Joint Hearing on "Partial-Birth Abortion: The Truth"
March 11, 1997
Testimony by Vicki Saporta
National Abortion Federation
Executive Director
The National Abortion Federation (NAF) is the oldest and largest professional association of abortion providers, representing medical professionals at over 300 clinics and physicians' offices throughout the United States and Canada. Their primary goal, and ours, is to ensure the quality and accessibility of abortion services. We are pleased to submit this testimony for the written record on the joint hearing, entitled "Partial-Birth Abortions: The Truth," held on March 11, 1997, by the Senate Judiciary Committee and the House Judiciary Subcommittee on the Constitution.
We appreciate having this opportunity to set the record straight. To begin with, what you have asked us to testify about -- so-called "partial birth abortion" -- is not a medical procedure that is defined anywhere in the scientific, medical literature. Rather, it is an inflammatory term intended by anti-choice groups to obscure medical reality and conceal the harm that will result if this proposed legislation is enacted.
It is difficult to determine what medical procedures in fact would be prohibited by this vague and ambiguous proposed legislation (S.6/H.R.929). Although these vaguely worded bills may encompass a medical procedure known as intact dilation and evacuation ("intact D&E") as performed by some physicians, they may also encompass other medical procedures that are performed in second and third-trimester abortions. Moreover, the bills make no distinction between abortions performed before viability and those that are performed after viability. As we have pointed out from the earliest days of the debate, intact D&Es are used both before and after fetal viability.
Putting aside the very critical ambiguities and weaknesses inherent in this proposed legislation, it is important to identify what this proposed legislation will and will not do. This proposed legislation does nothing to reduce the number of abortions that are performed at any stage of pregnancy. What it will do is force a woman and her doctor to make decisions not on the basis of what is in the woman's best medical interest given her specific circumstances, but rather on the basis of what Congress has dictated.
The anti-choice groups want Congress to believe that women are seeking abortions in their eighth and ninth months of pregnancy so that, as propaganda from the National Conference of Catholic Bishops implies, they can fit into their prom dresses. Such outrageous and insulting claims are an affront to women who have needed abortions late in their pregnancies to preserve their lives or their health.
More generally, this proposed legislation is part of a larger effort by abortion opponents to eliminate women's access to abortion, procedure by- procedure. Indeed, Representative Chris Smith is quoted in USA Today, on November 1, 1995, saying: "[W]e will begin to focus on the methods [of abortion] and declare them to be illegal."
The decision to have an abortion at any stage of pregnancy is a highly personal decision. Before viability, a woman's right to have an abortion is constitutionally protected. And even after fetal viability, there are women who need abortions to preserve their lives or health, including cases of severe fetal anomalies. Their decisions, too, are constitutionally protected.
Women, in consultation with their physicians, must be permitted to make these difficult personal decisions with access to the procedures that are best suited to their specific circumstances. Banning a specific method of abortion, such as intact D&E, prevents physicians from using the procedure that best suits a patient's particular medical circumstances. It is only physicians in consultation with their patients -- not Congress -- who are qualified to make these medical determinations. The government should not intrude into the sphere of medical decision-making at the expense of women's lives and health.
More recently, anti-choice groups have attempted to obscure the harm that this bill could cause women and their families by diverting attention to such issues as the specific number of times this procedure is performed or the precise moment at which fetal demise occurs. It is regrettable that the substance of the debate has been sidetracked by these issues.
In the few days before hearings on HR. 1833 in June of 1995, we received requests from Congressional staff and members of the press to provide an estimate of how many intact D&E procedures took place each year. To our knowledge, no national statistics were (or are now) maintained in a thorough and consistent manner by type of abortion procedure. Therefore, in an effort to respond to these requests, we contacted several physicians, including the two leading authorities on this procedure, Dr. James McMahon and Dr. Martin Haskell. Based on the information these physicians provided, we reached an estimate of the number of intact D&E's performed each year. This estimate represented our good faith effort to respond to these inquiries based on the best information we had at the time.
In September 1996, press reports suggested that the number of intact D&E's was higher than we originally estimated. As a result, we attempted to obtain a revised estimate. What we concluded was that this task was impossible. Because of the absence of national statistics, because we are not aware of every doctor who performs intact D&E's (some of whom may elect not to come forward for fear of harassment or even violence), and because of questions raised by physicians regarding what precisely qualifies as an intact D&E, we recognized that an accurate estimate could not be obtained. What we do know is that statistics collected by the Alan Guttmacher Institute, and recognized by the Centers for Disease Control and Prevention, state that 89 percent of all abortions are done in the first trimester, when intact ME is not used. Those statistics also show that only about one percent of all abortions occur after the 20th week.
In another effort to sidetrack the debate, abortion opponents have attempted to shift the focus away from the harm this bill could cause by focusing instead on the precise moment at which fetal demise occurs during intact ME procedures. In 1995, we relied on statements of one of the physicians who pioneered intact ME to the effect that anesthesia and/or the combination of steps taken to prepare for the procedure leads to neurological fetal demise. We later learned that the American Society of Anesthesiologists disagreed with this assertion. What further complicates the issue is that physicians do not routinely record the moment of fetal demise. Nonetheless, NAF agrees with the testimony of Dr. Norig Ellison, president of the Society, that pregnant women can undergo surgeries and deliveries safely with anesthesia when the objective of the surgery is not to affect the fetus.
It is clear that the anti-choice lobby has focused on numbers and the precise manner in which intact D&E's are performed as a tactic to distract Congress from understanding that intact D&E's are an appropriate medical procedure that must remain available to women who need them. If the focus is maintained on this fundamental issue, Congress could not, in good conscience, support the proposed ban.
During the House and Senate hearings in 1995, we heard from some of the women who needed intact D&E's. The women, who came from a variety of religious and political backgrounds, told us about their personal tragedies. They told us how excited they had been to find out they were going to have a baby, only to be devastated to discover serious fetal anomalies that were incompatible with life. They shared with us the profoundly difficult and agonizing decisions they had faced. They spoke about making the best decisions they could with the medical advice of their doctors. They underwent the procedure which was recommended as medically appropriate for them, intact D&E.' Some of the women went on to get pregnant again and to have healthy babies. Neither Dr. Cook nor any other PHACT doctors have ever reviewed a single one of these women's medical charts and physically examined them. They cannot responsibly say that intact D&E's were not medically indicated in their specific situations.
These women shared their deeply personal experiences with all of us so that other women who find themselves in similar tragic circumstances will have the same medical options available to them. The government should not eliminate from a physician's alternatives a medical procedure, which for some women may be the best and most appropriate course of treatment. We ask that Congress look at this issue with compassion and common sense, and not permit anti-choice groups to eliminate abortion rights and physicians' medical treatment options one procedure at a time. Government intrusion into medical decision-making by banning intact D&E procedures puts women's health and lives at risk.
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