of abortion.

Screen Shot 2015-12-18 at 1.50.30 PM
(Source: CDC; 2009 is most recent data available)

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Texas Abortion Case Isn't About Abortion, But The Rule Of Law

Whole Woman’s Health v. Cole, the Texas abortion case that is now before the Supreme Court, is really about the rule of law and how federal judges maintain it by holding states to external standards. The case follows Planned Parenthood of Southeastern Pa. v. Casey, which forbade states from using the desire to protect women’s health as a pretext for curtailing their access to abortion services. But how is a judge to distinguish a pretext from a genuine concern for patient safety?

Casey seemed to say that unless all possible connections between a regulation and patients’ wellbeing can be ruled out completely, a state’s proffered reason is bona fide. That’s far too weak a standard, and later cases seemed to confirm it by saying that states don’t have to show that their laws will actually protect women from documented perils. Seeing this, Texas and other pro-life states have done exactly what Casey forbids. They’ve enacted laws that shut down abortion clinics while shouting “Women are in danger! Women are in danger!” The issue in Cole is whether states must prove that access-impeding laws address real safety problems. If the Court says no, Casey will be a dead letter.

It should be plain to everyone that lawmakers won’t respect constitutional limitations on their own. Politics is a brass-knuckles world. The people who thrive in it aren’t rule-followers by nature, and their incentives are terrible. When they can gain by doing something, they will, the Constitution be damned. That’s where judges come in. They’re supposed to keep lawmakers in line by delivering swift kicks to their posteriors when they violate the Constitution.

If you own a gun, attend church, express opinions on Islam, read books, browse the internet, use birth control, listen to hip-hop, play violent video games, watch movies, oppose America’s foreign wars, or exercise any other civil liberty, you should want judges to apply their boots as needed. Millions of Americans would love to curtail your freedoms. Lucky for you that there’s a line beyond which the will of the people cannot reach, and that judges enforce it.

Cole asks about the need for an enforcer in the context of abortion. Must courts “consider whether and to what extent laws that restrict abortion for the stated purpose of promoting health actually serve the government’s interest in promoting health?” Of course! The Constitution protects a personal space into which a state may not stick its nose without a good reason. But a state cannot have a good reason unless the policy it wants to enact will do what it claims. Here, Texas says it wants to protect women from conditions that endanger their health. If this is true, Texas should be able to identify documented risks and show that its law will reduce them.

As obvious as this may seem, courts have generally allowed states to handle safety as they see fit. Consider Roe v. Wade, the decision that identified a protected right of access to abortion services during the first trimester. It recognized that a state “has a legitimate interest in seeing to it that abortion, like any other medical procedure, is performed under circumstances that insure maximum safety for the patient,” and it added that this “interest obviously extends at least to the performing physician and his staff, to the facilities involved, to the availability of after-care, and to adequate provision for any complication or emergency that might arise.” Roe v. Wade cemented the propriety of public micro-management of the delivery of health care for the purpose of protecting patients.
 Roe’s reference to “maximum safety” empowers states to do all sorts of mischief. Nobody wants “maximum safety” because it costs too much. Who would spend $1 million to reduce the risk of a post-abortion infection by .00001%? But by allowing states to require “maximum safety,” Roe enables them to say: “Pay the $1 million or forego the procedure.”

That’s what Texas did. Its 2013 statute is a cost-magnifying, job-killing work of art—but Texas Republicans don’t care because the jobs belong to abortionists. The law subjects abortion clinics to the same building requirements that apply to ambulatory surgical centers. Knowing that their patients can’t afford the prices they’d have to charge to cover the cost of reconstruction, many clinics closed. Others succumbed because the doctors who staff them couldn’t obtain admitting privileges at nearby hospitals, which Texas’ new law also requires. Similar regulations closed all but one of Missouri’s abortion facilities, and would have closed all of Cincinnati’s clinics had Ohio’s health department not granted a last-minute exemption.

Texas Attorney General Ken Paxton thinks it’s just fine to saddle abortion clinics with high costs. “The advancement of the abortion industry’s bottom line shouldn’t take precedence over women’s health,” he contends. What a clever gambit. To put abortionists out of business, Texas’ lawmakers need only declare that women deserve the finest health care money can buy. Who but a misogynist would quarrel with that?
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Let's talk about abortion

The Green Party recently proposed that abortion be available on demand up to 20 weeks’ gestation, and up to birth where there is risk to the mother’s mental health or a foetal abnormality. These changes would significantly liberalise New Zealand law and were met with strong opposition. Given that abortion rates in New Zealand have reduced in the past decade and that more than 98 per cent of abortions are approved on grounds of maternal mental health, there was little support for a law change.

The Green’s policy posed another important challenge overlooked in the abortion debate: the need to protect a woman’s choice to continue a pregnancy and to be supported to do so. The Greens said they would do this by making more counselling and income support available. But there are deeper questions for those who would see abortion rates reduce even further. Do we understand why women consider terminating their pregnancy, and are we satisfied that they have real alternatives available?

Abortion is legal in New Zealand only when two certifying consultants agree that continuing the pregnancy would result in serious danger to the woman’s mental or physical health or that the baby would have a serious disability. The consultants may also consider the woman’s age and whether the pregnancy is the result of rape or incest. If a decision is made to permit an abortion to proceed, counselling is offered before the woman makes her final decision.

We have seen a real decrease in the rate of abortion in New Zealand in recent years. In 2012, there were 14,745 abortions performed (or 16.1 abortions per 1000 women aged 15–44 years). This was the lowest number since 1995 (13,652). Women aged 20–24 years accounted for 30 per cent of abortions in any year over that period, but this dropped from a peak of 41 abortions per 1000 in 2003, to 29 in 2012. There has also been a notable decrease in the abortion rate for women aged 15–19 years—down from 27 per 1000 in 2007, to 16 in 2012.

But a significant number are still choosing to terminate an unwanted pregnancy. In more than a third of cases, women have chosen to terminate a second pregnancy, and a third of that group have chosen to do so a third time.

The Salvation Army believes life is a gift from God and that we are answerable to God for the taking of life. We, like many other churches, accept the moment of fertilisation as the start of human life. We believe society has a responsibility to care for others, and especially to protect and promote the welfare of vulnerable people, including unborn children. This responsibility also extends to those women faced with unwanted pregnancy who may consider abortion—they are also vulnerable and need our care and support.

Our statistics with respect to child and family vulnerability are troubling. An estimated 285,000 children live in poverty in New Zealand. An estimated 20–30,000 children are at risk of maltreatment, abuse or neglect, and 4000 come under CYF care annually after substantiated findings of maltreatment. Before we condemn decisions to abort, we need to understand that adding another vulnerable child to these statistics may be the alternative unless something practical is done to support a different outcome.

The Salvation Army has supported women who found value in choosing not to abort when this at first seemed to be the only option. The following personal stories are real, and shared with permission (names have been changed for privacy reasons).

Moira came into a Salvation Army centre seeking food parcel assistance. She was struggling to cope with the day-to-day demands of managing on a limited budget. Moira had a strained relationship with a young man, who was not the father of her children. She became pregnant and was overwhelmed with the prospect of another child to look after with no real support. Abortion seemed the only option and one that was easy to obtain.

Moira joined a Salvation Army ‘life skills group’ for young mums and came to its weekly ‘home group’—a meal and Bible study one night per week. As she began to feel better supported, Moira decided that abortion was just not for her. She went on to have the baby, who was adopted out to a couple with fertility problems. Moira has continued to flourish and sees her adopted-out baby occasionally.

Jan had twin daughters. When they were three, her relationship with their father broke up. After this, she got into several unhealthy relationships, eventually becoming pregnant to a man with a number of other children to several women, who was not contributing to the care of any of them. Jan saw that his promises to care for her were shallow and hollow and decided that abortion was the only way out.

Some months after aborting the pregnancy, Jan suffered a severe emotional and mental breakdown. She attempted suicide and was hospitalised for several weeks. This was followed by sessions with a psychiatrist and ongoing counselling from The Salvation Army.

Jan made good progress and then became pregnant again, this time to a young man who wasn’t able to commit to any sort of relationship. She hadn’t been into the Salvation Army centre for some time and felt embarrassed to come back, but after much encouragement was helped to explore the options for her baby. Jan desperately wanted this baby (a boy) to grow up with a father. Her daughters had regular visits with their dad and she felt it vital that her son have this as well, yet she knew she couldn’t be in a relationship with his father.

Jan came to the decision that adoption was the best way forward. She had her baby, who was placed with a couple in an open adoption. The Salvation Army provided family therapy to help Jan’s girls understand what was happening, and counselling to help Jan work through the adoption process. Jan went on to find a stable relationship. She has since married and has another little boy.

The Salvation Army is successful in supporting women to pursue choices other than abortion, with positive outcomes for mother and child. Sometimes we provide continued support when people take paths we may not have wished for them. It is not our role to judge, but we can provide real options that assure life and wellbeing for mother and baby.

Abortion is an issue that will continue to spark public debate. What will Salvationists do to respond? Our beliefs need to be seen in action if we hope to influence people’s choices. We can: 

    show love, compassion and fellowship, not judgement, to those we meet who are faced with an unwanted pregnancy
    be prepared to journey in love with all those affected, recognising the decision to terminate a pregnancy carries emotional and physical implications for many years, often damaging relationships and personal self-worth
    provide practical support to address poverty or family dysfunction, which may be a factor in deciding to terminate a pregnancy 
    advocate for a society that promotes wholeness, freedom, quality of life and the development of every person’s potential.
Collect by: http://tinyurl.com/hstppmj

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