Gynecology: More Abortions: The Reasons Why

The growing use of more reliable methods of birth control, notably “the pills,” might be expected to cut down the number of U.S. abortions. But abortions are on the rise. Many doctors agree with the estimate made by Johns Hopkins’ Dr. Harold Rosen,* an expert on the subject. His estimate is that frankly illegal abortions, ranging from $50 back-room jobs to $1,500 opera tions performed by skilled surgeons, will rise some 10% this year to a total well over 1,500,000. Also increasing, by at least 10%, is the much smaller but significant number of medically acceptable “therapeutic abortions,” performed in good hospitals, to protect the pregnant woman. Doctors expect them to exceed 18,000 this year.

Abortion is illegal everywhere in the U.S., but 45 states make an exception if physicians are convinced that it is necessary to save a woman’s life. Some medical men interpret the laws liberally to protect not only the woman’s life but also her health — and the health of her expected child. If the laws are narrowly construed, many of the therapeutic abortions now being performed in first-rate hospitals by reputable doctors are technically illegal.

Two Disasters. After a decline in therapeutic abortions for almost two decades, thanks to medical progress, two disasters spurred the current increase. First was the thalidomide tragedy, which left some 10,000 European babies deformed or crippled, and in the U.S. led to the publicized case of Sherry Finkbine, who went to Sweden to be aborted. The other was an even worse disaster: the German measles (rubella) epidemic that began late in 1963 in New England. It moved slowly across the U.S., is still claiming victims in the Pacific states, and is expected to leave more than 30,000 U.S. babies stillborn or crippled. Doctors widely disagree as to what proportion of women who get the infection early in pregnancy will bear blind or deformed babies. The most authoritative estimate, from Johns Hopkins’ Dr. Alexander J. Schaffer, places it at 40% if the mother catches the infection in the first month of pregnancy, declining to 10% in the third month.

A number of doctors argue that German measles is no valid reason for abortion. Says Tulane’s Dr. Isadore Dyer, a chief of obstetrics at New Orleans’ vast Charity Hospital: “If between 10% and 20% of the women who contract the disease in those first three months are going to have babies with anomalies, it seems rather drastic to destroy the other 80% or 90% to guard against this.” Other physicians take precisely the opposite view. Dr. Daniel G. Morton, obstetrics chief at the University of California Medical Center in Los Angeles, states frankly: “Therapeutic abortions have been done here for German measles and other reasons.” Among the “other reasons” accepted at many medical centers are rape and incest.

Psychological Hangover. By far the commonest reason, wherever the law is liberally construed, is not the physical condition of the mother-to-be but her mental state. Many pregnant women insist that if they are forced to carry and bear an unwanted child, they will go mad or commit suicide. The majority who claim this are married women who have had as many children as they want. Few of those who see their pregnancies through ever suffer from mental breakdowns; similarly, few who get legal abortions are left with a severe psychological scar. But psychiatrists and other doctors tend to agree that women who desperately seek illegal abortions almost inevitably suffer from a “postabortion hangover.” Says Manhattan Psychoanalyst Leah Schaefer: “Sometimes a woman feels so guilty that she blames everything, especially a subsequent difficult birth, on her having had an illegal abortion.”

Most hospitals have committees of three to seven physicians to pass on staff members’ recommendations for therapeutic abortions. But the boards have vastly different standards. Says Dr. Rosen: “The definitions of valid reason for abortion vary from physician to physician, from hospital to hospital, and from day to day within the same hospital. The board of one hospital may refuse to accept a recommendation, yet the same application may be almost immediately submitted to the board of an adjacent hospital—with, at times, almost the same staff—and be approved.”

If a woman is turned down on all sides but has enough money, she can go to Scandinavia, Switzerland or Japan, where a legal abortion is easier to obtain, or to Mexico or Puerto Rico, where abortions are technically illegal but relatively easy to arrange, under medical auspices, for $150 to $300.

Changing the Law. Because U.S. laws are confusing and frequently disregarded, the American Law Institute has recommended a model abortion code. It would legalize abortions performed in licensed hospitals if at least two physicians agree that there is substantial risk of grave damage to the mother’s physical or mental health, or of the child’s being born with a grave physical or mental defect, or when the pregnancy results from rape or incest. This would legalize abortions in the German-measles cases. Bills to amend the law along these lines were introduced, but failed, in New York and California.

With the moral and philosophical issues of legal abortion still in hot debate, few legislators are willing to campaign openly for changes in the law. Perhaps, says Columbia University’s Dr. Robert E. Hall, it is up to obstetricians to do so—because they are the people who are stretching or breaking the law. To that end, many prominent physicians, sociologists and clergymen have formed the Association for the Study of Abortion. Its first president, appropriately, is Obstetrician Hall.

*Editor of Therapeutic Abortion (Julian Press; $7.50), which, though published in 1954, is still one of the best compilations on the subject.