[1] Article: “Abortion Poll: Not Clear-Cut; Wording of a Question Makes a Big Difference.” By E.J. Dionne, Jr. New York Times, August 18, 1980. Page A15. <www.nytimes.com>

What do the American people think about abortion? It depends on how you ask them the question. …

Do you think there should be an amendment to the Constitution prohibiting abortions, or shouldn’t there be such an amendment? … Yes [=] 29% … No [=] 67% …

Do you believe there should be an amendment to the constitution protecting the life of the unborn child, or shouldn’t there be such an amendment? Yes [=] 50% … No [=] 39% …

For facts about what constitutes a scientific survey and the factors that impact their accuracy, visit Just Facts’ research on Deconstructing Polls & Surveys.

[2] Book: The Practice of Statistics (4th edition). By Daren S. Starnes, Daniel S. Yates, and David S. Moore. W. H. Freeman and Company, 2010.

Page 224:

The wording of questions is the most important influence on the answers given to a sample survey. Confusing or leading questions can introduce strong bias, and changes in wording can greatly affect a survey’s outcome. …

Don’t trust the results of a sample survey until you have read the exact questions asked. The amount of nonresponse and the date of the survey are also important. Good statistical design is part, but only a part, of a trustworthy survey.

[3] Article: “Erase the Words, Change the Language and You Can Control the Debate and Rewrite History.” By Evie Loveband. Idiom, 2012. Pages 44–45. <search.informit.com.au>

Abstract:

Language is power; power for influencing society, shifting reality, rewriting history, undermining perspectives and establishing solidarity. One can manipulate language for the purpose of gaining and maintaining authority or employ disguising and distorting expressions to veil the truth. Nonetheless, language too can be utilised as a tool to promote equality, to build allegiance and to endorse unity in our society. With careful selection of and modification to language, any one user has the power to control the debate and rewrite history.

[4] Entry: “child.” Merriam-Webster. Accessed September 9, 2023 at <www.merriam-webster.com>

Definition 3a: “an unborn or recently born person.”

[5] Entry: “fetus.” Black’s Medical Dictionary (41st edition). Scarecrow Press, 2006. Pages 269–270.

Page 269: “The name given to the unborn child after the eighth week of development.”

[6] Entry: “baby.” Merriam-Webster. Accessed September 9, 2023 at <www.merriam-webster.com>

Definition 1a: “an extremely young child; especially: infant.”

[7] Entry: “neonatal intensive care.” Black’s Medical Dictionary (41st edition). Scarecrow Press, 2006.

Page 487: “The provision of a dedicated unit with special facilities, including one-to-one nursing and appropriate technology, for caring for premature and seriously ill newborn babies.”

[8] Entry: “fetus.” Merriam-Webster’s Collegiate Dictionary, Encyclopædia Britannica Ultimate Reference Suite, 2004.

The etymology of this word is: “Middle English, from Latin, act of bearing young, offspring; akin to Latin fetus newly delivered, fruitful—more at feminine.”

[9] Entry: “fetus.” Dorland’s Illustrated Medical Dictionary (29th edition). W. B. Saunders Company, 2000.

Page 661: “the unborn offspring in the postembryonic period, after major structures have been outlined, in humans from nine weeks after fertilization until birth.”

[10] Entry: “fetal.” Dorland’s Illustrated Medical Dictionary (29th edition). W. B. Saunders Company, 2000.

Page 661: “of or pertaining to a fetus; pertaining to in utero development after the embryonic period.”

[11] Textbook: Langman’s Medical Embryology (9th edition). By T. W. Sadler. Lippincott Williams & Wilkins, 2004.

Page 117: “The period from the beginning of the ninth week to birth is known as the fetal period.”

[12] For example, in April of 2001, the U.S. House of Representatives passed the “Unborn Victims of Violence Act.” This bill would have made it a crime for people to harm a “child in utero” except for an abortion done with the consent of the mother. The bill defines a child in utero as “a member of the species homo sapiens, at any stage of development, who is carried in the womb.” In their coverage of this vote, CNN, Reuters, the New York Times, the Washington Post, ABC, USA Today, MSNBC, and CBS all used the word “fetus” or “fetal” as a blanket phrase for humans at any stage prior to birth. As shown by Black’s Medical Dictionary, this term applies only “after the eighth week of development.”

[13] Commentary: “Where’s the Baby? The AP Misses the Point.” By Kathryn Jean Lopez. National Review, March 13, 2002. <www.nationalreview.com>

NOTE: This column criticizes the Associated Press for misapplying the word “fetus” to humans who are born alive after an abortion. As shown by Black’s Medical Dictionary and the Royal College of Obstetricians and Gynaecologists, this term does not apply after birth.

[14] Article: “Obama’s View on Abortion May Divide Catholics.” By John M. Broder. New York Times, August 6, 2008. <www.nytimes.com>

“Republicans are gearing up campaigns to depict Mr. Obama as a radical on the question of abortion, because as a state senator in Illinois he opposed a ban on the killing of fetuses born alive.”

NOTE: As shown by Black’s Medical Dictionary and the Royal College of Obstetricians and Gynaecologists, this term does not apply after birth.

[15] Commentary: “Fetus or Baby?” By Christine Chinlund. Boston Globe, February 17, 2003. <www.boston.com>

“Some pretty impartial sources, from the American College of Obstetricians and Gynecologists to Webster’s Dictionary, say that any unborn child is considered a fetus.”

NOTE: Later in the column, the author quotes the following definition of “fetus” from Webster’s, which does not support the assertion she made: “An unborn offspring, especially in its later stages and specifically in humans, from about the eighth week after conception until birth.” The author did not attempt to substantiate the claim about the American College of Obstetricians and Gynecologists, and Just Facts could find no such information on their website.

[16] Press release: “States May Provide SCHIP [State Children’s Health Insurance Program] Coverage for Prenatal Care.” United States Department of Health and Human Services, September 27, 2002. <wayback.archive-it.org>

“The final regulation, which will be published in the Federal Register on Wednesday, October 2, allows states to file a state plan amendment to use existing SCHIP funding for coverage for children from conception to birth and up to age 19.”

NOTE: As the quote above explains, the regulation is applicable from the point of conception onwards, yet the following articles use the word “fetus” to describe the beneficiaries:

• Article: “HHS [U.S. Department of Health and Human Services] Proposes Insurance for Fetuses; Opponents Call It a Ploy to Pave Way for Ban on Abortion.” By Alan Cooperman & Amy Goldstein. Washington Post, February 1, 2002. Page A-01.
• Article: “ ‘Unborn Child’ Coverage Moves Ahead: Abortion Rights Advocates Oppose the New Regulation.” By Catherine Berger. CNN, September 27, 2002. <www.cnn.com>
  “The regulation allows states to expand eligibility to cover a fetus under the State Children’s Health Insurance Program (SCHIP) without having to receive a waiver from HHS.”
• Article: “Government Gives Fetuses ‘Unborn Child’ Status.” Fox News (with contribution from the Associated Press), February 1, 2002. <www.foxnews.com>

[17] Press release: “RCOG [Royal College of Obstetricians and Gynaecologists] Statement on the Article ‘One Baby in 30 Left Alive After Medical Termination’ (London Daily Mail, 20 April 2007).” Royal College of Obstetricians and Gynaecologists, April 20, 2007. <www.rcog.org.uk>

“If the fetus has had a lethal injection, it will normally die. However, there are some instances when there are signs of life at birth. All babies must be treated with dignity and respect. Palliative care should be provided till the baby dies where relevant.”

NOTE: Observe how the Royal College of Obstetricians and Gynaecologists accurately uses the word “baby” after birth.

[18] Book: English for Journalists (2nd edition). By Wynford Hicks. Routledge, 1998.

Page 73: “Jargon is specialized vocabulary, familiar to the members of a group, trade or profession. If you write for a newspaper or general magazine you should try to translate jargon into ordinary English whenever you can. … A common source of jargon is scientific, medical, government and legal handouts.”

[19] Book: Writing for Journalists. By Wynford Hicks, Sally Adams & Harriet Gilbert. Routledge, 1999.

Page 125:

This emphasis on plainness and simplicity has been repeated by those who lay down the law about journalistic style. The Economist Pocket Style Book, first published in the 1980s, quotes George Orwell’s “six elementary rules” from his famous essay, “Politics and the English Language”, written in 1946. … 5. Never use a foreign phrase, a scientific word or a jargon word if you can think of an everyday English equivalent.

[20] Book: The New Oxford Guide to Writing. By Thomas S. Kane. Oxford University Press, 1988.

Page 199: “Jargon is technical language misused. Technical language, the precise diction demanded by any specialized trade or profession, is necessary when experts communicate with one another. It becomes jargon when it is applied outside the limits of technical discourse.”

[21] Book: The New York Public Library Writer’s Guide to Style and Usage. Edited by Andrea J. Sutcliffe. Stonesong Press/Harper Collins, 1994.

Page 586: “When writing for a specialized audience—one familiar with the topic or field—a writer must use jargon; it is the common idiom. When writing for a lay audience or the general public, a writer should use jargon only when necessary and define it carefully. Where plain English serves equally well, it should be used instead.”

[22] Entry: “gravida.” Dorland’s Illustrated Medical Dictionary (29th edition). W.B. Saunders Company, 2000.

Page 770: “a pregnant woman”

[23] For example, the following searches performed on October 2, 2020 yielded thousands of results for “fetus” and one result for “gravida” that refers to a pregnant woman:

NOTES:

• † One of these results uses “gravida” to describe a pregnant woman. Six refer to a publication of the Westchester Women’s Poetry Collective entitled Gravida.
• ‡ These results does not use “gravida” to describe a pregnant woman.

[24] Article: “A Woman Married a Paroled Murderer. Years Later, He Killed All Her Children.” By Kristine Phillips. Washington Post, March 8, 2017. <www.washingtonpost.com>

“In 1991, Michigan man Gregory Green stabbed his wife in the face and chest, killing her and their unborn child.”

[25] Article: “Parents of Slain Pregnant Woman Forgive Suspect.” By Dan Nephin. Associated Press, July 25, 2008. <usatoday30.usatoday.com>

“The parents of a slain pregnant woman said Friday they have forgiven the suspect charged with killing their daughter and cutting her baby out of the womb.”

[26] Article: “Fetus or Baby?” By Christine Chinlund (Ombudsman). Washington Post, February 17, 2003. Page A13. <www.boston.com>

The Globe was technically correct when it referred to the youngest shooting victim in the Feb. 5 MBTA [Massachusetts Bay Transportation Authority] Orange Line tragedy as a “fetus.” But sometimes you can be technically correct and wrong at the same time. This was one of those times.

The facts: On the night of Feb. 5, Hawa Adama Barry, in the ninth month of pregnancy, was shot in the abdomen during a stand-off between two groups of young men on the T.

Early reports from authorities suggested that the baby died in the womb. Thus, the Globe’s headline the next day read: “Passenger shot, her fetus dies as men clash on T.” Other media outlets had similar accounts but used “unborn baby” rather than “fetus.”

Readers were quick to object to “fetus.” A few echoed the abortion-related debate about when life begins, but most argued that the use of such a clinical word to describe an almost full-term baby made the Globe look silly and insensitive.

“I thought it truly dehumanized the tragic murder, especially for the mother but also for those who have children and recognize that a parent refers to a baby weeks from birth as just that—a baby,” wrote one reader who, with his wife, had suffered lost pregnancies. “This has nothing to do with the abortion debate—though I can hear the ‘prolife’ people now. It has everything to do with the death of a child.”

Kerri Bean from Milton called to say the Globe’s word choice so “horrified” several of her friends that they wanted to cancel the paper. “This is not a matter of being prochoice or not,” she said. “It’s a matter of being a mother.”

Wrote another subscriber: “Those criminals on the train committed murder, not abortion”—and indeed several readers pointed out that police hope to bring murder charges against the shooter. Yet another reader, noting that “Every other news channel, TV, and newspaper called it a baby,” demanded to know how the Globe came to use “fetus.” He added: “I’m sure there’s some sort of angle here.”

[27] Article: “Baby Saved as Heroes Lift Bus Off Crushed Mom.” Associated Press, August 15, 2008. <www.nbcnews.com>

“Dozens of strangers converged from all directions to lift a 5-ton bus off the body of a pregnant woman—a heroic effort that managed to save the life of her child but was too late for her.”

[28] Paper: “Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures.” By Marc Van de Velde and Frederik De Buck. Fetal Diagnosis and Therapy, April 25, 2012. Pages 201–209. <www.karger.com>

Page 201: “At present, the unborn child is increasingly being treated as a patient in its own right.”

[29] Book: Writing for Journalists. By Wynford Hicks, Sally Adams & Harriet Gilbert. Routledge, 1999.

Page 125:

This emphasis on plainness and simplicity has been repeated by those who lay down the law about journalistic style. The Economist Pocket Style Book, first published in the 1980s, quotes George Orwell’s “six elementary rules” from his famous essay, “Politics and the English Language”, written in 1946. … 5. Never use a foreign phrase, a scientific word or a jargon word if you can think of an everyday English equivalent.

[30] Book: Exploring Emergent Brain Dynamics: Prebirth to Adolescence. Edited by April A. Benasich and Urs Ribary. MIT Press, 2018.

Chapter 1: “Exploring Emergent Brain Dynamics.” By April A. Benasich and Urs Ribary. Pages 1–14.

Page 4:

Prior to birth, the brain undergoes a substantive degree of development and many of these early steps lay the foundation for later maturation. Studying the developing brain in human embryos and fetuses is laden with challenges. In his review, Alain Chédotal (Chapter 3) examines the role of axon guidance molecules in the regulation of cell—cell interactions during normative and atypical development. He points out that although various methods exist to study axon guidance in animals, technical and ethical issues pose significant challenges in the developing human. To visualize and track neuronal connectivity successfully in pre-birth humans, Chédotal stresses the need for improved noninvasive imaging methods (e.g., 3D and 4D obstetrical ultrasonography, 3D power Doppler ultrasound, in utero MRI [magnetic resonance imaging], and diffusion tensor imaging tractography) and recommends development of novel methods.

[31] Webpage: “Emergent Brain Dynamics.” MIT Press. Accessed August 28, 2019 at <mitpress.mit.edu>

Summary

Experts explore the maturation of nonlinear brain dynamics from a developmental perspective and consider the relationship of neurodevelopmental disorders to early disruption in dynamic coordination.

This volume in the Strüngmann Forum Reports series explores the complex mechanisms that accompany the dynamic processes by which the brain evolves and matures. Integrating perspectives from multiple disciplines, the book identifies knowledge gaps and proposes innovative ways forward for this emerging area of cross-disciplinary study. The contributors examine maturation of nonlinear brain dynamics across systems from a developmental perspective and relate these organizing networks to the establishment of normative cognition and pathology seen in many neurodevelopmental disorders. …

Endorsement

This volume of edited chapters by many leaders in this important field of study, is the product of one of the remarkable meetings organized by the Ernst Strungmann Forum, based on an in-depth symposium examining and debating the details of the fundamentally important question, ‘how do early experiences influence brain development to determine who we become?’ Much important information is provided by this influential volume, and essential unresolved questions, problems, and concerns are elucidated, making this an important read for experts and for those newly introduced to the issues raised therein.

– Fred H. Gage, Adler Professor, Laboratory of Genetics, Salk Institute for Biological Studies

[32] Textbook: Pediatric Toxicology: Diagnosis and Management of the Poisoned Child. By Timothy B. Erickson and others. McGraw-Hill, 2005.

Page 46: “The categories of human in utero exposure consist of maternal drugs of abuse, maternal environmental exposure, and maternal prescription drug use.”

[33] Textbook: Review of Medical Physiology (22nd edition). By William F. Ganong. McGraw Hill, 2005.

Page 259: “Exposure of human females to androgen in utero does not change the cyclic pattern….”

[34] Textbook: Before We Are Born: Essentials of Embryology and Birth Defects (5th edition). By Keith L. Moore & T.V.N. Persaud. W.B. Saunders Company, 1998.

Page 500: “The zygote and early embryo are living human organisms.”

NOTE: Entry: “organism.” American Heritage Dictionary of Science. Edited by Robert K. Barnhart. Houghton Mifflin, 1986. Page 456: “a living body made up of separate parts, such as ribosomes, vacuoles, cells, tissues, and organs, which work together to carry on the various processes of life”

[35] Textbook: The Developing Human: Clinically Oriented Embryology (7th edition). By Keith L. Moore & T. V. N. Persaud. Saunders, 2003.

Page 2: “Zygote. This cell results from the union of an oocyte and a sperm during fertilization. A zygote is the beginning of a new human being (i.e., an embryo).”

[36] Book: An Atlas of the Human Embryo and Fetus: A Photographic Review of Human Prenatal Development. By Jan E. Jirásek (MD, DSc, Laboratory of Reproductive Embryology, Institute for the Care of Mother and Child, Prague, Czech Republic). Parthenon Publishing Group, 2001.

Page 21: “A human being originates from two living cells: the oocyte (female germ cell) and the spermatozoon (male germ cell), transmitting the torch of life to the next generation.”

[37] Textbook: Human Life Before Birth. By Frank J. Dye. Harwood Academic Publishers, 2000.

[38] Entry: “abortion.” American Heritage Dictionary of Science. Houghton Mifflin, 1986.

Page 2: “a birth that occurs before the embryo or fetus develops enough to live on its own, usually during the first twelve weeks of pregnancy (spontaneous abortion) … SYN: miscarriage.”

Pages ix–xi:

The expert help of the Editorial Committee [of Contributing Scientists] has enabled us to formulate definitions and explanations that correspond to recent findings of scientists working in their various disciplines. Precise editorial review in the offices of the publisher has contributed to a standard of excellence.

This is a dictionary of the basic terms of the physical and the biological sciences. …

The compiling of a specialized dictionary is, perhaps more than in most other reference books, the result of many scholars and editors working together. We are fortunate to have an outstanding group of active scientists, who read, commented upon and corrected the entire manuscript, and we are indented to them for their thorough work.

[39] Textbook: Before We Are Born: Essentials of Embryology and Birth Defects (5th edition). By Keith L. Moore & T.V.N. Persaud. W.B. Saunders Company, 1998.

Page 109: “The expected date of delivery (EDD) of a fetus is 266 days, or 38 weeks, after fertilization; that is, 280 days, or 40 weeks, after LNMP [last normal menstrual period] (Table 7-1).” 

[40] Book: Color Atlas of Life Before Birth. By Marjorie A. England. Year Book Medical Publishers, 1983.

Page 12: “Most clinicians do not know the fertilization date; the only date available to them is the first day of the last menstrual period. They use this date to define a menstrual age stretching from time 0, which is usually 14 days before fertilization….”

[41] Book: How Life Begins. By Christopher Vaughn. Random House, 1996.

Page 8: “In other words, most obstetricians figures are based on a forty-week pregnancy when you’re actually pregnant for only thirty-eight weeks.”

[42] Book: Color Atlas of Physiology (5th edition). By Agamemnon Despopoulos & Stefan Silbernagl. Thieme, 2003.

Page 308: “Fertilization usually takes place on the first day after intercourse….”

[43] Textbook: Langman’s Medical Embryology (9th edition). By T. W. Sadler. Lippincott Williams & Wilkins, 2004.

Page 122: “The oocyte is normally fertilized within 12 hours of ovulation. However, sperm deposited in the reproductive tract up to 6 days prior to ovulation can survive to fertilize oocytes. Thus, most pregnancies occur when sexual intercourse occurs within a 6-day period that ends on the day of ovulation.”

[44] Book: Psychological Development and Early Childhood. By John Oates, Clare Wood & Andrew Grayson. Blackwell, 2005.

Page 217: “Genotype: The complete set of genes present in an individual. The genotype is determined at fertilization when genetic information from the egg and sperm is combined.”

[45] Book: Mayo Clinic Guide to a Healthy Pregnancy. By the Mayo Clinic. Collins, 2004.

Page 45 (section on fertilization): “This genetic material will determine your baby’s sex, eye color, hair color, body size, facial features and—at least to some extent—intelligence and personality. … Your baby’s sex is determined at the moment he or she is conceived.”

[46] Entry: “life.” American Heritage Dictionary of Science. Houghton Mifflin, 1986.

Page 359: “the form of existence that organisms like animals and plants have and that inorganic objects or organic dead bodies lack; animate existence, characterized by growth, reproduction, metabolism, and response to stimuli.”

Pages ix–xi:

The expert help of the Editorial Committee [of Contributing Scientists] has enabled us to formulate definitions and explanations that correspond to recent findings of scientists working in their various disciplines. Precise editorial review in the offices of the publisher has contributed to a standard of excellence.

This is a dictionary of the basic terms of the physical and the biological sciences. …

The compiling of a specialized dictionary is, perhaps more than in most other reference books, the result of many scholars and editors working together. We are fortunate to have an outstanding group of active scientists, who read, commented upon and corrected the entire manuscript, and we are indented to them for their thorough work.

[47] Textbook: Essentials of Human Development: A Life-Span View (6th edition). By Robert Kail and John Cavanaugh. Cengage Learning, 2013.

Page 42:

Period of the Zygote (Weeks 1 and 2) …

Fertilization begins the period of the zygote, the technical term for the fertilized egg. This period ends when the zygote implants itself in the wall of the uterus (see Figure 2.4). During these two weeks, the zygote grows rapidly though cell division (see Figure 2.4). The zygote travels down the Fallopian tube toward the uterus and divides for the first time; it then continues to do so every 12 hours.

[48] Article: “Zygote.” Encyclopaedia Britannica. Accessed March 14, 2018 at <www.britannica.com>

“The joining of haploid gametes to produce a diploid zygote is a common feature in the sexual reproduction of all organisms except bacteria.”

[49] Paper: “The Marks, Mechanisms and Memory of Epigenetic States in Mammals.” By Vardhman K. Rakyan & others. Biochemical Journal, May 15, 2001. <portlandpress.com>

“Sexual reproduction in mammals results in the formation of a zygote, a single cell which contains all the necessary information to produce an entire organism comprised of billions of cells grouped into multitudinous cell types.”

[50] Book: Human Gametes and Preimplantation Embryos: Assessment and Diagnosis. Edited by David K. Gardner, Denny Sakkas, Emre Seli, and Dagan Wells. Springer, 2013.

Chapter 23: “Carbohydrate Analysis and Embryo Viability.” By Michelle Lane and David K. Gardner. Pages 259–266.

Page 260:

Concomitantly with the distinct changes in physiology that occur during development from the zygote to the blastocyst stage are dynamic changes in the metabolism of the embryo. At the zygote stage, the embryo is initially quiescent with a low metabolic and biosynthetic activity. At these early stages, the embryo predominantly uses the carboxylic acids pyruvate and lactate as its preferred energy substrates.^14–16 Therefore, at these early stages of development the embryo is completely reliant on mitochondrial-based metabolism for ATP [Adenosine triphosphate] generation. However, the embryo does take up low levels of glucose,^{14, 15} which are likely metabolized by the pentose-phosphate pathway for the maintenance of reducing power in the cell particularly in the production of reduced glutathione for protection against oxidative stress. Furthermore, there is a recent understanding that the metabolism of glucose by the hexosamine biosynthesis pathway in the early embryo may be important in establishing O-linked glycosylation that is important for later stage development.^{17, 18} Therefore, it may be that this metabolism of glucose, although at a low level during the early stages of pre-implantation development, is essential for setting the subsequent metabolic program.

[51] Entry: “stimulus.” Oxford Dictionary of Biochemistry and Molecular Biology. Oxford University Press, 1997.

Page 619: “any event or phenomenon, such as radiation, electrical potential, or addition of molecules that leads to excitation of a tissue or cell.”

[52] Entry: “stimulus.” Collins English Dictionary (12th edition). HarperCollins, 2014.

“(Physiology) any drug, agent, electrical impulse, or other factor able to cause a response in an organism.”

[53] Paper: “The Role of PAF in Embryo Physiology.” By Chris O’Neill. Human Reproduction Update, May 2005. Pages 215–228. <humupd.oxfordjournals.org>

Page 215:

Embryo-derived paf [platelet-activating factor] … is produced by de novo synthesis. This synthesis commences soon after fertilization and persists throughout the preimplantation phase. … Paf also acts in an autocrine fashion as a trophic/survival factor for the early embryo. In vitro, supplementation of culture media with paf improves embryo development. …

Paf was the first mediator released by the preimplantation embryo to be identified (O’Neill, 1985a,b). It was subsequently shown that paf stimulated embryo metabolism (Ryan and others, 1989), cell-cycle progression (Roberts and others, 1993) and embryo viability (Spinks and O’Neill, 1988; Ryan and others, 1990b; Spinks and others, 1990) providing evidence for an autocrine loop in the early embryo. Insulin (Wales and others, 1985) also exerts trophic effects on the early embryo, the early embryo expresses a functional receptor for insulin (Harvey and Kaye, 1988; Heyner and others, 1989), but not insulin itself, suggesting that potential endocrine stimulation of embryo development also occurred. The possibility that a range of trophic factors may act on the early embryo was suggested by the detection of mRNA for a range of peptide growth factor ligands and their corresponding receptors (Rappolee and others, 1988). Since these observations, many putative autocrine, paracrine and endocrine factors have been implicated in supporting preimplantation embryo development (Kane and others, 1997; Kaye, 1997; Hardy and Spanos, 2002).

[54] Entry: “fertilization.” Encyclopedia & Dictionary of Medicine, Nursing & Allied Health (7th edition). Edited by Benjamin Frank Miller. W. B. Saunders, 2003.

“in human reproduction, the process by which the male’s sperm unites with the female’s oocyte, creating a new life.”

[55] Entry: “embryo.” Van Nostrand’s Scientific Encyclopedia. Edited by Douglas M. Considine. Springer, 2013.

Page 1142: “At the moment the sperm cell of the human male meets the ovum of the female and the union results in a fertilized ovum (zygote), a new life has begun.”

[56] Textbook: Excellence in Biology: Teacher’s Guide. By Jane Avis, Bridget Farham, and Karoline Hanks. Cambridge University Press, 2016. <www.cambridge.org>

Page 20: “fertilisation – in human reproduction, the process by which the male’s sperm unites with the female’s oocyte, creating a new life”

[57] Textbook: The Developing Human: Clinically Oriented Embryology (7th edition). By Keith L. Moore & T. V. N. Persaud. Saunders, 2003.

Page 2: “Zygote. This cell results from the union of an oocyte and a sperm during fertilization. A zygote is the beginning of a new human being (i.e., an embryo).”

Page 33: “The zygote is genetically unique because half of its chromosomes come from the mother and half from the father. The zygote contains a new combination of chromosomes that is different from that in the cells of either of the parents. This mechanism forms the basis of biparental inheritance and variation of the human species.”

[58] Book: An Atlas of the Human Embryo and Fetus: A Photographic Review of Human Prenatal Development. By Jan E. Jirásek (MD, DSc, Laboratory of Reproductive Embryology, Institute for the Care of Mother and Child, Prague, Czech Republic). Parthenon Publishing Group, 2001.

Page 21: “A human being originates from two living cells: the oocyte (female germ cell) and the spermatozoon (male germ cell), transmitting the torch of life to the next generation.”

[59] Teaching guide: “Human Genetic Variation.” U.S. Department of Health and Human Services, National Institutes of Health, National Human Genome Research Institute, 2007. <www.ncbi.nlm.nih.gov>

“The human genome comprises about 3 × 10⁹ base pairs of DNA, and the extent of human genetic variation is such that no two humans, save identical twins, ever have been or will be genetically identical.”

[60] Calculated with data from:

a) Textbook: The Developing Human: Clinically Oriented Embryology (7th edition). By Keith L. Moore & T. V. N. Persaud. Saunders, 2003.
Page 16: “Human development begins at fertilization when a male gamete or sperm (spermatozoa) unites with a female gamete or oocyte (ovum) to form a single cell—a zygote.”
Page 33: “The zygote is genetically unique because half of its chromosomes come from the mother and half from the father. The zygote contains a new combination of chromosomes that is different from that in the cells of either of the parents. This mechanism forms the basis of biparental inheritance and variation of the human species.”

b) Book: Population and Evolutionary Genetics: A Primer. By Francisco J. Ayala. Benjamin Cummings Publishing Company, 1982.
Page 53: “Considerable genetic variation exists in most natural populations. … Consider humans with a 6.7% heterozygosity detectable by electrophoresis. If we assume there are 30,000 structural gene loci in a human being, which may be an underestimate, a person will be heterozygous at 30,000 X 0.067 = 2010 loci. Such an individual can theoretically produce 2²⁰¹⁰ ≈ 10⁶⁰⁵ different kinds of gametes [reproductive cells].”

c) Book: Human Reproductive Biology (3rd edition). By Richard E. Jones & Kristen H. Lopez. Academic Press, 2006.
Page 46: “Hunter-gatherer women experience about 160 lifetime ovulation cycles (menstrual cycles) as compared to 450 in women living in developed countries.”

CALCULATION: 10⁶⁰⁵ possible genetically unique reproductive cells per woman / 450 ovulation cycles = 2.2X10⁶⁰²

NOTE: The above calculation only accounts for the genetic variation of the female. Therefore, the odds against a woman conceiving the same pre-birth human twice (with or without the same mate) are actually much higher than this.

[61] Determined with data from:

a) Textbook: Foundations of Modern Cosmology. By John F. Hawley & Katherine A. Holcomb. Oxford University Press, 1998.
Page 454: “There are perhaps 10⁸⁰ baryons in our visible universe, and about 10⁹ photons per baryon.”

b) Book: The Inflationary Universe. By Alan Guth. Helix Books, 1997.
Page 108: “Since we believe that the observed universe has a baryon number of 10⁷⁸, the conservation of baryon number would imply that it always had a baryon number of 10⁷⁸.”

c) Book: Six Easy Pieces: Essentials of Physics Explained By Its Most Brilliant Teacher. By Richard Feynman. Basic Books, 1996.
Page 85: “There are a number of strange particles, a neutron and a proton are examples, which are called baryons.”

d) Article: “Atom.” World Book Encyclopedia, 2007 Deluxe Edition.
“Tiny as atoms are, they consist of even more minute particles. The three basic types are protons, neutrons, and electrons. Each atom has a definite number of these subatomic particles.”

NOTE: As shown above, all atoms contain at least one baryon, and thus 10⁸⁰ represents a rough maximum for the number of atoms in the visible universe.

[62] Book: Genetic Destinies. By Peter Little. Oxford University Press, 2002.

Page 34: “Identical twins have exactly the same DNA and it so follows that any feature that is defined by gene differences should be identical between them.”

[63] Paper: “The Marks, Mechanisms and Memory of Epigenetic States in Mammals.” By Vardhman K. Rakyan & others. Biochemical Journal, May 2001. Pages 1–10. <portlandpress.com>

Page 1: “These modifications interfere with the DNA–protein interactions that facilitate transcription, resulting in transcriptional silencing of the epigenetically modified allele. Epigenetic modifications can, therefore, cause phenotypic variation in the absence of genetic differences.”

[64] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1982.

Page 35: “In the third week the body unfolds. It is one-tenth of an inch long; the heart begins to beat; the brain has two lobes; the early spinal cord is bordered by the future vertebrae and muscle segments.”

[65] Book: Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery. Churchill Livingstone, 1989.

Page 261: “By Stage 9 (twentieth to twenty-second days) the neural groove is deepening and the first somites begin to appear about midway along it. The cranial half of the groove, representing developing brain, begins to develop a cephalic flexure, optic primordia become visible and early head and tail folds have appeared, as Stage 10 is approached.”

[66] Textbook: Biology: Investigating Life on Earth (2nd edition). By Vernon L. Avila. Jones and Bartlett, 1995.

Page 693: “First, the embryo has its own circulatory system, complete with a heart that started beating only 24 days after conception….”

[67] Webpage: “Merck Manual: Development of the Embryo.” By Raul Artal-Mittelmark. Merck, May 2021. Modified 9/2022. <www.merckmanuals.com>

Most organs begin to form about 3 weeks after fertilization, which equals 5 weeks of pregnancy (because doctors date pregnancy from the first day of the woman’s last menstrual period, which is typically 2 weeks before fertilization). At this time, the embryo elongates, first suggesting a human shape. Shortly thereafter, the area that will become the brain and spinal cord (neural tube) begins to develop. The heart and major blood vessels begin to develop earlier—by about day 16. The heart begins to pump fluid through blood vessels by day 20, and the first red blood cells appear the next day.

[68] Webpage: “The First Trimester.” Johns Hopkins Medicine. Accessed September 21, 2023 at <www.hopkinsmedicine.org>

“First Trimester Fetal Growth and Development Benchmarks … By the end of four weeks … The neural tube (which becomes the brain and spinal cord), the digestive system, and the heart and circulatory system begin to form. … The heart is beating.”

[69] Textbook: The Developing Human: Clinically Oriented Embryology (11th edition). By Keith L. Moore, T.V.N. Persaud, and Mark G. Torchia. Elsevier, 2020.

Page 59: “By the end of the third week, the blood is circulating, and the heart begins to beat at approximately day 22. The cardiovascular system is the first organ system to reach a functional state. The embryonic heartbeat can be detected using Doppler ultrasonography during the fourth week, approximately six weeks after the last normal menstrual period….”

[70] Paper: “The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life.” By Cheryl Mei Jun Tan and Adam James Lewandowski. Fetal Diagnosis and Therapy, May 2020. Pages 373–386. <karger.com>

Pages 373–374:

The human heart is one of the first organs to form and function during embryogenesis^{1, 2}. By the end of gestational week 3, passive oxygen diffusion becomes insufficient to support metabolism of the developing embryo^3–5, and thus the fetal heart becomes vital for oxygen and nutrient distribution². The initiation of the first heart beat via the primitive heart tube begins at gestational day 22, followed by active fetal blood circulation by the end of week 4^{1, 3–5}. The start of early heart development involves several types of progenitor cells that are derived from the mesoderm, proepicardium, and neural crest. This eventually leads to the formation of the 4-chambered heart by gestational week 7 via heart looping and complex cellular interactions in utero².

[71] Article: “Embryology, Heart Tube.” By Kristen L. Farraj and Roman Zeltser. StatPearls Publishing 2023. <www.ncbi.nlm.nih.gov>

“The heart is the first functional organ that develops in humans and all other vertebrate embryos. The heart first begins to beat by week 4 of development. During the beginning stages of development, the embryo forms a trilaminar disc that matures into the looped heart along with its 5 regions. … On day 23 of development, the heart finally begins to pump.”

[72] Webpage: “Embryology: Cardiovascular System – Heart Development.” By M.A. Hill. University of New South Wales Embryology. Accessed September 22, 2023 at <embryology.med.unsw.edu.au>

“In human embryos the heart begins to beat at about 22–23 days, with blood flow beginning in the 4th week. The heart is therefore one of the earliest differentiating and functioning organs.”

[73] Textbook: Anatomy & Physiology. By Lindsay M. Biga and others. OpenStax, 2019. <open.oregonstate.education>

Chapter 19: “The Cardiovascular System: The Heart.” Pages 1173–1262.

Pages 1255–1256:

The human heart is the first functional organ to develop. It begins beating and pumping blood around day 21 or 22, a mere three weeks after fertilization. This emphasizes the critical nature of the heart in distributing blood through the vessels and the vital exchange of nutrients, oxygen, and wastes both to and from the developing baby. The critical early development of the heart is reflected by the prominent heart bulge that appears on the anterior surface of the embryo.

The heart forms from an embryonic tissue called mesoderm around 18 to 19 days after fertilization. Mesoderm is one of the three primary germ layers that differentiates early in development that collectively gives rise to all subsequent tissues and organs. The heart begins to develop near the head of the embryo in a region known as the cardiogenic area. Following chemical signals called factors from the underlying endoderm (another of the three primary germ layers), the cardiogenic area begins to form two strands called the cardiogenic cords. As the cardiogenic cords develop, a lumen rapidly develops within them. At this point, they are referred to as endocardial tubes (Figure 19.5.1). The two tubes migrate together and fuse to form a single primitive heart tube. The primitive heart tube quickly forms five distinct regions. …

The five regions of the primitive heart tube develop into recognizable structures in a fully developed heart.

[74] Book: Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery. Churchill Livingstone, 1995.

Page 329: “Stages 10 to 12. Occupying days 21–23, 23–25, 25–27 respectively, … primary cerebral vesicles appear. … Rudimentary limb buds appear and the heart tubes fuse into a common loop in which contractile activity commences. The primordia of the thyroid gland, lungs, liver, pancreas, and mesonephric tubules are all identifiable.”

[75] Book: Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery. Churchill Livingstone, 1995.

Page 329: “Stages 16 to 20. Roughly equivalent to the 6th and 7th weeks…. The pontine flexure, cerebral hemispheres and cerebellum are developing.”

[76] Article: “Brain.” New Millennium Encyclopedia. Simon and Shuster, 1999.

“The cerebrum is the largest part of the human brain, making up approximately 85 percent of the brain’s weight; its large surface area (cortex) and intricate development account for the superior intelligence of humans, compared with other animals. … A large part of the human cortex, the frontal area, is used for awareness, intelligence, and memory.”

[77] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1982.

Page 52:

In the sixth and seventh weeks, nerves and muscles work together for the first time. If the area of the lips, the first to become sensitive to touch, is gently stroked, the baby, who then is still an embryo, responds by bending the upper body to one side and making a quick backward motion with the arms. This is called a “total pattern” response because it involves most of the body rather than the approximate local part.

NOTE: The details above are documented by photos. Page 52: “All of the photographs in this book that show the movement of the baby are taken from” films made by Davenport Hooker at the University of Pittsburgh.

[78] Intrauterine picture taken at seven weeks after fertilization under the direction of Professor Andrzej Skawina of Collegium Medicum Jagiellonian University (Krakow, Poland) and Antoni Marsinek of the Czerwiakowski Gynecological and Obstetrics Hospital (Krakow, Poland); Photographers: Andrzej Zachwieja and Jan Walczewski. Copyright: Life Issues.

NOTE: A number of different photographers have published intrauterine photos. Just Facts asked several of these individuals for permission to reproduce their pictures, and Life Issues was the only one who consented. The pictures from Life Issues look similar to those taken by the other photographers.

[79] Book: Gray’s Anatomy: The Anatomical Basis of Medicine and Surgery. Churchill Livingstone, 1995.

Page 95: “When mammalian embryos reach a certain size, growth rather than morphogenesis occurs. The embryo is referred to as a fetus; this occurs at 56–57 postovulatory days in humans when the onset of bone marrow formation in the humerus can be seen (Streeter 1949); at this stage more than 90% of the named structures of the adult body have appeared.”

[80] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1962.

Page 48: “The appearance of the first bone cells marks the end of the embryonic period. This criterion was chosen by embryologists because the beginning bone formation coincides with the essential completion of the body.”

[81] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1962.

Pages 52–53: “By the beginning of this third month the baby moves spontaneously, without being touched, for the first time.”

[82] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Pages 954–955:

B. Early Fetal Period (Third Month) …

Division of the heart into chambers is complete, and a definitive vascular system carries blood to and from all body parts. …

All components of the brain and the spinal cord are formed, and nerves link the stem of the brain and the spinal cord to all tissues and organs of the body.

[83] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1962.

Pages 53–54: “In the ninth and tenth weeks, if the baby’s forehead is touched, he may turn his head away and pucker up his brow and frown. … [T]he entire body becomes sensitive to touch with a notable exception: the sides, back and top of the head.”

[84] Intrauterine picture taken at 11 weeks after fertilization under the direction of Professor Andrzej Skawina of Collegium Medicum Jagiellonian University (Krakow, Poland) and Antoni Marsinek of the Czerwiakowski Gynecological and Obstetrics Hospital (Krakow, Poland); Photographers: Andrzej Zachwieja and Jan Walczewski. Copyright: Life Issues.

NOTE: A number of different photographers have published intrauterine photos. Just Facts asked several of these individuals for permission to reproduce their pictures, and Life Issues was the only one who consented. The pictures from Life Issues look similar to those taken by the other photographers.

[85] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Page 962:

Attempts to suckle have been seen in utero and in aborted fetuses of 3 months. …

Reflexes that develop during the third month involve the mouth and the head…. Electrical activity of the nervous system is discernible at the same time, but periods of electrical silence can occur up to midterm.

[86] Textbook: Human Genetics: Concepts and Applications (3rd edition). By Ricki Lewis. McGraw Hill, 1998.

Page 56: “By week 12, the fetus sucks its thumb, kicks, makes fists and faces, and has the beginnings of baby teeth.”

[87] Article: “Wired to Be Social: The Ontogeny of Human Interaction.” By Umberto Castiello and others. PLoS ONE, October 7, 2010. <journals.plos.org>

Page 2: “The results showed that the spatial and temporal characteristics of foetal movements were by no means uncoordinated, but depended on the goal of the different motor acts, suggesting a surprisingly advanced level of motor planning.”

Page 3:

Each woman was identified by the prenatal sonologist during her first visit at the 12th week of pregnancy and foetal age was calculated comparing the mother’s last menstruation date and the measurements of the foetus (Crown Rump Length) taken during the ultrasound examination.

Page 9:

Twin pregnancies constitute an experiment of nature which offers the unique opportunity to explore social behaviour before birth. By investigating kinematic profiles of movements in five pairs of twin foetuses, we demonstrated that, by the 14th week of gestation, twin foetuses not only display movements directed towards the uterine wall and self-directed movements, but also movements specifically aimed at the co-twin. …

Analysis of the kinematic profiles for the different categories of movements corroborates our main hypothesis that these early contacts do not occur accidentally, but reflect motor planning.

Page 10:

In this article we describe changes in the kinematic profiles of movement in twin foetuses probing the social dimension of motor planning and control. The central advance of this study is the demonstration that ‘social actions’ are already performed in the second trimester of gestation. Starting from the 14th week of gestation twin foetuses plan and execute movements specifically aimed at the co-twin. These findings force us to predate the emergence of social behaviour: when the context enables it, as in the case of twin foetuses, other-directed actions are not only possible but predominant over self-directed actions.

NOTE: This article uses the obstetric method of counting from the last menstrual period as evidenced by the statement that “foetal age was calculated” based on the “mother’s last menstruation date.” Thus, two weeks must be subtracted to provide the actual time since fertilization.

[88] Ultrasound taken on November 25, 1997. Gestational age (GA) is 14 weeks and 4 days counted from the LMP. This falls under the category of 15 weeks after LMP and 13 weeks after fertilization.

[89] Textbook: Before We Are Born: Essentials of Embryology and Birth Defects (5th edition). By Keith L. Moore & T.V.N. Persaud. W.B. Saunders Company, 1998.

Page 106: “Limb movements, which occur at the end of the embryonic period (8 weeks), become coordinated by the 14th week, but are too slight to be felt by the mother.”

[90] Book: Embryology: Board Review Series (2nd edition). By Ronald W. Dudek & James D. Fix. Lippincott Williams & Wilkins, 1998.

Page 246:

B. Fourth month (weeks 13–16)

1. Ossification of the skeleton is extensive.
2. Body hair starts developing.
3. Spleen is an important site of hemopoiesis.
4. Eyes, ears, and nose approach typical appearance.
5. Eye movements begin.

[91] Intrauterine picture taken at 16 weeks after fertilization under the direction of Professor Andrzej Skawina of Collegium Medicum Jagiellonian University (Krakow, Poland) and Antoni Marsinek of the Czerwiakowski Gynecological and Obstetrics Hospital (Krakow, Poland); Photographers: Andrzej Zachwieja and Jan Walczewski. Copyright: Life Issues.

NOTE: A number of different photographers have published intrauterine photos. Just Facts asked several of these individuals for permission to reproduce their pictures, and Life Issues was the only one who consented. The pictures from Life Issues look similar to those taken by the other photographers.

[92] Paper: “Pain and its Effects in the Human Neonate and Fetus.” By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Pages 1321–1329. <www.nejm.org>

Page 1322:

Cutaneous sensory receptors appear in the perioral [mouth] area of the human fetus in the 7th week of gestation; they spread to the rest of the face, the palms of the hands and the soles of the feet by the 11th week, to the trunk and proximal parts of the arms and legs by the 15th week, and to all cutaneous and mucous surfaces by the 20th week. …

Development of the fetal neocortex begins at 8 weeks of gestation, and by 20 weeks each cortex has a full complement of 10⁹ neurons.

NOTE: This article uses the obstetric method of counting from the last menstrual period as evidenced by the chart on page 1322, which uses a gestation of 40 weeks for pregnancy. Two weeks must be subtracted to provide the actual time since fertilization.

[93] Article: “Brain.” New Millennium Encyclopedia. Simon and Shuster, 1999.

“The cerebrum is the largest part of the human brain, making up approximately 85 percent of the brain’s weight; its large surface area (cortex) and intricate development account for the superior intelligence of humans, compared with other animals. … A large part of the human cortex, the frontal area, is used for awareness, intelligence, and memory.”

[94] Ultrasound taken on December 24, 1997. Gestational age (GA) is 19 weeks and 4 days counted from the last menstrual period. This falls under the category of 20 weeks after LMP and 18 weeks after fertilization.

[95] Article: “Fetus.” American Medical Association Complete Medical Encyclopedia. Random House, 2003.

Page 558: “At 20 weeks, the fetus is 10 inches long and about 11 ounces. The limbs have lengthened, and teeth and hair are beginning to form. The fetus now sleeps and wakes and hears sounds.”

[96] Intrauterine picture taken at 20 weeks after fertilization under the direction of Professor Andrzej Skawina of Collegium Medicum Jagiellonian University (Krakow, Poland) and Antoni Marsinek of the Czerwiakowski Gynecological and Obstetrics Hospital (Krakow, Poland); Photographers: Andrzej Zachwieja and Jan Walczewski. Copyright: Life Issues.

NOTE: A number of different photographers have published intrauterine photos. Just Facts asked several of these individuals for permission to reproduce their pictures, and Life Issues was the only one who consented. The pictures from Life Issues look similar to those taken by the other photographers.

[97] Ultrasound taken on May 31, 1999. Gestational age (GA) is 21 weeks and 5 days counted from the last menstrual period. This falls under the category of 22 weeks after LMP and 20 weeks after fertilization.

[98] Ruling: Roe v. Wade. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Burger, Brennan, Douglas, Stewart, Marshall, Powell. Concurring: Burger, Douglas, Stewart. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] XI:

(a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician.

(b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health.

(c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.

[99] Ruling: Planned Parenthood of Southeastern PA v. Casey. United States Supreme Court. June 29, 1992. <caselaw.findlaw.com>

Majority:

[T]he State may take measures to ensure that the woman’s choice is informed, and measures designed to advance this interest will not be invalidated as long as their purpose is to persuade the woman to choose childbirth over abortion. These measures must not be an undue burden on the right.

As with any medical procedure, the State may enact regulations to further the health or safety of a woman seeking an abortion. Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right. [505 U.S. 833, 879]

Our adoption of the undue burden analysis does not disturb the central holding of Roe v. Wade, and we reaffirm that holding. Regardless of whether exceptions are made for particular circumstances, a State may not prohibit any woman from making the ultimate decision to terminate her pregnancy before viability.

NOTE: The next three footnotes provides facts about when viability occurs.

[100] Report: “Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks’ 4 Days’ Gestation.” By Kaashif A. Ahmad and others. Pediatrics, December 2017. <www.ncbi.nlm.nih.gov>

Page 1:

Recent literature confirms that, at the lower limit of extrauterine survival, substantial intercenter variability exists in resuscitation practice. The reasons for this variability are unclear, but may be related to disagreement on how to apply the best interests standard to extremely premature infants. Currently, both obstetric and pediatric societies recommend against assessing for viability or attempting resuscitation before 22 weeks’ gestation. In this context, we report the unimpaired 2-year outcome of a female infant resuscitated after delivery at 21 weeks’ 4 days’ gestation and 410 g birth weight. She may be the most premature known survivor to date.

Page 2: “We ascertained maturity by last menstrual period dating of 21 weeks 4 days, consistent with 9-week ultrasound dating of 21 weeks 2 days.”

NOTE: A “last menstrual period dating of 21 weeks 4 days” corresponds to 19 weeks and 4 days weeks after fertilization, or about 20 weeks. [Book: Color Atlas of Life Before Birth. By Marjorie A. England. Year Book Medical Publishers, 1983. Page 12: “Most clinicians do not know the fertilization date; the only date available to them is the first day of the last menstrual period. They use this date to define a menstrual age stretching from time 0, which is usually 14 days before fertilization….”]

[101] Article: “Extreme Preemie Born at 21 Weeks Young at Emory Decatur Hospital.” By George Franco. FOX 5 Atlanta News, December 26, 2019. <www.fox29.com>

Jemarius Jachin Harbor … emerged into the world at only 21 weeks young, weighing only 13 ounces, smaller than the size of a hand on Friday December 20. …

Gina Phillips, Director of Medical Services, with Pregnancy Aid Clinics, which helps at risk mothers said premature babies born at 23 weeks are considered the limit of viability.

“At 22 weeks some are surviving but 21 weeks is a very rarity it would be short of a miracle,” said Phillips.

She said the typical survival rate for a baby born at 21 weeks is less than four percent. …

She remains optimistic because in medicine and technology have improved survival chances of extreme preemie babies. “They did have a 21-week-old and four-day baby girl survived in Europe and without any complications, she’s several years old now,” said Phillips.

NOTE: “Gestation is the period of time between conception and birth. During this time, the baby grows and develops inside the mother’s womb. Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman’s last menstrual cycle to the current date.” [Webpage: “Gestational Age.” U.S. National Library of Medicine, National Institutes of Health. Last updated October 8, 2020. <medlineplus.gov>]

[102] Article: “Extreme Preemie, ‘About the Size of a Hand,’ Goes Home in Georgia.” FOX6 Milwaukee News, July 1, 2020. <www.fox6now.com>

Born at just 21 weeks old, Jemarius Harbor’s parents say the chances of him surviving were slim.

“He was about the size of a hand,” Jessica McPherson, Harbor’s mom said. “He had a lot of things that weren’t fully developed.” Harbor weighed 13 ounces when he was born back in December. …

For the past six months, Harbor’s parents have gone back and forth from their Jonesboro home to Emory Decatur Hospital. …

At nine pounds four ounces and about a month after his original due date in May, Harbor went home for the first time on Father’s Day.

[103] Book: Embryology: Board Review Series (2nd edition). By Ronald W. Dudek & James D. Fix. Lippincott Williams & Wilkins, 1998.

Page 247:

D. Sixth month (weeks 21–24)

1. Rapid eye movements begin.
2. Skin is wrinkled and pink or red.
3. Blink-startle reflex is demonstrable on vibroacoustic stimulation of mother’s abdomen.
4. Fingernails are present.
5. Surfactant is secreted by Type II pneumocytes of the lungs.

[104] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Page 962: “Taste buds are functional at 6 months, and the modality for sweetness is well differentiated. Increased ‘drinking’ of the amniotic fluid is effected when sweet substances are introduced.”

[105] Book: The First Nine Months of Life (2nd edition). By Geraldine Lux Flanagan. Simon & Shuster, 1962.

Page 71: “In the fifth and sixth months the grip becomes strong. This baby is holding a rod and moves his arm up and down as the rod is moved.”

NOTE: The statement above is documented with a photo.

Page 52: “All of the photographs in this book that show the movement of the baby are taken from” films made by Davenport Hooker at the University of Pittsburgh.

[106] Paper: “Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 Through December 1996.” By James A. Lemons, Avroy A. Fanaroff, and others. Pediatrics, January 2001. <pediatrics.aappublications.org>

Page 4:

Fig. 3. Mortality Before Discharge by Gestational Age as Estimated by Best Obstetrical Estimate Among Infants Born in NICHD [National Institute of Child Health and Human Development] Neonatal Research Network Centers Between January 1, 1995 and December 31, 1996. Data expressed as percentage died and 95% confidence intervals for each gestational age group.

NOTES:

• In the description of the chart above, the term “obstetrical estimate” implies that the weeks are counted from the last menstrual period. To confirm, Just Facts wrote to one of the paper’s authors (Dr. Fanaroff), and he replied: “We do not try to get to the issue of day of conception hence when we refer to gestational age we are always going back to the Last Menstrual Period.”
• The chart above indicates that the mortality rate at a gestational age of 26 weeks is less than 20%. Hence, the survival rate at 24 weeks after fertilization is more than 80%.

[107] Paper: “Fetal Homologue of Infant Crying.” By J.L. Gingras and others. Archives of Disease in Childhood: Fetal and Neonatal Edition, April 27, 2005. Pages F415–F418. <www.ncbi.nlm.nih.gov>

Page F415: “[I]n a stable state (quiet or active sleep), the fetus was challenged with … [vibroacoustic stimulation]. [This] … was provided by an artificial larynx (model 5c; Western Electric) that emits fundamental tones of about 100 Hz and 95 dB and was mechanically altered to provide exactly 0.5 second of stimulation. … The physiological intrauterine noise intensity has been reported to be about 85 dB.⁵”

Page F418: “The behaviors were seen in all gestational ages studied, indicating that the behavior occurs as early as 28 weeks gestation, and possibly earlier.”

[108] Advisory: “Hearing Conservation Program.” University Health Services, University of Cincinnati, June 11, 1999. <ehs.uc.edu>

[109] Paper: “Pain and its Effects in the Human Neonate and Fetus.” By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Pages 1321–1329. <www.nejm.org>

Page 1325:

Most recently the motor responses of 124 healthy full-term neonates to a pinprick in the leg were reported to be flexion and adduction of the upper and lower limbs associated with grimacing, crying, or both, and these responses were subsequently quantified. Similar responses have also been documented in very premature neonates, and in a recent study, Fitzgerald and others found that premature neonates (<30 weeks) not only had lower thresholds for a flexor response but also had increased sensitization after repeated stimulation. …

In other studies of the cry response to painful procedures, neonates were found to be more sensitive to pain than older infants (those 3 to 12 months old)….

NOTE: This article uses the obstetric method of counting from the last menstrual period, as evidenced by the chart on page 1322, which uses a gestation of 40 weeks for pregnancy. Two weeks must be subtracted to provide the actual time since fertilization.

[110] Paper: “Symptom Management: Acute Pain, Chapter 3—Pain in Preverbal Children.” United States National Institutes of Health, Publication Number 94-2421, June 1994. <www.nih.gov>

Page 2:

Fitzgerald demonstrated that that the pain threshold was low in premature infants. … [H]uman neonates subjected to repeated heel lances on one foot exhibited a pain threshold lower in the injured foot than in the noninjured foot. Treatment of the affected foot with a local anesthetic cream raised the pain threshold. … Serotonin (5HT) is a biogenic amine transmitter that serves an important role in pain modulation. … Serotonin levels in the young infants are low and may limit the effectiveness of the endogenous pain control mechanisms (Fitzgerald 1991b). These finding led Fitzgerald (1991b) to speculate that the established pain in the neonate could be worse than the observed pain response.

[111] Paper: “Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 Through December 1996.” By James A. Lemons, Avroy A. Fanaroff, and others. Pediatrics, January 2001. <pediatrics.aappublications.org>

Page 4:

Fig. 3. Mortality Before Discharge by Gestational Age as Estimated by Best Obstetrical Estimate Among Infants Born in NICHD [National Institute of Child Health and Human Development] Neonatal Research Network Centers Between January 1, 1995 and December 31, 1996. Data expressed as percentage died and 95% confidence intervals for each gestational age group.

NOTES:

• In the description of the chart above, the term “obstetrical estimate” implies that the weeks are counted from the last menstrual period. To confirm, Just Facts wrote to one of the paper’s authors (Dr. Fanaroff), and he replied: “We do not try to get to the issue of day of conception hence when we refer to gestational age we are always going back to the Last Menstrual Period.”
• The chart above indicates that the mortality rate at a gestational age of 30 weeks is less than 5%. Hence, the survival rate at 28 weeks after fertilization is more than 95%.

[112] This picture of a premature infant was taken three days after birth at 32 weeks after fertilization (34 weeks post-LMP).

[113] Paper: “Flavor Sensing in Utero and Emerging Discriminative Behaviors in the Human Fetus.” By Beyza Ustun and others. Psychological Science, October 2022. Pages 1651–1663. <journals.sagepub.com>

Page 1651:

The diet of pregnant women exposes fetuses to a variety of flavors consisting of compound sensations involving smell, taste, and chemesthesis. The effects of such prenatal flavor exposure on chemosensory development have so far been measured only postnatally in human infants. Here, we report the first direct evidence of human fetal responsiveness to flavors transferred via maternal consumption of a single-dose capsule by measuring frame-by-frame fetal facial movements. Pregnant women and their fetuses based in the northeast of England were involved in this study from 32 to 36 weeks’ gestation.

Page 1652:

Through their developing sensory abilities, fetuses are alert to aspects of their environment in the womb. For example, by swallowing and inhaling the amniotic fluid, a fetus can sense the flavors of food eaten by its mother. However, the current literature on human studies has exclusively focused on postnatal outcomes of prenatal flavor exposure. Instead, by analyzing their facial reactions, we present direct, novel evidence that fetuses can discriminate different flavors in amniotic fluid. We found that when fetuses were exposed to carrot flavor, they were more likely to show “laughter-face” reactions, and when they were exposed to kale flavor, they were more likely to show “cry-face” reactions. We also found that facial responses to flavors became more complex as fetuses matured. This study sheds new light not only on fetal sensory abilities but also on the specificity of facial responses to different flavors relating to their discriminative abilities.

Page 1653:

One hundred mothers between the ages of 18 and 40 years … with healthy, singleton fetuses were enrolled in this study. We chose a target sample size of 100 before recruitment to obtain 85% power … for the main comparison, that is, fetal FMs depending on the flavor exposure. Given that a recent study … reported a large and significant effect size in fetal movements at 32 weeks, medium and even large effect sizes are not unusual in this type of research. We opted to stop collecting data in the study when we reached a predetermined number of participants. Although we were able to recruit 100 women, we could not include all scans in the study for a variety of reasons.

Page 1654:

For this study, at 32 and 36 weeks’ gestation, all women underwent nonmedical 4D ultrasound scans in accordance with the British Medical Ultrasound Society guidelines…. All participants were asked not to ingest anything in the hour prior to their appointment to optimize the effect of the flavor stimuli. In the experimental groups, participants had abstained from consuming any food and/or drink involving carrot and kale on the day of the scan. Experimental group mothers swallowed one vegetable capsule (carrot/kale) with a mouthful of water approximately 20 min … before each scan. The waiting time was based on the time needed for the capsule shell to dissolve in the small…. Control group mothers were not exposed to any flavorant before and/or throughout the scans.

[114] Textbook: Before We Are Born: Essentials of Embryology and Birth Defects (5th edition). By Keith L. Moore & T.V.N. Persaud. W.B. Saunders Company, 1998.

Page 109: “The expected date of delivery (EDD) of a fetus is 266 days, or 38 weeks, after fertilization; that is, 280 days, or 40 weeks, after LNMP [last normal menstrual period] (Table 7-1).” 

[115] Entry: “neonate.” Dorland’s Illustrated Medical Dictionary (29th edition). W. B. Saunders Company, 2000.

Page 1184: “a newborn infant.”

[116] Ruling: Roe v. Wade. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Burger, Brennan, Douglas, Stewart, Marshall, Powell. Concurring: Burger, Douglas, Stewart. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] VIII:

Specific and direct harm medically diagnosable even in early pregnancy may be involved. Maternity, or additional offspring, may force upon the woman a distressful life and future. Psychological harm may be imminent. Mental and physical health may be taxed by child care. There is also the distress, for all concerned, associated with the unwanted child, and there is the problem of bringing a child into a family already unable, psychologically and otherwise, to care for it. In other cases, as in this one, the additional difficulties and continuing stigma of unwed motherhood may be involved. All these are factors the woman and her responsible physician necessarily will consider in consultation.

[Section] XI:

For the stage subsequent to viability the State, in promoting its interest in the potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion except where necessary, in appropriate medical judgment, for the preservation of the life or health of the mother. …

In Doe v. Bolton, post, p. 179, procedural requirements contained in one of the modern abortion statutes are considered. That opinion and this one, of course, are to be read together.

[117] Ruling: Doe v. Bolton. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Brennan, Stewart, Marshall, Powell. Concurring: Burger, Douglas. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] IV: “[T]he medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman’s age—relevant to the wellbeing of the patient. All these factors may relate to health.”

[118] Ruling: Planned Parenthood of Southeastern PA v. Casey. United States Supreme Court. June 29, 1992. <caselaw.findlaw.com>

Majority:

It must be stated at the outset and with clarity that Roe’s essential holding, the holding we reaffirm, has three parts. First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the State. Before viability, the State’s interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman’s effective right to elect the procedure. Second is a confirmation of the State’s power to restrict abortions after fetal viability if the law contains exceptions for pregnancies which endanger the woman’s life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.

[119] Ruling: Doe v. Bolton. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Brennan, Stewart, Marshall, Powell. Concurring: Burger, Douglas. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] IV:

D. The appellants next argue that the District Court should have declared unconstitutional three procedural demands of the Georgia statute: (1) that the abortion be performed in a hospital accredited by the Joint Commission on Accreditation of Hospitals:¹¹ (2) that the procedure be approved by the hospital staff abortion committee; and (3) that the performing physician’s judgment be confirmed by the independent examinations of the patient by two other licensed physicians. …

We hold that the JCAH-accreditation [Joint Commission on Accreditation of Hospitals] requirement does not withstand constitutional scrutiny in the present context. …

We conclude that the interposition of the hospital abortion committee is unduly restrictive of the patient’s rights and needs that, at this point, have already been medically delineated and substantiated by her personal physician. …

There remains, however, the required confirmation by two Georgia-licensed physicians in addition to the recommendation of the pregnant woman’s own consultant (making under the statute, a total of six physicians involved, including the three on the hospital’s abortion committee). We conclude that this provision, too, must fall.

The statute’s emphasis, as has been repetitively noted, is on the attending physician’s “best clinical judgment that an abortion is necessary.” That should be sufficient. The reasons for the presence of the confirmation step in the statute are perhaps apparent, but they are insufficient to withstand constitutional challenge. … If a physician is licensed by the State, he is recognized by the State as capable of exercising acceptable clinical judgment.

[120] Article: “Daschle Bill May Not Ban Anything; Abortionists Could Use Own Judgment.” By Frank J. Murray. Washington Times, May 15, 1997. <www.washingtontimes.com>

… Dr. Warren Hern, who literally wrote the textbook on “Abortion Practice.”

The Denver gynecologist said the fact of occasional death in childbearing can justify any abortion, no matter how late it is done.

“I will certify that any pregnancy is a threat to a woman’s life and could cause ‘grievous injury’ to her ‘physical health,’ ” Dr. Hern said, using key words from the Daschle bill….

[121] Webpage: “The Guttmacher Institute’s Future.” Guttmacher Institute Board of Directors, June 23, 2005. <www.guttmacher.org>

Guiding Principles …

The Institute works to protect, expand and equalize access to information, services and rights that will enable women and men to

• avoid unplanned pregnancies;

• prevent and treat sexually transmitted infections, including HIV [human immunodeficiency virus];

• exercise the right to choose abortion;

• achieve healthy pregnancies and births; and

• have healthy, satisfying sexual relationships.

[122] Webpage: “Who Was Alan Guttmacher?” Guttmacher Institute. Accessed July 28, 2021 at <bit.ly>

The Guttmacher Institute, an independent, nonprofit, tax-exempt organization with offices in New York and Washington, D.C., was established in 1968 to provide research, policy analysis and education in the fields of reproductive health, reproductive rights and population. It was named to honor a distinguished obstetrician-gynecologist, author and leader in reproductive rights. While Alan F. Guttmacher was president of the Planned Parenthood Federation of America and a leader in the International Planned Parenthood Federation in the 1960s and early 1970s, he saw the need for the institution that now bears his name, and he nurtured its development.

[123] Webpage: “Perspectives on Sexual and Reproductive Health: A Journal of Peer-Reviewed Research.” Guttmacher Institute. Accessed July 28, 2021 at <www.guttmacher.org>

“Perspectives on Sexual and Reproductive Health is published by the Guttmacher Institute in partnership with Wiley-Blackwell and is available online only.”

[124] Paper: “Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives.” By Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore. Perspectives on Sexual and Reproductive Health, September 2005. Pages 100–118. <www.guttmacher.org>

Page 110:

Lawrence B. Finer is associate director for domestic research, Lori F. Frohwirth is research associate, Lindsay A. Dauphinee is research assistant, Susheela Singh is vice president for research and Ann M. Moore is senior research associate—all at the Guttmacher Institute, New York. …

Methods: In 2004, a structured survey was completed by 1,209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites. Bivariate analyses examined differences in the reasons for abortion across subgroups, and multivariate logistic regression models assessed associations between respondent characteristics and reported reasons.

Page 111:

Our eight-page questionnaire covered in detail the reasons why the respondent chose to terminate her pregnancy. The first question was open-ended: “Please describe briefly why you are choosing to have an abortion now. If you have more than one reason, please list them all, starting with the most important one first.”

Page 113:

Table 2. Percentage of women reporting that specified reasons contributed to their decision to have an abortion, 2004 and 1987 … 2004 (N=1,160) … Possible problems affecting the health of the fetus [=] 13 … Physical problem with my health [=] 12 … Was a victim of rape [=] 1 … Became pregnant as a result of incest [=] <0.5

Page 118:

This study is subject to some limitations. Our sample is not strictly nationally representative. Also, only 58% of the abortion patients seen by the participating facilities completed the survey, and nonresponse on some variables—notably, income—was high. However, the social and demographic characteristics of respondents were similar to those of two nationally representative surveys, which provides some reassurance that the findings are representative of abortion patients in the United States.

[125] Paper: “Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives.” By Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore. Perspectives on Sexual and Reproductive Health, September 2005. Pages 100–118. <www.guttmacher.org>

Page 111:

Our eight-page questionnaire covered in detail the reasons why the respondent chose to terminate her pregnancy. The first question was open-ended: “Please describe briefly why you are choosing to have an abortion now. If you have more than one reason, please list them all, starting with the most important one first.”

Page 114:

Table 3. Percentage distribution of women having an abortion, by their most important reason for having the abortion, 2004 and 1987 … 2004 (N=957) … Physical problem with my health [=] 4 … Possible problems affecting the health of the fetus [=] 3 … Was a victim of rape [=]<0.5 … [Became pregnant as a result of incest not large enough to be listed]

[126] Textbook: Statistics: Concepts and Controversies (6th edition). By David S. Moore and William I. Notz. W. H. Freeman and Company, 2006.

Pages 42–43:

The variability of a statistic from a random sample does not depend on the size of the population as long as the population is at least 100 times larger than the sample.

Why does the size of the population have little influence on the behavior of statistics from random samples? Imagine sampling harvested corn by thrusting a scoop into a lot of corn kernels. The scoop doesn’t know whether it is surrounded by a bag of corn or by an entire truckload. As long as the corn is well mixed (so that the scoop selects a random sample), the variability of the result depends only on the size of the scoop.

Page 44:

News reports often only mention the margin of error. Most often this margin of error is for 95% confidence. That is, if we choose many samples, the truth about the population would be within the margin of error 95% of the time. We can estimate the margin of error for 95% confidence based on a simple random sample of size n by the formula 1/√n. As this formula suggests, only the size of the sample, not the size of the population matters. This is true as long as the population is much larger than the sample.

CALCULATION: 1/√1,209 = 2.9%

[127] Paper: “Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives.” By Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, and Ann M. Moore. Perspectives on Sexual and Reproductive Health, September 2005. Pages 100–118. <www.guttmacher.org>

Page 117:

Women’s reported reasons for ending pregnancies have been consistent over time. Furthermore, the proportion of women reporting each major reason changed relatively little between 1987 and 2004. The few larger changes appear to have been at least partially due to changes in the composition of the population, rather than entirely to changes in women’s tendency to give those reasons.

[128] Paper: “Reasons Why Women Have Induced Abortions: A Synthesis of Findings From 14 Countries.” By Sophia Chae and others. Contraception, October 2017. Pages 233–241. <www.sciencedirect.com>

Page 233:

We examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. …

In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women’s sociodemographic characteristics.

Page 238:

Table 2. Percentage distribution of women who had an abortion by main reason given for seeking abortion, various countries and years …

Risk to maternal health … Belgium, 2011 [=] 2.9 … Kyrgyz Republic, 2012 [=] 44.4 …

Risk to fetal health … Azerbaijan, 2006 [=] 1.1 … Belgium, 2011 [=] 1.1 … Ghana, 2007 [=] 1.1 … Turkey, 2003 [=] 7.2

Page 239:

This study contains several limitations. In 11 of the 14 countries, the timeframe for abortions was 5 years prior to the survey, while marital status, educational attainment, and residence were measured at the time of the survey. Thus, women’s characteristics at the time of their abortion may differ from those at the time of the survey; this likely affects younger women disproportionately. Moreover, recall bias may affect women’s responses, especially for those who obtained an abortion further in the past. Future research should consider using panel data to overcome this limitation.

[129] Webpage: “Five Ways to Prevent Abortion (And One Way That Won’t).” Planned Parenthood, January 1, 2004. Updated 9/22/06. <www.plannedparenthood.org>

The way to prevent abortion is not to make it illegal. That won’t work. It never has. Whenever governments have made abortions illegal, they have not stopped them. Throughout the centuries, when women have felt abortion to be their only option, they have had them. Whether they were legal or not. In the two decades before abortion was legal in the United States, nearly one million women went “underground” each year for illegal operations. Thousands died for lack of medical care. Tens of thousands were maimed. All were forced to behave as if they were criminals in order to do what they felt was right for themselves. We hope those days are gone forever, even though anti-choice extremists are determined to turn back the clock.

[130] Fact Sheet: “Abortion After the First Trimester.” Planned Parenthood. Accessed October 2002 at <www.plannedparenthood.org>

“Presently the death rate from abortion at all stages of gestation is 0.6 per 100,000 procedures (Paul and others, 1999).”

NOTE: “Paul and others, 1999” is a secondary source that cites the CDC. See next footnote.

[131] Book: A Clinician’s Guide to Medical and Surgical Abortion. By Maureen Paul & others. Churchill Livingstone, 1999.

Page 19: “In the United States mortality [from abortion] was (per 100,000) 2.6 during the period 1972–1976, 0.9 in 1977–1981, 0.7 in 1982–1986, and 0.6 in 1987–1991 (based on deaths reported by the CDC [U.S. Centers for Disease Control] and number of abortions from AGI [Alan Guttmacher Institute]).”

NOTE: This corresponds to the figure for subsequent years quoted in the next footnote.

[132] Fact sheet: “Abortion Surveillance.” U.S. Centers for Disease Control, National Center for Chronic Disease Prevention & Health Promotion, June 7, 2002. <www.cdc.gov>

“The case-fatality rate for known legal induced abortion for 1993 to 1997 was 0.6 deaths per 100,000 legal abortions.”

[133] Report: “Abortion Surveillance—United States, 1996.” By Lisa M. Koonin and others. U.S. Centers for Disease Control, Division of Reproductive Health, July 30, 1999. <www.cdc.gov>

“Table 19. Number of Deaths and Case-Fatality Rates* for Abortion-Related Deaths Reported to CDC [U.S. Centers for Disease Control], by Type of Abortion – United States, 1972–1992 … Year [=] 1972 … Illegal [=] 39 … Year [=] 1974 … Legal [=] 26 … * Legal induced abortion-related deaths per 100,000 legal induced abortions.”

NOTE: The data in this source and the sources cited in the next footnote come from different divisions of the CDC and are at variance with one another due to methodological dissimilarities. It was necessary to use data from both divisions because the data from this source only goes back to 1972, and the sources in the next footnote do not isolate legal vs. illegal abortion-related deaths.

[134] Calculated with data from:

a) Report: “Table 290F. Deaths For Approximately 64 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1950–59.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 169 (of PDF): “Cause of Death [=] Abortion”

b) Report: “Table 290A. Deaths For 60 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1960–67.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 169 (of PDF): “Cause of Death [=] Abortion”

c) Report: “Table 290A. Deaths For 69 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1968–78.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 358 (of PDF): “Cause of Death [=] Abortions”

d) Report: “Resident Population by Age, Color, and Sex: United States, 1950–1959.” U.S. Centers for Disease Control, National Center for Health Statistics. Mailed to Just Facts from the aforementioned agency, August 7, 2008.

e) Report: “Population by Age Groups, Race, and Sex for 1960–97.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 19 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1961–1969”

Page 21 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1971–1979”

[135] Article: “Maternal Mortality Surveillance, United States, 1980–1985.” By Lisa M. Koonin & others. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, December 1, 1988. <www.cdc.gov>

Finally, the coding system used by national vital statistics and states to describe maternal deaths includes a combination of outcomes of pregnancy (e.g. ectopic pregnancy, abortion), immediate causes of death (e.g., hemorrhage), and underlying obstetrical conditions that contribute to death (e.g., obstructed labor). This system of classification precludes a determination of the real causes of maternal death. To develop strategies to prevent maternal deaths, public health personnel need to know the immediate cause of death as well as the underlying conditions that led to death.

[136] Calculated with data from:

a) Report: “Table 290F. Deaths For Approximately 64 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1950–59.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 167 (of PDF): “Cause of Death [=] Deliveries and Complications of Pregnancy, Childbirth and the Puerperium”

b) Report: “Table 290A. Deaths For 60 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1960–67.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 167 (of PDF): “Cause of Death [=] Deliveries and Complications of Pregnancy, Childbirth and the Puerperium”

c) Report: “Table 290A. Deaths For 69 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1968–78.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 363 (of PDF): “Cause of Death [=] Other Complications of Pregnancy, Childbirth and the Puerperium”

d) Report: “Resident Population by Age, Color, and Sex: United States, 1950–1959.” U.S. Centers for Disease Control, National Center for Health Statistics. Mailed to Just Facts from the aforementioned agency, August 7, 2008.

e) Report: “Population by Age Groups, Race, and Sex for 1960–97.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 19 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1961–1969”

Page 21 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1971–1979”.

[137] Article: “Maternal Mortality Surveillance, United States, 1980–1985.” By Lisa M. Koonin & others. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, December 1, 1988. <www.cdc.gov>

“Death certificates alone may not provide adequate information on the sequence of events that led to death. Ultimately a single code is assigned to classify the underlying cause of death. Often, however, several factors may contribute to a death; therefore, the death cannot be adequately described with a unidimensional code.”

[138] Calculated with data from:

a) Report: “Table 290F. Deaths For Approximately 64 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1950–59.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 1 (of PDF): “Cause of Death [=] All Causes”

Page 43 (of PDF): “Cause of Death [=] Malignant Neoplasms”

Page 199 (of PDF): “Cause of Death [=] Motor Vehicle Accidents”

Page 208 (of PDF): “Cause of Death [=] Homicide”

b) Report: “Table 290A. Deaths For 60 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1960–67.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 1 (of PDF): “Cause of Death [=] All Causes”

Page 40 (of PDF): “Cause of Death [=] Malignant Neoplasms”

Page 200 (of PDF): “Cause of Death [=] Motor Vehicle Accidents”

Page 210 (of PDF): “Cause of Death [=] Homicide”

c) Report: “Table 290A. Deaths For 69 Selected Causes, By 10-Year Age Groups, Race, And Sex: United States, 1968–78.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 2 (of PDF): “Cause of Death [=] All Causes”

Page 73 (of PDF): “Cause of Death [=] Malignant Neoplasms Including Neoplasms of Lymphatic and Hematopoietic Tissues”

Page 406 (of PDF): “Cause of Death [=] Motor Vehicle Accidents”

Page 422 (of PDF): “Cause of Death [=] Homicide”

d) Report: “Resident Population by Age, Color, and Sex: United States, 1950–1959.” U.S. Centers for Disease Control, National Center for Health Statistics. Mailed to Just Facts from the aforementioned agency, August 7, 2008.

e) Report: “Population by Age Groups, Race, and Sex for 1960–97.” U.S. Centers for Disease Control, National Center for Health Statistics. Accessed August 2008 at <www.cdc.gov>

Page 19 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1961–1969”

Page 21 (of PDF): “Resident Population of the United States by 10 Year Age Groups, Race, and Sex for 1960 and Revised Estimates for 1971–1979”

[139] Fact sheet: “Abortion After the First Trimester in the United States.” By John Mugge and others. Revised by Deborah Golub. Planned Parenthood, 2004. Accessed February 16, 2017 at <www.plannedparenthood.org>

Page 3:

The risk of death from medication abortion through 63 days’ gestation is about one per 100,000 procedures (Grimes, 2005). The risk of death with surgical abortion is about one per 1,000,000 through 63 days’ gestation (Bartlett and others, 2004). The risk of death from miscarriage is about one per 100,000 (Saraiya and others, 1999). But the risk of death associated with childbirth is about 10 times as high as that associated with all abortion (Christiansen & Collins, 2006).

[140] Paper: “Pregnancy-Associated Deaths: A 15-Year Retrospective Study and Overall Review of Maternal Pathophysiology.” By Lydia R. Christiansen & Kim A. Collins. American Journal of Forensic Medicine and Pathology, March 2006. Pages 11–19. <www.ncbi.nlm.nih.gov>

Page 11:

Pregnancy-related death is defined by the International Classification of Diseases, Tenth Revision (ICD-10) as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. In the year 2000, a collaborative effort involving World Health Organization (WHO), UNICEF [United Nations Children’s Fund], and UNFPA [United Nations Population Fund] estimated 660 maternal deaths in the United States. This averages 11 maternal deaths per 100,000 live births reported.

Page 13: “The risk of death from complications of pregnancy decreased approximately 99% during the 20th century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982.⁴”

Page 18: “It is evident that homicides, suicides, and accidents account for a large proportion of pregnancy-related deaths.”

NOTE: The figures from “Christiansen & Collins, 2006” cannot be used as a comparator for the others studies cited by Planned Parenthood in the footnote above (i.e., Grimes, Bartlett) because these studies are limited by gestational age and do not apply to “all abortion.”

[141] Fact sheet: “Abortion After the First Trimester.” Planned Parenthood. Accessed October 2002 at <www.plannedparenthood.org>

“Presently the death rate from abortion at all stages of gestation is 0.6 per 100,000 procedures (Paul and others, 1999). The risk of death associated with childbirth is about 10 times as high as that associated with abortion (AGI [Alan Guttmacher Institute], 1998).”

NOTE: “Paul and others, 1999” and “AGI, 1998” are secondary sources that cite the CDC [U.S. Centers for Disease Control]. See the next two footnotes.

[142] Book: A Clinician’s Guide to Medical and Surgical Abortion. By Maureen Paul & others. Churchill Livingstone, 1999.

Page 19: “In the United States mortality [from abortion] was (per 100,000) 2.6 during the period 1972–1976, 0.9 in 1977–1981, 0.7 in 1982–1986, and 0.6 in 1987–1991 (based on deaths reported by the CDC [U.S. Centers for Disease Control] and number of abortions from AGI [Alan Guttmacher Institute]).”

[143] Webpage: “Facts in Brief\Induced Abortion.” Guttmacher Institute. Accessed October 2002 at <bit.ly>

The risk of death associated with childbirth is about 10 times as high as that associated with abortion. …

The data in this fact sheet are the most current available. Most are from research conducted by the Alan Guttmacher Institute and/or published in its peer-reviewed journals. An additional source is the Centers for Disease Control and Prevention.

[144] Report: “Strategies to Reduce Pregnancy-Related Deaths: From Identification and Review to Action.” By Cynthia Berg and others. Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, 2001. <stacks.cdc.gov>

Page 14:

Sources of pregnancy-related deaths are listed below in order of simplicity and convenience:

• Death certificate cause-of-death codes—the core source for finding cases.

• Manual review of death certificates.

• Pregnancy check boxes on death certificates.

• Computerized linkages of vital records.

• Other computerized data sources.

• Obstetricians, other clinicians, and groups.

• The news media.

• Autopsy and medical records.

[145] Correspondence: “Chang and Berg Respond To Horon.” By Jeani Chang & Cynthia J. Berg. American Journal of Public Health, November 2005. Pages 1879–1880. <www.ajph.org>

“We have no choice but to rely on the methods used by each reporting area to determine whether a death (including a death because of homicide) is pregnancy-associated. As stated in our discussion, the cause of death on death certificates is the most common way of ascertaining pregnancy-associated deaths.”

[146] Report: “Strategies to Reduce Pregnancy-Related Deaths: From Identification and Review to Action.” By Cynthia Berg and others. Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, 2001. <stacks.cdc.gov>

Page 13:

Currently, no single source of information captures all pregnancy-related deaths, despite all deaths and essentially all live births in the United States being registered by Vital Statistics. Several reasons account for this failure:

• Lack of physician training in, or knowledge about, how to fill out a death certificate.

• ICD[International Classification of Diseases] coding rules that make the cause-of-death code on a death certificate fall outside the range of conditions considered to be pregnancy-related (in ICD-9, those codes are 630–676; in ICD-10, chapter O).

• Reliance on death certificate data to estimate cause of death.

• Medical records that fail to indicate that the events leading to death began with pregnancy, especially if the death occurred during the postpartum period.

• Medical and autopsy records that cannot be located or are not available for review.

[147] Article: “Maternal Mortality Surveillance, United States, 1980–1985.” By Lisa M. Koonin & others. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, December 1, 1988. <www.cdc.gov>

At present, vital statistics collected by NCHS [National Center for Health Statistics] are the only source of information about U.S. ratios of maternal mortality. Until January 1988, no systematic, national system existed for studying the epidemiology of maternal mortality. Some states collect and publish state ratios of maternal mortality; however, both the national and the state vital statistics systems have several limitations.

First, information reported from vital statistics alone is limited. Death certificates alone may not provide adequate information on the sequence of events that led to death. Ultimately a single code is assigned to classify the underlying cause of death. Often, however, several factors may contribute to a death; therefore, the death cannot be adequately described with a unidimensional code.³¹

[148] Correspondence: “Chang and Berg Respond To Horon.” By Jeani Chang & Cynthia J. Berg. American Journal of Public Health, November 2005. Pages 1879–1880. <www.ajph.org>

We have no choice but to rely on the methods used by each reporting area to determine whether a death (including a death because of homicide) is pregnancy-associated. As stated in our discussion, the cause of death on death certificates is the most common way of ascertaining pregnancy-associated deaths. Next is computerized linking of deaths among women of reproductive age with birth certificates and fetal death certificates; we believe this system is used in about half the reporting areas.

[149] Report: “Strategies to Reduce Pregnancy-Related Deaths: From Identification and Review to Action.” By Cynthia Berg and others. Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, 2001. <stacks.cdc.gov>

Page 18:

Linking Vital Records

Death certificates for reproductive-aged women who die can be linked with certificates of reportable pregnancy outcomes (live births and fetal deaths) that occurred during the preceding year. Although many states require that induced abortions be reported, only one includes on its records identifying data that could be used to link those records with other computerized records. Linking data sets is being done in an increasing number of states, and published reports indicate that such links can increase case ascertainment by 36%† to 153% (Table 3, Box 3). However, linking vital records cannot ensure that all pregnancy-related deaths will be identified, since only about two-thirds to three-quarters of pregnancy-related deaths are associated with either a live birth or a fetal death. Excluded from linkages would be deaths associated with ectopic pregnancies, induced and some spontaneous abortions, gestational trophoblastic disease, and undelivered pregnancies.

NOTE: † This figure of 36% is in error. The figure should be 30%, as per Table 3 on page 19, which is the cited source (see below).

Page 19:

[150] Report: “Strategies to Reduce Pregnancy-Related Deaths: From Identification and Review to Action.” By Cynthia Berg and others. Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, 2001. <stacks.cdc.gov>

Page 18:

Linking Vital Records

Death certificates for reproductive-aged women who die can be linked with certificates of reportable pregnancy outcomes (live births and fetal deaths) that occurred during the preceding year. Although many states require that induced abortions be reported, only one includes on its records identifying data that could be used to link those records with other computerized records.

[151] Article: “Maternal Mortality Surveillance, United States, 1980–1985.” By Lisa M. Koonin & others. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, December 1, 1988. <www.cdc.gov>

Finally, the coding system used by national vital statistics and states to describe maternal deaths includes a combination of outcomes of pregnancy (e.g. ectopic pregnancy, abortion), immediate causes of death (e.g., hemorrhage), and underlying obstetrical conditions that contribute to death (e.g., obstructed labor). This system of classification precludes a determination of the real causes of maternal death. To develop strategies to prevent maternal deaths, public health personnel need to know the immediate cause of death as well as the underlying conditions that led to death.

[152] Report: “Strategies to Reduce Pregnancy-Related Deaths: From Identification and Review to Action.” By Cynthia Berg and others. Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, 2001. <stacks.cdc.gov>

Page 25:

Maternal Mortality Review Committees

In most cases, the state is the level at which pregnancy-related deaths are reviewed, although the process can occur in some very large cities and counties. The legislation that enables maternal mortality review and the review committee’s place within the governmental organization vary widely from state to state.

[153] Webpage: “CDC’s Abortion Surveillance System: FAQs.” U.S. Centers for Disease Control, Division of Reproductive Health. Updated January 06, 2017. <www.cdc.gov>

Are States Required to Report Their Abortion Statistics to CDC?
 

No, states and areas voluntarily report data to CDC for report preparation. CDC’s Division of Reproductive Health prepares surveillance reports as data becomes available. There is no national requirement for data submission or reporting.

[154] Phone call from Just Facts to the U.S. Centers for Disease Control, Division of Reproductive Health, July 1, 2008.

Just Facts requested a state-by-state breakdown of the data in Table 19 of “Abortion Surveillance—United States, 2004,” which shows abortion-related fatalities for 1972–2003. The CDC would not release this data on the grounds that it would violate their privacy agreements with certain states.

[155] Paper: “Physician and Public Opinions on Quality of Health Care and the Problem of Medical Errors.” By Andrew R. Robinson and others. Archives of Internal Medicine, October 28, 2002. Pages 2186–2190. <archinte.ama-assn.org>

Page 2186: “Uniformly, physicians believed that fear of medical malpractice is a barrier to reporting of errors and that greater legal safeguards are necessary for a mandatory reporting system to be successful.”

Page 2189: “Table 4. Colorado and National Physician Opinions … Medical malpractice litigation is a barrier to the reporting of medical errors. … National No. (%) [=] 299 (98.4)”

NOTE: 98.4% of physicians in the national sample agreed with this statement.

[156] Report: “Vital Statistics of the United States, 1989. Volume II—Mortality, Part A.” U.S. Centers for Disease Control, National Center for Health Statistics and Prevention, 1993. <www.cdc.gov>

Page 13 (of PDF):

Symbols Used in Tables

Data not available ---

Category not applicable …

Quantity zero –

Page 262: “Table 1-25. Deaths From 282 Selected Causes, by Race—United States and Each State: 1989.”

NOTE: Abortion-related mortality data provided by the CDC’s [U.S. Centers for Disease Control] National Center for Health Statistics is at variance with that provided by CDC’s Division of Reproductive Health due to methodological dissimilarities. The National Center for Health Statistics is only cited here because the Division of Reproductive Health does not break down their national data on a state-by states basis. In July 2008, Just Facts filed a Freedom of Information Act Request with the CDC for this data and is awaiting a response.

[157] Report: “Vital Statistics of the United States, 1990. Volume II—Mortality, Part A.” U.S. Centers for Disease Control, National Center for Health Statistics and Prevention, 1994. <www.cdc.gov>

Page 262: “Table 1-25. Deaths From 282 Selected Causes, by Race—United States and Each State: 1990.”

[158] Report: “Vital Statistics of the United States, 1991. Volume II—Mortality, Part A.” U.S. Centers for Disease Control, National Center for Health Statistics and Prevention, 1996. <www.cdc.gov>

Page 262: “Table 1-25. Deaths From 282 Selected Causes, by Race—United States and Each State: 1991.”

[159] Report: “Vital Statistics of the United States, 1992. Volume II – Mortality, Part B.” U.S. Centers for Disease Control, National Center for Health Statistics and Prevention, 1996. <www.cdc.gov>

Page 320: “Table 8-6. Deaths From 72 Selected Causes, by 10-Year Age Groups, Race, and Sex.”

[160] Autopsy number 89-593: “Erica Richardson.” By Julia C. Goodin & others. Office of the Chief Medical Examiner, State of Maryland, June 28, 1989. Autopsy performed on March 3, 1989. <health.maryland.gov>

Page 1: “Description of Injury … Close examination of the anterior portion of the uterus showed a large irregular perforation of the anterior lower uterine wall which extended into a portion of the cervix.”

Page 5:

Opinion: This, 16 year old black female, Erica Richardson, died from rupture of lower uterus and cervix with complications, including hemorrhage into the pelvic cavity surrounding the uterus and air embolism (air escaping into the vasculature and heart). According to police reports, the deceased was known to have been pregnant and this is consistent with autopsy findings. However, she had undergone an evacuation [abortion] procedure which resulted in perforation of the uterus.

[161] Article: “Teen’s Death After Abortion Brings Suit.” By Larry Perl. Prince George’s Journal Weekly, May 30–31, 1990.

The malpractice suit claims that on the evening of March 1, 1989, Dr. Gene Crawford punctured 16-year-old Erica Kae Richardson’s uterus and cervix—then left her “bleeding to death” on an operating table in his Laurel office for four hours, without monitoring vital signs.

At 10:45 p.m., Crawford carried Richardson to her aunt’s car and told the aunt to “take [her] home and out her to bed,” the suit states. … The aunt, deciding that her niece needed “emergency treatment,” drove to Bowie Health Center, where Richardson was rushed into the emergency room at 11 p.m., in respiratory arrest, and died shortly after midnight the suit states. …

Richardson’s mother … referred questions to the attorneys. … Donald McLaughlin said Richardson’s aunt, Denise Crarey, helped Richardson get an abortion without telling Richardson’s mother. McLaughlin added that though Crarey and Richardson’s mother are sisters, they have “a very strained relationship.” Crarey, a registered nurse, took Richardson first to Washington Hospital Center, which wouldn’t perform the abortion because Richardson was too far along in her pregnancy, McLaughlin said.

[162] Article: “Mother Is Suing Doctor: Daughter Died After Abortion.” By Melanie Mader. Maryland Laurel Leader, June 29, 1990. Pages A1, 3. <www.baltimoresun.com>

Page A3: “Richardson-Smith was unaware that her daughter was having an abortion until the Bowie medical center called her, McLaughlin said.”

[163] Press release: “Human Life International Claims Maryland Health Department ‘Ignores, Covers-Up’ Abortion Deaths.” PR Newswire, November 21, 1991. <www.prnewswire.com>

“Erica Richardson, 16, died March 2, 1989, just hours after an abortion was performed upon her by Dr. Gene O. Crawford at his Metropolitan Women’s Center, 9811 Mallard Dr., Laurel, Md.”

[164] Article: “2 Tragedies Raise Doubts About Suitland Clinic; Abortion Patient, Left Paralyzed, Files Suit.” By Retha Hill. Washington Post, August 13, 1990. Page A1. <www.washingtonpost.com>

Kioko and Lofton said they have also been interviewed by board investigators about the death of Debra M. Gray, a 34-year-old woman….

The Physicians Quality Assurance Board is also looking at the case of Debra Gray, a secretary at the Naval Hospital, who went to the Hillview night clinic on July 12, 1989. …

Paramedics were called to the clinic, where Gray had gone into cardiac arrest; her brain was deprived of oxygen for at least 12 minutes, according to the autopsy records and family members. Gray, who was later found to have traces of heroin in her system, was rushed to Malcolm Grow Hospital at Andrews Air Force Base, where doctors detected no brain activity. Three days later, doctors disconnected life support systems. …

The state Medical Examiner’s Office reported that Gray’s death was precipitated by a reaction of the heroin in her system with the barbiturate. …

Kioko, who was the gynecologist performing the abortion, said that a registered nurse mixed and injected the barbiturate into Gray, and that clinic personnel thought it would put her into a “twilight” state rather than under general anesthesia.

Barbara Lofton agreed with Kioko that no anesthesiologist was at the clinic during the time Logan and Gray underwent abortions, but she said physicians administered the anesthetic. Kioko denied that.

[165] Article: “2 Tragedies Raise Doubts About Suitland Clinic; Abortion Patient, Left Paralyzed, Files Suit.” By Retha Hill. Washington Post, August 13, 1990. Page A1. <www.washingtonpost.com>

Susanne Renee Logan was three months pregnant when she went to Hillview Women’s Medical Surgical Center for an abortion. …

In sworn statements contained in a lawsuit Logan has filed, paramedics said that the 32-year-old woman was blue and in cardiac arrest when they arrived. Paramedics said clinic personnel attempted to revive her with a medicine that medical experts say has no effect on reversing the reaction to Brevital. Clinic workers had tried to resuscitate her with oxygen equipment that was not working. An oxygen mask placed over her nose and mouth was upside down. Furthermore, there was no anesthesiologist on duty to administer the drug or monitor Logan’s vital signs, according to interviews with clinic personnel. …

After four months in a coma, Logan, who suffered extensive brain damage in the Sept. 9 incident, is almost completely paralyzed. …

The emergency workers gave Logan the stimulant epinephrine intravenously, after which her heartbeat was restored.

[166] Article: “Botched-Abortion Victim Dies in Baltimore.” Washington Times, December 2, 1992. <www.washingtontimes.com>

“Susanne Logan, the Forestville woman who was paralyzed in a botched 1989 abortion at a Suitland clinic, died in Baltimore yesterday of complications from pneumonia, just three weeks after she won a multimillion-dollar settlement in her case.”

[167] Article: “Pneumonia – Diseases.” By Robert Baird. American Chronicle, March 2, 2008.

[Pneumonia] is often the final complication of some other debilitating disorder, and this is why many people who get pneumonia die. Any one whose resistance is already low is very susceptible to pneumonia, so for people who are dying of heart failure, cancer, stroke or chronic bronchitis, the actual cause of death is often pneumonia. In anyone who is semi-conscious or paralyzed, infection of the lungs is extremely likely. This is because under such conditions the normal coughing reflex that keeps the lungs clear of mucus and stagnant fluid is reduced, or even absent.

[168] Book: Victims of Choice. By Kevin Sherlock. Brennyman Books, 1996.

Page 134:

Gladyss Estanislao. This 28-year-old married Filipina woman, a legal secretary who lived in Prince George’s County, died May 12, 1989, 17 days after Alan Ross reportedly performed a vacuum abortion on her at the Wisconsin Avenue Women’s Health Care Center in Bethesda. Ross reportedly failed to diagnose Gladyss was ectopically pregnant, and then he reportedly botched the abortion.

NOTE: The sources cited are Ms. Estanislao’s death certificate and a 12/5/91 article in The Wanderer. Note the discrepancy with the source below regarding the type of abortion procedure.

[169] Article: “Sudden Death Due to Rupture of Ectopic Pregnancy Concurrent with Therapeutic Abortion.” By Ling Li & John E. Smialek. Archives of Pathology & Laboratory Medicine, July 1993. Pages 698–700. <www.ncbi.nlm.nih.gov>

Page 698: “In 1989, a case of sudden death secondary to EP [ectopic pregnancy] was investigated by the Office of the Chief Medical Examiner for the State of Maryland, Baltimore.”

Page 699:

In 1989, a 28-year-old female college student was found unresponsive on the bathroom floor near her classroom. … the subject was transported to a local hospital where she was pronounced dead on arrival.

Further investigation revealed that the woman had been seen at a clinic for a missed abortion 17 days before her death and underwent a dilation and curettage [abortion procedure]. No surgical specimen was sent to the laboratory for pathologic examination before she left the clinic. …

… A 0.3 cm rupture site was located on the lateral surface [of the left fallopian tube], surrounded by hemorrhagic tissue.

[170] Commentary: “Ectopic Pregnancy in Association with Induced Abortion: Message for the Pathologist.” By Jane W. Hardman & others. Archives of Pathology & Laboratory Medicine, July 1993. Pages 696–697. <www.ncbi.nlm.nih.gov>

Page 696: “Admittedly, in each of these cases there was a failure on the part of clinicians to recognize the clinical signs of ectopic pregnancy and to follow up with the patients accordingly.”

Page 697: “In summary, recommendations that are already in place, had they been followed in the cases reported by Drs Li and Smialek, should have prevented the deaths of three young women.”

[171] Article: “Pregnancy.” By Lynn J. Romrell (Ph.D., Associate Dean for Education and Professor of Anatomy and Cell Biology, University of Florida College of Medicine). World Book Encyclopedia, 2007 Deluxe Edition.

“An ectopic pregnancy occurs when a fertilized egg implants itself outside the uterus, usually inside the fallopian tube, the tube through which the egg passes on its way from the ovary to the uterus. The developing baby cannot survive in an ectopic pregnancy. The pregnancy may be fatal to the mother if untreated.”

[172] Book: Essentials of Medical Ultrasound: A Practical Introduction to the Principles, Techniques and Biomedical Applications. Edited by Michael H. Repacholi and Deirdre A. Benwell. Humana Press, 1982.

Chapter 5: “Clinical Applications of Diagnostic Ultrasound.” By Edward A. Lyons. Pages 141–180.

Page 176: “An important diagnosis to make is that of an ectopic pregnancy. If the pregnancy test is positive and the uterus is empty, one may be able to visualize [via ultrasound] a mass in the tube. In that instance the diagnosis of ectopic is almost 100% certain.”

[173] Textbook: Ultrasound and the Fallopian Tube. Edited by Ilan E. Timor-Tritsch & Asim Kurjak. Parthenon Publishing Group, 1996.

Chapter 4: “Ultrasonic Aspects of Ectopic Pregnancy.” By I. E. Timor-Tritsch & others. Pages 27–50.

Page 29:

One of the explicit advantages of the modern pregnancy tests … is that they can be employed in the emergency room or in the office of the gynecologist. This definitely presents an advantage since, in applying this pregnancy test followed by an office ultrasound examination of the pelvis, a fast and almost always reliable diagnosis of the presence or absence of an abnormal or normal intrauterine pregnancy can be made. In the case of an ectopic pregnancy, the chances of making the diagnosis during the first visit to the gynecologist’s office or the emergency room are high.

[174] Textbook: Ultrasound and the Fallopian Tube. Edited by Ilan E. Timor-Tritsch & Asim Kurjak. Parthenon Publishing Group, 1996.

Chapter 5: “Conservative Management of Ectopic Pregnancy Based on Color Doppler Studies.” By F. Bonilla Musoles & others. Pages 51–62.

Page 51: “Even with techniques currently available, ectopic pregnancy … results in death for one of every 2000 women affected.¹ The incidence of ectopic pregnancies varies between 0.5 and 1% of all pregnancies.”

Page 52: “In most published reports about ectopic pregnancies, the diagnosis is established by [a specialized blood test] in patients with a positive pregnancy test in whom an intrauterine [in the uterus] gestational sac, with or without recognizable embryonic structures, cannot be seen by ultrasound examination.”

[175] Book: Victims of Choice. By Kevin Sherlock. Brennyman Books, 1996.

Pages 166–167:

The City of New York

Commissioner of Health

Stephen C. Joseph, M.D., M.P.H.

To: All Gynecologists, Anesthesiologists, Administrators and Others Concerned With the Provision of Abortion Services

From: Stephen Joseph, M.D., M.P.H., Commissioner of Health

Subject: Anesthesia Alert

Date: June 5, 1987 …

Complications of general anesthesia account for a substantial number of death resulting from reproductive-health-related surgery. …

During the period between 1981 and 1984, there were 30 legal abortion-related deaths in New York City….

… Particular attention must be given to dosage calculation by patient’s weight and drug interactions with other sedative or anesthetic agents.

[176] Calculated with data from the report: “Abortion Surveillance—United States, 2013.” By Tara C. Jatlaoui and others. U.S. Centers for Disease Control, Division of Reproductive Health, November 25, 2016. <www.cdc.gov>

Page 43:

Table 23. Number of Deaths and Case-Fatality Rates* for Abortion-Related Deaths Reported to CDC [U.S. Centers for Disease Control], by Type of Abortion — United States, 1973–2012^† … Type of Abortion … Induced … Legal^§ … Year 1981 [=] 8 … Year 1982 [=] 11 … Year 1983 [=] 11 … Year 1984 [=] 12 …

* Number of legal induced abortion-related deaths per 100,000 reported legal induced abortions. Because a substantial number of legal induced abortions occurred outside reporting areas that provided data to CDC, national case-fatality rates (i.e., number of legal induced abortion-related deaths per 100,000 reported legal induced abortions in the United States) were calculated with denominator data from a more complete source.^(15,67) Case-fatality rates were computed for consecutive 5-year periods during 1973–2012 because rates based on <20 cases are highly variable.⁽³⁸⁾

^† Certain numbers might differ from those in reports published previously because additional information has been supplied to CDC subsequent to publication.

^§ An abortion is defined as legal if it was performed by a licensed clinician within the limits of state law.

CALCULATION: 8 + 11 + 11 + 12 = 42

[177] Calculated with data from:

a) Webpage: “City of New York & Boroughs: Population & Population Density from 1790.” Demographia. Accessed August 2008 at <www.demographia.com>

“Population (In Thousands) … 1980 … Total [=] 7,072”

b) Webpage: “Historical National Population Estimates: July 1, 1900 to July 1, 1999.” U.S. Census Bureau, April 11, 2000. Revised June 28, 2000. <www2.census.gov>

“National Population … July 1, 1980… Total [=] 227,224,681”

CALCULATIONS:

• 7,072,000 people in New York City / 227,224,681 people in the U.S. = 3.1%.
• 30 legal abortion-related deaths in New York City / 42 legal abortion-related deaths reported by the Centers for Disease Control = 71.4%.

[178] Webpage: “Abortion Services.” Planned Parenthood of Nassau County. Accessed June 28, 2008 at <www.plannedparenthood.org>

Abortion DOES NOT

• Prevent future pregnancies

• Make miscarriage more likely

• Cause premature birth, birth defects or low infant birth weight in future pregnancies

• Increase the chance of infant death in the future

• Cause breast cancer

[179] Paper: “Cost Consequences of Induced Abortion as an Attributable Risk for Preterm Birth and Impact on Informed Consent.” By Byron C. Calhoun, Elizabeth Shadigian & Brent Rooney. Journal of Reproductive Medicine, October 2007. Pages 929–937. <www.ncbi.nlm.nih.gov>

Page 930: “Fifty-nine studies were reviewed for preterm birth and links to abortion…. From this review, we selected 5 of the most recent, representative studies with an association between induced abortion and preterm birth as detailed examples of the 59 studies published in Appendix B….”

Pages 930–931:

Five large, recent, international studies have shown an association of prior abortions to preterm delivery^3,6–9 (Table IV), and 50 studies over the last 50 years have shown a statistically significant association (Appendix B). All of the studies found a statistically significant increase in preterm births before 32 weeks for women undergoing at least 1 first-trimester abortion, with the ORs [odds ratios] ranging from 1.3 to 2.5.^3,6–9 Women undergoing [two or more] abortions had an even larger risk of preterm birth, with ORs ranging from 1.8 to 5.2.^3,6–9.

[180] Webpage: “Preterm Birth.” March of Dimes, February 2007. <www.marchofdimes.com>

Premature birth is a serious health problem. Premature babies are at increased risk for newborn health complications, as well as lasting disabilities, such as mental retardation, cerebral palsy, lung and gastrointestinal problems, vision and hearing loss, and even death. Many premature babies require care in a neonatal intensive care unit (NICU), which has specialized medical staff and equipment that can deal with the multiple problems faced by premature infants. …

All premature babies are at risk for health problems, but those born before about 32 weeks of gestation face the highest risk.

[181] Webpage: “Abortion Services: Risks and Side Effects.” Planned Parenthood of the Rocky Mountains. Updated September 21, 2007. Accessed July 2008 at <www.plannedparenthood.org>

“Serious, long-term emotional problems after abortion are about as common as they are after childbirth.”

[182] Webpage: “Abortion Procedures.” Planned Parenthood, February 8, 2008. Accessed July 2008 at <www.plannedparenthood.org>

“Serious, long-term emotional problems after abortion are about as uncommon as they are after giving birth.”

[183] Webpage: “Ask Dr. Cullins: Is Having an Abortion Emotionally and Psychologically Dangerous?” Planned Parenthood, August 6, 2004. Updated 1/23/07. <www.plannedparenthood.org>

Q: Is having an abortion emotionally and psychologically dangerous?

A: No. Most women feel relief after an abortion. Serious emotional problems after abortion are much less likely than they are after giving birth. But anti choice extremists make false claims about this. They want people to believe that most women who choose abortion suffer severe and long lasting emotional trauma. This is not true.

[184] Webpage: “Pregnant, Now What?” By Jon Knowles. Planned Parenthood, January 1, 1993. Revised 5/5/07 by Jennifer Johnsen. <www.plannedparenthood.org>

Beware of so-called “crisis pregnancy centers” that are anti-abortion. These fake clinics advertise free pregnancy testing to lure women into their anti-choice agenda.

Crisis pregnancy centers

• may perform your pregnancy tests without medical supervision.

• won’t give you complete and correct information about all options.

• may try to frighten you with misleading films and pictures that are designed to keep you from choosing abortion.

• will lie to you about the medical and emotional effects of abortion.

[185] Article: “Abortion Is Four Times Deadlier Than Childbirth: New Studies Unmask High Maternal Death Rates From Abortion.” By David C. Reardon. Post–Abortion Review, April–June 2000. <www.afterabortion.org>

“Since Finland has socialized medical care, these records are very accurate and complete.”

[186] Paper: “Suicides After Pregnancy in Finland, 1987–94: Register Linkage Study.” By Mika Gissler, Elina Hemminki & Jouko Lonnqvist. British Medical Journal, December 7, 1996. <www.bmj.com>

Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. … There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100 000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population.

[187] Paper: “Deaths Associated With Pregnancy Outcome: A Record Linkage Study of Low Income Women.” By David C. Reardon and others. Southern Medical Journal, August 2002. Pages 834–841. <www.afterabortion.org>

Page 837: “Table 2. Detailed Cause-Specific Deaths and Death Rates in 8 Subsequent Years for Women with a History of at Least One Abortion Compared with Women Having No Known History of Abortion, by Reproductive History … Cause of Death … (1) Delivery Only … Suicides [=] 24.9 … Cause of Death … (2) Abortion Only … Suicides [=] 62.8”

CALCULATION: 62.8 Abortion Only Suicides / 24.9 Delivery Only Suicides = 2.5

[188] Article: “Changing Abortion’s Pronoun.” By Stephanie Simon. Los Angeles Times, January 7, 2008. <www.latimes.com>

The concept of post-abortion trauma is hotly disputed. Several studies published in peer-reviewed medical journals suggest that women who have had abortions are more prone to depression or drug abuse. But the research does not prove cause and effect, Stotland said.

It may be, she said, that women who have abortions are more emotionally unstable in the first place. Abortion is one of the most common surgeries in the country, with more than 1 million performed a year; while some who chose the procedure surely come to regret it, doctors say they see no epidemic of trauma in either men or women.

[189] Paper: “Deaths Associated With Pregnancy Outcome: A Record Linkage Study of Low Income Women.” By David C. Reardon and others. Southern Medical Journal, August 2002. Pages 834–841. <www.afterabortion.org>

Page 838: “Table 3. Risk of Death by Specific Causes in 8 Subsequent Years for Women with Only One Known Pregnancy (Those with an Abortion vs Those with a Delivery) … Delivery of First Pregnancy and No Abortions … Cause of Death … Suicides [=] 19.1 … Abortion of First Pregnancy … Cause of Death … Suicides [=] 63.0”

CALCULATION: 63.0 Abortion of First Pregnancy / 19.1 Delivery of First Pregnancy and No Abortions = 3.3

[190] Article: “Abortion and Subsequent Mental Health: Review of the Literature.” By Carlo V. Bellieni (MD) and Giuseppe Buonocore (MD, PhD). Psychiatry and Clinical Neurosciences, July 2013. Pages 301–310. <onlinelibrary.wiley.com>

Page 301:

The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. … Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. …

We performed a search in PubMed and Medscape from the year 1995 to 2011. We used as key words the following: “abortion,” “mental disorder,” “depression” “anxiety,” “illicit drugs” “tobacco,” “alcohol.”

Page 302:

We retrieved 36 papers.^7–42 We excluded seven studies: two for absence of a control group,^{26, 40} one because the control group was composed of women’s partners,²⁵ one because it did not use a validated questionnaire,²² one because it compared the consequences of medical and surgical abortion,⁴² one because it was a re-elaboration of a previous paper to investigate the causes of the increase of depression in the abortion group,¹⁹ and one because there was no statistical comparison between abortion and childbirth groups.³⁹

Page 307: “The rates of the single outcomes in the various groups of women should be outlined; in some studies rates are not available, and this makes this analysis difficult, but there is a general convergence of the data.”

[191] Calculated with data from the paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 75:

Aim: The goal of this retrospective cohort study was to analyze the relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany.

Methods: Women who had undergone induced abortions for the first time in 281 gynecological practices in Germany between January 2007 and December 2016 were included (index date). Women with live births were matched (1:1) to those with induced abortion by age, index year, and physician. The main outcome of the study was the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder as a function of induced abortion. Survival analyses and Cox regression models were used to investigate the association between induced abortion and psychiatric disorders.

Results: This study included 17581 women who had had an induced abortion and 17581 women who had had a live birth.

Page 76:

This study was based on data from the Disease Analyzer database (IQVIA), which compiles drug prescriptions, diagnoses, and basic medical and demographic data obtained directly and in anonymous format from computer systems used in the practices of general practitioners and specialists…. Diagnoses (International Classification of Diseases, 10th revision [ICD 10]), prescriptions (Anatomical Therapeutic Chemical [ATC] classification system), and the quality of reported data are being monitored by IQVIA based on a number of criteria (e.g., completeness of documentation, linkage between diagnoses and prescriptions). In Germany, the sampling methods used for the selection of medical practices were appropriate for obtaining a representative database of general and specialized practices…. The prescription statistics for several drugs were very similar to the data available from pharmaceutical prescription reports. The age groups for the given diagnoses in the Disease Analyzer database also matched those in corresponding disease registries. …

This study included women who had undergone induced abortions … for the first time in one of 281 gynecological practices in Germany between January 2007 and December 2016 (index date). There were several inclusion criteria: no documentation of pregnancy with abortive outcome … or delivery including antenatal screening and postpartum care … in their medical history prior to the index date or within 10 years after the index date; age between 12 and 45 years at index date; and no diagnosis of depression, anxiety disorder, adjustment disorder, or somatoform disorder prior to the index date. After applying similar inclusion criteria, women who had had live births were matched (1:1) to those who had had induced abortions by age, index year, and physician. The index date for the live birth group was a randomly selected visit between January 2007 and December 2016….

This retrospective cohort study, including more than 35000 women followed in gynecological practices in Germany, found that the incidence of depression and somatoform disorder was higher in those with induced abortions than in those with live births. Cox regression models further showed that induced abortion was associated with depression, adjustment disorder, and somatoform disorder.

CALCULATION: 17,581 + 17,581 = 35,162

[192] Paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 76:

This study included 17581 women who had had induced abortions and 17581 women who had had live births. The mean age was 32.7 (SD 5.4) years, and 24.0% of the population was aged between 26 and 30 years…. Within 10 years of the induced abortion or live birth, 6.7% of the women who had had induced abortions and 5.4% of those who had had live births were diagnosed with depression (log-rank p-value = 0.003). … Induced abortion was positively associated with depression (hazard ratio [HR] = 1.34; 95% confidence interval [CI]: 1.11–1.64), adjustment disorder … and somatoform disorder … but not with anxiety disorder….

[193] Paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 76:

This study included 17581 women who had had induced abortions and 17581 women who had had live births. The mean age was 32.7 (SD 5.4) years, and 24.0% of the population was aged between 26 and 30 years…. Within 10 years of the induced abortion or live birth, 6.7% of the women who had had induced abortions and 5.4% of those who had had live births were diagnosed with depression…. The respective figures were 3.4% and 2.7% for anxiety disorder (log-rank p-value = 0.255)…. Induced abortion was positively associated with depression … adjustment disorder … and somatoform disorder … but not with anxiety disorder (HR = 1.17; 95% CI: 0.89–1.54).

[194] Paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 76:

This study included 17581 women who had had induced abortions and 17581 women who had had live births. The mean age was 32.7 (SD 5.4) years, and 24.0% of the population was aged between 26 and 30 years…. Within 10 years of the induced abortion or live birth, 6.7% of the women who had had induced abortions and 5.4% of those who had had live births were diagnosed with depression…. The respective figures were 6.2% and 5.6% for adjustment disorder (log-rank p-value = 0.116)…. Induced abortion was positively associated with depression … adjustment disorder (HR = 1.45; 95% CI: 1.19–1.76) and somatoform disorder … but not with anxiety disorder….

[195] Webpage: “Adjustment Disorders.” Johns Hopkins Medicine. Accessed September 26, 2023 at <www.hopkinsmedicine.org>

An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person’s life. The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening. Stressful events or changes in the life of your child or adolescent may be a family move, the parents’ divorce or separation, the loss of a pet, or the birth of a sibling. A sudden illness or restriction to your child’s life due to chronic illness may also result in an adjustment response.

While adults can experience adjustment disorders, it is predominantly diagnosed in children and adolescents.

[196] Paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 76:

This study included 17581 women who had had induced abortions and 17581 women who had had live births. The mean age was 32.7 (SD 5.4) years, and 24.0% of the population was aged between 26 and 30 years…. Within 10 years of the induced abortion or live birth, 6.7% of the women who had had induced abortions and 5.4% of those who had had live births were diagnosed with depression…. The respective figures were … 19.3% and 13.3% for somatoform disorder (log-rank p-value < 0.001). … Induced abortion was positively associated with depression … adjustment disorder … and somatoform disorder (HR = 1.56; 95% CI: 1.38–1.76), but not with anxiety disorder….

[197] Article: “Somatoform Disorders.” By Oliver Oyama and others. American Family Physician, November 1, 2007. <www.aafp.org>

The somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms. They include somatization disorder (involving multisystem physical symptoms), undifferentiated somatoform disorder (fewer symptoms than somatization disorder), conversion disorder (voluntary motor or sensory function symptoms), pain disorder (pain with strong psychological involvement), hypochondriasis (fear of having a life-threatening illness or condition), body dysmorphic disorder (preoccupation with a real or imagined physical defect), and somatoform disorder not otherwise specified (used when criteria are not clearly met for one of the other somatoform disorders). These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments, focusing on the management of the disorder rather than its cure, using appropriate medications and psychotherapy for comorbidities, maintaining a psychoeducational and collaborative relationship with patients, and referring patients to mental health professionals when appropriate.

The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of clinically significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified.1 These disorders often cause significant emotional distress for patients and are a challenge to family physicians.

[198] Paper: “Relationship Between Induced Abortion and the Incidence of Depression, Anxiety Disorder, Adjustment Disorder, and Somatoform Disorder in Germany.” By Louis Jacob and others. Journal of Psychiatric Research, July 2019. Pages 75–79. <www.sciencedirect.com>

Page 78:

The two major strengths of this study are the number of women available for analysis and the use of real-world data from gynecological practices where diagnoses are continuously documented, allowing for unbiased exposure assessment (no recall bias). Nonetheless, the results of the present study should be interpreted in the light of several limitations. Firstly, diagnoses relied on ICD 10 codes only, and there was no information on the severity of the psychiatric disorders examined. Secondly, psychiatric disorders may have been insufficiently documented by gynecologists, leading to an underestimation of depression, anxiety disorder, adjustment disorder, and somatoform disorder. Thirdly, we had no data on factors known to have a significant impact on mental health (e.g., loneliness, social support, alcohol use), and this may have biased our findings. Finally, this was a retrospective study, and it was thus not possible to determine causality or temporality in the association between induced abortion and psychiatric disorders.

[199] Paper: “Randomised Controlled Trials – the Gold Standard for Effectiveness Research.” By Eduardo Hariton & Joseph J Locascio. BJOG (British Journal of Obstetrics & Gynecology), June 19, 2018. <obgyn.onlinelibrary.wiley.com>

Randomised controlled trials (RCTs) are the reference standard for studying causal relationships between interventions and outcomes as randomisation eliminates much of the bias inherent with other study designs. …

RCTs are prospective studies that measure the effectiveness of interventions. Although no study is likely on its own to prove causality, randomisation reduces bias and provides a rigorous tool to examine cause–effect relationships between an intervention and outcome. This is because the act of randomisation in a large study balances participant characteristics (both observed and unobserved) between the groups, allowing attribution of any differences in outcome to the intervention. This is not possible with any other study design, so RCTs are considered the reference standard for driving practice….

[200] Book: Regression With Social Data: Modeling Continuous and Limited Response Variables. By Alfred DeMaris. John Wiley & Sons, 2004.

Page 9:

Regression modeling of nonexperimental data for the purpose of making causal inferences is ubiquitous in the social sciences. Sample regression coefficients are typically thought of as estimates of the causal impacts of explanatory variables on the outcome. Even though researchers may not acknowledge this explicitly, their use of such language as impact or effect to describe a coefficient value often suggest a causal interpretation. This practice is fraught with controversy….

Page 12:

Friedman … is especially critical of drawing causal inferences from observational data, since all that can be “discovered,” regardless of the statistical candlepower used, is association. Causation has to be assumed into the structure from the beginning. Or, as Friedman … says: “If you want to pull a causal rabbit out of the hat, you have to put the rabbit into the hat.” In my view, this point is well taken; but it does not preclude using regression for causal inference. What it means, instead, is that prior knowledge of the causal status of one’s regressors is a prerequisite for endowing regression coefficients with a causal interpretation, as acknowledged by Pearl 1998.

Page 13: “In sum, causal modeling via regression, using nonexperimental data, can be a useful enterprise provided we bear in mind that several strong assumptions are required to sustain it. First, regardless of the sophistication of our methods, statistical techniques only allow us to examine associations among variables.”

[201] Article: “Late-Term Elective Abortion and Susceptibility to Posttraumatic Stress Symptoms.” By Priscilla K. Coleman and others. Journal of Pregnancy, June 28, 2010. <www.hindawi.com>

Page 2: “Finally, women who seek late-term abortions (after 16 weeks) are significantly more likely to be under age 18, Black, unemployed, and/or poor¹¹.”

[202] Paper: “Late-Term Abortion.” By Janet E. Gans Epner and others. Journal of the American Medical Association, August 26, 1998. Pages 724–729. <jamanetwork.com>

Page 724:

Definitions of Trimesters and Viability

In this article, early second-trimester abortion procedures refer to those performed at 13 through 15 weeks of gestation. Mid second-trimester abortion procedures are those performed at 16 through 19 weeks of gestation. Late second-trimester abortions refer to procedures performed at 20 through 27 weeks of gestation. Late-term abortions refer to procedures performed during the third trimester, defined as 27 weeks of gestation or more. Weeks of gestation are defined in terms of the first day of the last menstrual period. However, gestational age may vary depending on whether the stage of pregnancy is calculated from the first day of the last menstrual period, from the estimated time of fertilization, or from the estimated time of implementation.^3,4 Such distinctions are important when regulations or legal provisions refer to weeks of gestation or trimesters.

[203] Paper: “Late-Term Abortion for Fetal Anomaly: Vietnamese Women’s Experiences.” By Tine Gammeltoft and others. Reproductive Health Matters, September 2008. Pages 46–56. <www.tandfonline.com>

Page 47: “This article focuses on 17 women who had a late-term abortion due to a fetal malformation….”

Page 48: “The 17 pregnancies were terminated at varying stages of gestation: two women were at 14–18 weeks, eight at 19–24 weeks, five at 25–30 weeks and two at 32–35 weeks.”

[204] Article: “Health Law: Legislative Restrictions on Abortion.” By B. Jessie Hill. Virtual Mentor, American Medical Association Journal of Ethics, February 2012. <journalofethics.ama-assn.org>

Page 133: “[S]he was neither a patient seeking a late-term abortion nor a doctor who performs them, and therefore she was not directly affected by the law⁷.”

[205] Webpage: “Abortion Services.” Boulder Abortion Clinic, Accessed October 29, 2020 at <www.drhern.com>

Boulder Abortion Clinic offers the following abortion services

• First Trimester Abortion up to 13 Weeks

• Second Trimester Abortion up to 26 Weeks

• Third Trimester Abortion (commonly known as late term abortion) over 26 Weeks …

[206] Paper: “State Actions on Reproductive Health Issues in 1996.” By Terry Sollom. Perspectives on Sexual and Reproductive Health, January/February 1997. Pages 35–40. <www.guttmacher.org>

Page 39:

Antiabortion activists have vowed to pursue legislative bans on D&X [dilation and extraction] abortions with even greater intensity in 1997, which undoubtedly will lead to wide-ranging discussions and actions on late-term abortions, opening floodgates that may prove very difficult to close. This could be the case particularly if moderate lawmakers continue to express misgivings about the availability of abortion late in pregnancy.

[207] Article: “Abortion Restrictions and the Drive for Mental Health Parity: A Conflict in Values?” By Cynthia Dailard. Guttmacher Policy Review, June 1999. <www.guttmacher.org>

Page 5:

Just over one year later, in September 1998, Sen. Dick Durbin (D-IL), another consistent supporter of reproductive rights, went a step further. With a bipartisan group of prochoice senators, he introduced the Late-Term Abortion Limitation Act, which incorporates Daschle’s proposal, including its distinction between physical and mental health conditions, but adds another requirement—that a second physician, not involved in performing the abortion, be consulted to certify that the reason for the abortion meets the narrow requirements of the bill.

[208] Paper: “Prenatal Testing for Down Syndrome: Comparison of Screening Practices in the UK and USA.” By Dagmar Tapon. Journal of Genetic Counseling, April 2010. Pages 112–130. <onlinelibrary.wiley.com>

“In the USA, late-term abortions were often carried out through ‘intact dilatation and extraction’, a procedure called ‘partial birth abortion’ by the anti-abortion community…. A ban on ‘partial birth abortion’ in 2003 by President George W Bush and upheld in 2007 by the US Supreme Court leaves few safe alternatives for third trimester abortion according to the American College of Obstetrics and Gynecology….”

[209] Paper: “Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability.” By Robert M. Gonzalez and Donna Gilleskie. Demography, April 2017. Pages 701–720. <www.ncbi.nlm.nih.gov>

Page 704:

Definitions …

The late fetal period begins at 22 completed weeks of gestation (or at a weight of the fetus of 500 grams) and ends at birth. The early neonatal period begins at birth of the fetus and covers the first seven days after birth. The perinatal period encompasses both the late fetal and early neonatal periods. The infant period spans the first year after birth. Mortality rates are defined by the number of deaths occurring in a particular period and the number of live births.

Page 707:

An additional possibility may be that Cuba may count late term abortions (LTAs) as part of late fetal deaths, which would lead to substantially higher levels of late fetal deaths given Cuba’s high abortion rates.¹⁶

[210] Webpage: “Anniversary of the Murder of Dr. George Tiller.” Planned Parenthood, May 31, 2017. <www.plannedparenthood.org>

“Tiller cared for women having to make some of the most difficult decisions a woman can make, including late-term abortion services.”

[211] Article: “Abortion Pros and Cons Gain Emotional Weight.” By Francis X. Clines. New York Times, November 8, 1995. <www.nytimes.com>

“But her fury became clear as the Senate began debating the proposed banning and criminalization of the very sort of late-term abortion procedure she found herself requiring.”

[212] Article: “The Reincarnation of Pro-Life.” By Emily Bazelon (Yale Law School). New York Times Magazine, May 27, 2011. <www.nytimes.com>

“In a 2007 poll, Gallup found that twice as many people favor making late-term abortion illegal than favor overturning Roe (72 percent versus 35 percent).”

[213] Article: “Michigan Judge Allows Incest Victim to Seek Late-Term Abortion.” By Linda Perlstein. Washington Post, July 25, 1998. <www.washingtonpost.com>

“The decision appeared to end at least the legal part of a drama that for a brief moment served as a nexus for issues—late-term abortions and crossing state lines to escape restrictive laws—that have fueled the abortion debate in Congress and around the country.”

[214] Article: “Harsh Details Shift Tenor of Abortion Fight; Both Sides Bend Facts On Late-Term Procedure.” By Barbara Vobejda & David Brown. Washington Post, September 17, 1996. Page A01. <www.washingtonpost.com>

“A contentious subtext in this war of images has been the question of why women seek late-term abortions.”

[215] Webpage: “House Passes Late-Term Abortion Ban.” By Pete Kasperowicz. The Hill, June 18, 2013. <thehill.com>

“The House voted Tuesday to impose a nationwide ban on abortions after 22 weeks of pregnancy over Democratic objections that the bill represents a dramatic attempt by Republicans to restrict abortion rights.”

[216] Twitter post: “Incredibly Moving Piece on the Realities of Late-Term Abortion for Families.” By Planned Parenthood Action, February 7, 2014. <twitter.com>

“Incredibly moving piece on the realities of late-term abortion for families, and why it matters right now”

[217] Webpage: “Late-Term Abortion Care For Maternal/Fetal Indications.” Capital Women’s Group. Accessed September 20, 2023 at <www.capitalwomensservices.com>

“Capital Women’s Group offers late-term abortion care up to 36 weeks under certain circumstances, such as for fetal or maternal indications. All requests for late-term abortion care are handled on a case-by-case basis after consultation with our clinicians.”

[218] Webpage: “Late-Term Abortion Care Colorado.” Clinics for Abortion & Reproductive Excellence. Accessed September 20, 2023 at <abortionclinics.org>

“Founded May 1, 1992 by LeRoy and Mary Lou Carhart, our mission is to provide late term abortions in Colorado…. We provide assistance to women in Colorado with late term abortions, third trimester abortions, abortion after 27 weeks, maternal indication abortions, fetal indication abortions, and birth control.”

[219] Webpage: “A Conversation with Faye Wattleton: Part 1, Historical Perspectives.” Planned Parenthood Advocates of Arizona, February 4, 2013. <advocatesaz.org>

“The [most] significant erosion is this court’s willingness to uphold a law that could ignore a woman’s health in making the decision to permit a late-term abortion.”

[220] Paper: “Who Seeks Abortions at or After 20 Weeks.” By Diana Greene Foster and Katrina Kimport. Perspectives on Sexual and Reproductive Health, December 2013. Pages 210–218. <onlinelibrary.wiley.com>

Page 210:

The considerable majority of abortions (91%) take place in the first trimester, before the end of the 13th week of pregnancy; 7% are performed at 14–20 weeks, and 1% at 21 weeks or later.⁴ Nonetheless, this final category constitutes a substantial number of abortions: Given an estimated 1.21 million abortions in the United States annually,⁵ more than 15,000 likely take place after 20 weeks.

[221] Webpage: “Perspectives on Sexual and Reproductive Health: A Journal of Peer-Reviewed Research.” Guttmacher Institute. Accessed October 30, 2023 at <www.guttmacher.org>

“Perspectives on Sexual and Reproductive Health (1969–2020) published peer-reviewed, policy-relevant research and analysis on sexual and reproductive health and rights in the United States and other high-income countries.”

[222] Webpage: “The Guttmacher Institute’s Future.” Guttmacher Institute Board of Directors, June 23, 2005. <www.guttmacher.org>

Guiding Principles …

The Institute works to protect, expand and equalize access to information, services and rights that will enable women and men to

• avoid unplanned pregnancies;

• prevent and treat sexually transmitted infections, including HIV [human immunodeficiency virus];

• exercise the right to choose abortion;

• achieve healthy pregnancies and births; and

• have healthy, satisfying sexual relationships.

[223] Paper: “Who Seeks Abortions at or After 20 Weeks.” By Diana Greene Foster and Katrina Kimport. Perspectives on Sexual and Reproductive Health, December 2013. Pages 210–218. <onlinelibrary.wiley.com>

Page 210:

Causes of delay in obtaining abortion were assessed in open- and closed-ended questions; profiles of women who received later abortions were identified through factor analysis. …

The considerable majority of abortions (91%) take place in the first trimester, before the end of the 13th week of pregnancy; 7% are performed at 14–20 weeks, and 1% at 21 weeks or later.⁴ Nonetheless, this final category constitutes a substantial number of abortions: Given an estimated 1.21 million abortions in the United States annually,⁵ more than 15,000 likely take place after 20 weeks.

[224] Paper: “Who Seeks Abortions at or After 20 Weeks.” By Diana Greene Foster and Katrina Kimport. Perspectives on Sexual and Reproductive Health, December 2013. Pages 210–218. <onlinelibrary.wiley.com>

Page 210:

Recent years have seen the introduction of state bills seeking to ban abortions after 20 weeks.¹ …

¹ Guttmacher Institute, State policies on later abortions, State Policies in Brief (as of October 1, 2013), 2012, <www.guttmacher.org>, accessed Oct. 8, 2013.”†

NOTE: † The fact that this paper measures pregnancy from the last menstrual period is evidenced by the fact that it begins by citing the Guttmacher webpage above, which insists on this reckoning: As of January 1, 2019, this webpage stated: “Dating a pregnancy from fertilization goes against convention. When discussing pregnancy, medical professionals customarily date a pregnancy from the first day of the woman’s last menstrual period, because that is the date most women can pinpoint.”

[225] Book: Color Atlas of Life Before Birth. By Marjorie A. England. Year Book Medical Publishers, 1983.

Page 12: “Most clinicians do not know the fertilization date; the only date available to them is the first day of the last menstrual period. They use this date to define a menstrual age stretching from time 0, which is usually 14 days before fertilization….”

[226] Paper: “Pain and its Effects in the Human Neonate and Fetus.” By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Pages 1321–1329. <www.nejm.org>

Page 1322:

Cutaneous sensory receptors appear in the perioral [mouth] area of the human fetus in the 7th week of gestation; they spread to the rest of the face, the palms of the hands and the soles of the feet by the 11th week, to the trunk and proximal parts of the arms and legs by the 15th week, and to all cutaneous and mucous surfaces by the 20th week. …

Development of the fetal neocortex begins at 8 weeks of gestation, and by 20 weeks each cortex has a full complement of 10⁹ neurons.

NOTE: This article uses the obstetric method of counting from the last menstrual period as evidenced by the chart on page 1322, which uses a gestation of 40 weeks for pregnancy. Two weeks must be subtracted to provide the actual time since fertilization.

[227] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Pages 954–955:

B. Early Fetal Period (Third Month) …

Division of the heart into chambers is complete, and a definitive vascular system carries blood to and from all body parts. …

All components of the brain and the spinal cord are formed, and nerves link the stem of the brain and the spinal cord to all tissues and organs of the body.

[228] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Page 962:

Attempts to suckle have been seen in utero and in aborted fetuses of 3 months. …

Reflexes that develop during the third month involve the mouth and the head…. Electrical activity of the nervous system is discernible at the same time, but periods of electrical silence can occur up to midterm.

[229] Article: “Wired to Be Social: The Ontogeny of Human Interaction.” By Umberto Castiello and others. PLoS ONE, October 7, 2010. <journals.plos.org>

Page 2: “The results showed that the spatial and temporal characteristics of foetal movements were by no means uncoordinated, but depended on the goal of the different motor acts, suggesting a surprisingly advanced level of motor planning.”

Page 3:

Each woman was identified by the prenatal sonologist during her first visit at the 12th week of pregnancy and foetal age was calculated comparing the mother’s last menstruation date and the measurements of the foetus (Crown Rump Length) taken during the ultrasound examination.

Page 9:

Twin pregnancies constitute an experiment of nature which offers the unique opportunity to explore social behaviour before birth. By investigating kinematic profiles of movements in five pairs of twin foetuses, we demonstrated that, by the 14th week of gestation, twin foetuses not only display movements directed towards the uterine wall and self-directed movements, but also movements specifically aimed at the co-twin. …

Analysis of the kinematic profiles for the different categories of movements corroborates our main hypothesis that these early contacts do not occur accidentally, but reflect motor planning.

Page 10:

In this article we describe changes in the kinematic profiles of movement in twin foetuses probing the social dimension of motor planning and control. The central advance of this study is the demonstration that ‘social actions’ are already performed in the second trimester of gestation. Starting from the 14th week of gestation twin foetuses plan and execute movements specifically aimed at the co-twin. These findings force us to predate the emergence of social behaviour: when the context enables it, as in the case of twin foetuses, other-directed actions are not only possible but predominant over self-directed actions.

NOTE: This article uses the obstetric method of counting from the last menstrual period as evidenced by the statement that “foetal age was calculated” based on the “mother’s last menstruation date.” Thus, two weeks must be subtracted to provide the actual time since fertilization.

[230] Textbook: Before We Are Born: Essentials of Embryology and Birth Defects (5th edition). By Keith L. Moore & T.V.N. Persaud. W.B. Saunders Company, 1998.

Page 106: “Limb movements, which occur at the end of the embryonic period (8 weeks), become coordinated by the 14th week, but are too slight to be felt by the mother.”

[231] Paper: “Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures.” By Marc Van de Velde and Frederik De Buck. Fetal Diagnosis and Therapy, April 25, 2012. Pages 201–209. <www.karger.com>

Page 206: “Whether a fetus is capable of experiencing pain as a conscious and emotional feeling remains unclear and is subject to great debate,⁶⁷ but we cannot deny that the fetal nervous system mounts protective responses to tissue injury. A physiological fetal reaction to painful stimuli occurs from between 16 and 24 weeks’ gestation on.”

[232] Paper: “Pain and its Effects in the Human Neonate and Fetus.” By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Pages 1321–1329. <www.nejm.org>

Page 1322:

Cutaneous sensory receptors appear in the perioral [mouth] area of the human fetus in the 7th week of gestation; they spread to the rest of the face, the palms of the hands and the soles of the feet by the 11th week, to the trunk and proximal parts of the arms and legs by the 15th week, and to all cutaneous and mucous surfaces by the 20th week. …

Development of the fetal neocortex begins at 8 weeks of gestation, and by 20 weeks each cortex has a full complement of 10⁹ neurons.

NOTE: This article uses the obstetric method of counting from the last menstrual period as evidenced by the chart on page 1322, which uses a gestation of 40 weeks for pregnancy. Two weeks must be subtracted to provide the actual time since fertilization.

[233] Paper: “Effect of Direct Fetal Opioid Analgesia on Fetal Hormonal and Hemodynamic Stress Response to Intrauterine Needling.” By Nicholas M. Fisk and others. Anesthesiology, October 2001. Pages 828–835. <pubs.asahq.org>

Page 828: “Our group has shown that the human fetus from 18–20 weeks elaborates pituitary-adrenal, sympatho-adrenal, and circulatory stress responses to physical insults.”

[234] Article: “Fetus.” American Medical Association Complete Medical Encyclopedia. Random House, 2003.

Page 558: “At 20 weeks, the fetus is 10 inches long and about 11 ounces. The limbs have lengthened, and teeth and hair are beginning to form. The fetus now sleeps and wakes and hears sounds.”

[235] Intrauterine picture taken at 20 weeks after fertilization under the direction of Professor Andrzej Skawina of Collegium Medicum Jagiellonian University (Krakow, Poland) and Antoni Marsinek of the Czerwiakowski Gynecological and Obstetrics Hospital (Krakow, Poland); Photographers: Andrzej Zachwieja and Jan Walczewski. Copyright: Life Issues.

NOTE: A number of different photographers have published intrauterine photos. Just Facts asked several of these individuals for permission to reproduce their pictures, and Life Issues was the only one who consented. The pictures from Life Issues look similar to those taken by the other photographers.

[236] Ruling: Roe v. Wade. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Burger, Brennan, Douglas, Stewart, Marshall, Powell. Concurring: Burger, Douglas, Stewart. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] VIII:

Specific and direct harm medically diagnosable even in early pregnancy may be involved. Maternity, or additional offspring, may force upon the woman a distressful life and future. Psychological harm may be imminent. Mental and physical health may be taxed by child care. There is also the distress, for all concerned, associated with the unwanted child, and there is the problem of bringing a child into a family already unable, psychologically and otherwise, to care for it. In other cases, as in this one, the additional difficulties and continuing stigma of unwed motherhood may be involved. All these are factors the woman and her responsible physician necessarily will consider in consultation.

[Section] XI:

For the stage subsequent to viability the State, in promoting its interest in the potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion except where necessary, in appropriate medical judgment, for the preservation of the life or health of the mother. …

In Doe v. Bolton, post, p. 179, procedural requirements contained in one of the modern abortion statutes are considered. That opinion and this one, of course, are to be read together.

[237] Ruling: Doe v. Bolton. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Brennan, Stewart, Marshall, Powell. Concurring: Burger, Douglas. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] IV: “[T]he medical judgment may be exercised in the light of all factors—physical, emotional, psychological, familial, and the woman’s age—relevant to the wellbeing of the patient. All these factors may relate to health.”

[238] Ruling: Planned Parenthood of Southeastern PA v. Casey. United States Supreme Court. June 29, 1992. <caselaw.findlaw.com>

Majority:

It must be stated at the outset and with clarity that Roe’s essential holding, the holding we reaffirm, has three parts. First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the State. Before viability, the State’s interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman’s effective right to elect the procedure. Second is a confirmation of the State’s power to restrict abortions after fetal viability if the law contains exceptions for pregnancies which endanger the woman’s life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.

[239] Ruling: Doe v. Bolton. U.S. Supreme Court, January 22, 1973. Decided 7–2. Majority: Blackmun, Brennan, Stewart, Marshall, Powell. Concurring: Burger, Douglas. Dissenting: White, Rehnquist. <caselaw.findlaw.com>

Majority:

[Section] IV:

D. The appellants next argue that the District Court should have declared unconstitutional three procedural demands of the Georgia statute: (1) that the abortion be performed in a hospital accredited by the Joint Commission on Accreditation of Hospitals:¹¹ (2) that the procedure be approved by the hospital staff abortion committee; and (3) that the performing physician’s judgment be confirmed by the independent examinations of the patient by two other licensed physicians. …

We hold that the JCAH-accreditation [Joint Commission on Accreditation of Hospitals] requirement does not withstand constitutional scrutiny in the present context. …

We conclude that the interposition of the hospital abortion committee is unduly restrictive of the patient’s rights and needs that, at this point, have already been medically delineated and substantiated by her personal physician. …

There remains, however, the required confirmation by two Georgia-licensed physicians in addition to the recommendation of the pregnant woman’s own consultant (making under the statute, a total of six physicians involved, including the three on the hospital’s abortion committee). We conclude that this provision, too, must fall.

The statute’s emphasis, as has been repetitively noted, is on the attending physician’s “best clinical judgment that an abortion is necessary.” That should be sufficient. The reasons for the presence of the confirmation step in the statute are perhaps apparent, but they are insufficient to withstand constitutional challenge. … If a physician is licensed by the State, he is recognized by the State as capable of exercising acceptable clinical judgment.

[240] Article: “Daschle Bill May Not Ban Anything; Abortionists Could Use Own Judgment.” By Frank J. Murray. Washington Times, May 15, 1997. <www.washingtontimes.com>

… Dr. Warren Hern, who literally wrote the textbook on “Abortion Practice.”

The Denver gynecologist said the fact of occasional death in childbearing can justify any abortion, no matter how late it is done.

“I will certify that any pregnancy is a threat to a woman’s life and could cause ‘grievous injury’ to her ‘physical health,’ ” Dr. Hern said, using key words from the Daschle bill….

[241] Webpage: “States with Gestational Limits for Abortion (As of August 1, 2020).” Kaiser Family Foundation. Accessed June 22, 2021 at <bit.ly>

Notes

The U.S. Supreme Court has held that states may constitutionally ban or restrict abortions after the point of fetal viability except where necessary to preserve a woman’s life or health.

The exception of “physical health” permits abortions when the woman suffers from a “substantial and irreversible impairment of a major bodily function.”

[242] Article: “The Reincarnation of Pro-Life.” By Emily Bazelon (Yale Law School). New York Times Magazine, May 27, 2011. <www.nytimes.com>

… Terry O’Neill, president of NOW [National Organization for Women]—told her that people on their side were gun shy, afraid to bring a suit that could end up in the Supreme Court and thus test Justice Anthony Kennedy. Two decades ago, Kennedy was crucial to the 5-to-4 watershed decision to uphold Roe in Planned Parenthood v. Casey. But that was before Samuel Alito, an abortion opponent, replaced Sandra Day O’Connor, one of Kennedy’s co-authors in Casey. …

[L]itigators trying to uphold a woman’s right to an abortion are not running scared….

The bait that they have been wise to avoid involves the prohibition of abortion after 20 or 22 weeks of pregnancy. … If the abortion rights groups were to sue, they would risk returning to dangerous political ground. …

In a 2007 poll, Gallup found that twice as many people favor making late-term abortion illegal than favor overturning Roe (72 percent versus 35 percent).

[243] Article: “Harsh Details Shift Tenor of Abortion Fight; Both Sides Bend Facts On Late-Term Procedure.” By Barbara Vobejda & David Brown. Washington Post, September 17, 1996. Page A01. <www.washingtonpost.com>

“The usual alternative to intact D&E [dilation and evacuation] is ‘dismemberment D&E,’ in which the fetal limbs are pulled off the body in utero, sometimes while the fetus is still alive.”

[244] Paper: “Fetal Pain: Implications for Research and Practice.” By Vivette Glover and Nicholas M. Fisk. British Journal of Obstetrics & Gynaecology, August 19, 2005. Pages 881–886. <onlinelibrary.wiley.com>

Page 884: “Late terminations may cause pain to the fetus if they involve an invasive procedure, such as surgical dismemberment.”

[245] Paper: “Fetal Plasma Cortisol and Beta-Endorphin Response to Intrauterine Needling.” By X. Giannakoulopoulos and others. Lancet, July 9, 1994. Pages 77–81. <www.thelancet.com>

Page 80:

Just as physicians now provide neonates with adequate analgesia,⁵ our findings suggest that those dealing with the fetus should consider making similar modifications to their practice. This applies not just to diagnostic and therapeutic procedures on the fetus, but possibly also to termination of pregnancy, especially by surgical techniques involving dismemberment.

⁵ Rogers, MC. Do the Right Thing: Pain Relief in Infants and Children. New England Journal of Medicine 1992; 326: 55–56.

[246] Presentation: “Dilation and Extraction for Late Second Trimester Abortion.” By Martin Haskell. National Abortion Federation, September 13, 1992. <operationrescue.org>

Page 1:

The surgical method described in this paper [partial-birth abortion] differs from classic D&E [dilation and evacuation] in that it does not rely upon dismemberment to remove the fetus. Nor are inductions or infusions used to expel the intact fetus.

Rather, the surgeon grasps and removes a nearly intact fetus through an adequately dilated cervix. The author has coined the term Dilation and Extraction or D&X to distinguish it from dismemberment-type D&E’s.

[247] Article: “The Facts on Partial-Birth Abortion; Both Sides Have Misled the Public.” By Ruth Padawer. Bergen Record, September 15, 1996. <northjersey.newspapers.com>

Doctors at Metropolitan Medical in Englewood estimate that their clinic alone performs 3,000 abortions a year on fetuses between 20 and 24 weeks, of which at least half are by intact dilation and evacuation [D&E]. …

“I always try an intact D&E first,” said a Metropolitan Medical gynecologist, who, like every other provider interviewed for this article, spoke on condition of anonymity for fear of retribution. If the fetus isn’t breech, or if the cervix isn’t dilated enough, providers switch to traditional, or “classic,” D&E, in utero dismemberment.

[248] Ruling: West Alabama Women’s Center v. Miller. U.S. Court of Appeals for the Eleventh Circuit. August 22, 2018. Decided 3–0. Majority: Carnes, Dubina. Concurring: Abrams. <media.ca11.uscourts.gov>

Ed Carnes, Chief Judge: “This case involves a method of abortion that is clinically referred to as Dilation and Evacuation (D & E). Or dismemberment abortion, as the State less clinically calls it. That name is more accurate because the method involves tearing apart and extracting piece-by-piece from the uterus what was until then a living unborn child.”

[249] Article: “2nd Trimester Abortion: An Interview with W. Martin Haskell, MD.” Cincinnati Medicine, Fall 1993. Pages 18–19. <www.nrlc.org>

Page 19:

Q: What led you to develop D & X [dilation and extraction]?

A: D & E’s [dilation and evacuations], the procedure typically used for later abortions, have always been somewhat problematic because of the toughness and development of the fetal tissues. Most physicians do terminations after 20 weeks by saline infusion or prostaglandin induction, which terminates the fetus and allows tissue to soften.

[250] Ruling: West Alabama Women’s Center v. Miller. U.S. Court of Appeals for the Eleventh Circuit. August 22, 2018. Decided 3–0. Majority: Carnes, Dubina. Concurring: Abrams. <media.ca11.uscourts.gov>

Ed Carnes, Chief Judge:

Nearly 93% of abortions performed in Alabama occur before 15 weeks, at which time dismemberment abortion is unnecessary because the unborn child is small enough for practitioners to use other methods that the Act does not prohibit. For the 7% of abortions that occur after 15 weeks, 99% of them are by dismemberment. That’s because at that later stage of pregnancy dismemberment abortion is simpler and safer than other methods, with major complications arising less than 1% of the time.

[251] Ruling: Gonzales v. Carhart. United States Supreme Court, April 18, 2007. Decided 5–4. Majority: Kennedy, Roberts, Scalia, Thomas, Alito. Concurring: Thomas, Scalia. Dissenting: Ginsburg, Stevens, Souter, Breyer. <caselaw.findlaw.com>

Majority:

[Section] I (A): …

Of the remaining abortions that take place each year, most occur in the second trimester. The surgical procedure referred to as “dilation and evacuation” or “D&E” is the usual abortion method in this trimester. …

After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman’s cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of evacuating the fetus piece by piece continues until it has been completely removed. A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus. The doctor examines the different parts to ensure the entire fetal body has been removed. See, e.g., Nat. Abortion Federation, supra, at 465; Planned Parenthood, supra, at 962.

Some doctors, especially later in the second trimester, may kill the fetus a day or two before performing the surgical evacuation. They inject digoxin or potassium chloride into the fetus, the umbilical cord, or the amniotic fluid. Fetal demise may cause contractions and make greater dilation possible. Once dead, moreover, the fetus’ body will soften, and its removal will be easier. Other doctors refrain from injecting chemical agents, believing it adds risk with little or no medical benefit. Carhart, supra, at 907–912; Nat. Abortion Federation, supra, at 474–475.

[252] Ruling: Gonzales v. Carhart. United States Supreme Court, April 18, 2007. Decided 5–4. Majority: Kennedy, Roberts, Scalia, Thomas, Alito. Concurring: Thomas, Scalia. Dissenting: Ginsburg, Stevens, Souter, Breyer. <caselaw.findlaw.com>

Majority:

[Section] I (A): …

Of the remaining abortions that take place each year, most occur in the second trimester. The surgical procedure referred to as “dilation and evacuation” or “D&E” is the usual abortion method in this trimester. …

After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman’s cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of evacuating the fetus piece by piece continues until it has been completely removed. A doctor may make 10 to 15 passes with the forceps to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus. The doctor examines the different parts to ensure the entire fetal body has been removed. See, e.g., Nat. Abortion Federation, supra, at 465; Planned Parenthood, supra, at 962.

Some doctors, especially later in the second trimester, may kill the fetus a day or two before performing the surgical evacuation. They inject digoxin or potassium chloride into the fetus, the umbilical cord, or the amniotic fluid. Fetal demise may cause contractions and make greater dilation possible. Once dead, moreover, the fetus’ body will soften, and its removal will be easier. Other doctors refrain from injecting chemical agents, believing it adds risk with little or no medical benefit. Carhart, supra, at 907–912; Nat. Abortion Federation, supra, at 474–475. …

The main difference between the two procedures is that in [a partial-birth abortion] a doctor extracts the fetus intact or largely intact with only a few passes.

[Section] III (C) 1:

The Act excludes most D&Es [dilation and evacuations] in which the fetus is removed in pieces, not intact. … Removing the fetus in this manner does not violate the Act because the doctor will not have delivered the living fetus to one of the anatomical landmarks or committed an additional overt act that kills the fetus after partial delivery. …

D&E does not involve the delivery of a fetus because it requires the removal of fetal parts that are ripped from the fetus as they are pulled through the cervix.

[253] U.S. Code Title 7, Chapter 48, Section 1902: “Humane Methods of Livestock Slaughter.” Accessed September 9, 2023 at <www.law.cornell.edu>

No method of slaughtering or handling in connection with slaughtering shall be deemed to comply with the public policy of the United States unless it is humane. Either of the following two methods of slaughtering and handling are hereby found to be humane:

(a) in the case of cattle, calves, horses, mules, sheep, swine, and other livestock, all animals are rendered insensible to pain by a single blow or gunshot or an electrical, chemical or other means that is rapid and effective, before being shackled, hoisted, thrown, cast, or cut; or

(b) by slaughtering in accordance with the ritual requirements of the Jewish faith or any other religious faith that prescribes a method of slaughter whereby the animal suffers loss of consciousness by anemia of the brain caused by the simultaneous and instantaneous severance of the carotid arteries with a sharp instrument and handling in connection with such slaughtering.

[254] Code of Federal Regulations Title 9, Subchapter A, Part 313: “Humane Slaughter of Livestock.” Accessed September 9, 2023 at <www.law.cornell.edu>

§313.2 Handling of Livestock. …

(2) The dragging of disabled animals and other animals unable to move, while conscious, is prohibited.

§313.15 Mechanical; Captive Bolt. …

(a) Application of stunners, required effect; handling.

(1) The captive bolt stunners shall be applied to the livestock in accordance with this section so as to produce immediate unconsciousness in the animals before they are shackled, hoisted, thrown, cast, or cut. The animals shall be stunned in such a manner that they will be rendered unconscious with a minimum of excitement and discomfort. …

(3) Immediately after the stunning blow is delivered the animals shall be in a state of complete unconsciousness and remain in this condition throughout shackling, sticking and bleeding.

§313.16 Mechanical; Gunshot. …

(a) Utilization of firearms, required effect; handling.

(1) The firearms shall be employed in the delivery of a bullet or projectile into the animal in accordance with this section so as to produce immediate unconsciousness in the animal by a single shot before it is shackled, hoisted, thrown, cast, or cut. The animal shall be shot in such a manner that they will be rendered unconscious with a minimum of excitement and discomfort.

(3) Immediately after the firearm is discharged and the projectile is delivered, the animal shall be in a state of complete unconsciousness and remain in this condition throughout shackling, sticking and bleeding.

§313.30 Electrical; Stunning or Slaughtering with Electric Current. …

(3) Electric current. Each animal shall be given a sufficient application of electric current to ensure surgical anesthesia throughout the bleeding operation. Suitable timing, voltage and current control devices shall be used to ensure that each animal receives the necessary electrical charge to produce immediate unconsciousness. The current shall be applied so as to avoid the production of hemorrhages or other tissue changes which could interfere with inspection procedures.

[255] Public Law 116-72: “Preventing Animal Cruelty and Torture Act.” 116th U.S. Congress. Signed into law by Donald J. Trump on November 25, 2019. <www.congress.gov>

Sec. 2. Revision of Section 48.

(a) In General.—Section 48 of title 18, United States Code, is amended to read as follows:

Sec. 48. Animal crushing

(a) Offenses.—

1) Crushing.—It shall be unlawful for any person to purposely engage in animal crushing in or affecting interstate or foreign commerce or within the special maritime and territorial jurisdiction of the United States. …

f) Definitions.—In this section—

(1) the term “animal crushing” means actual conduct in which one or more living non-human mammals, birds, reptiles, or amphibians is purposely crushed, burned, drowned, suffocated, impaled, or otherwise subjected to serious bodily injury (as defined in section 1365 and including conduct that, if committed against a person and in the special maritime and territorial jurisdiction of the United States, would violate section 2241 or 2242);

[256] U.S. Code Title 18, Part I, Chapter 3, Section 48: “Animal Crushing.” Accessed September 9, 2023 at <www.law.cornell.edu>

(a) Offenses.—

(1) Crushing.—

It shall be unlawful for any person to purposely engage in animal crushing in or affecting interstate or foreign commerce or within the special maritime and territorial jurisdiction of the United States. …

(c) Penalties.—

Whoever violates this section shall be fined under this title, imprisoned for not more than 7 years, or both.

(d) Exceptions.—

(1) In general.—This section does not apply with regard to any conduct, or a visual depiction of that conduct, that is—

(A) a customary and normal veterinary, agricultural husbandry, or other animal management practice;

(B) the slaughter of animals for food;

(C) hunting, trapping, fishing, a sporting activity not otherwise prohibited by Federal law, predator control, or pest control;

(D) medical or scientific research;

(E) necessary to protect the life or property of a person; or

(F) performed as part of euthanizing an animal.

[257] U.S. Code Title 18, Part I, Chapter 65, Section 1365: “Tampering with Consumer Products.” Accessed September 9, 2023 at <www.law.cornell.edu>

(h) As used in this section …

(3) the term “serious bodily injury” means bodily injury which involves—

(A) a substantial risk of death;

(B) extreme physical pain;

(C) protracted and obvious disfigurement; or

(D) protracted loss or impairment of the function of a bodily member, organ, or mental faculty;

[258] Illinois Compiled Statues, Chapter 720, Title III, Section 12-20.5: “Dismembering A Human Body.” Accessed October 7, 2023 at <law.justia.com>

(a) A person commits dismembering a human body when he or she knowingly dismembers, severs, separates, dissects, or mutilates any body part of a deceased’s body.

(b) This Section does not apply to: …

(7) physicians licensed to practice medicine in all of its branches or holding a visiting professor, physician, or resident permit under the Medical Practice Act of 1987, performing acts in accordance with usual and customary standards of medical practice, or a currently enrolled student in an accredited medical school in furtherance of his or her education at the accredited medical school. …

(d) Sentence. Dismembering a human body is a Class X felony.

[259] Oregon Revised Statutes, Volume 04, Chapter 166, Section 166.087: “Abuse of Corpse in the First Degree.” Accessed October 7, 2023 at <law.justia.com>

(1) A person commits the crime of abuse of corpse in the first degree if the person: …

(b) Dismembers, mutilates, cuts or strikes a corpse.

(2) Abuse of corpse in the first degree is a Class B felony. [1993 c.294 §2]

Note: 166.087 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 166 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.

NOTE: See the next footnote, which documents that the note above doesn’t mean the statute “is any less the law.”

[260] “Preface to the Oregon Revised Statutes.” Oregon State Legislature, December 3, 2021. Modified 3/30/2022. <www.oregonlegislature.gov>

Page viii:

“Not added to and made a part of.” Notes may indicate that a particular ORS [Oregon Revised Statutes] section was not added to and made a part of the ORS chapter or series in which the section appears. These notes mean that the placement of the section was editorial and not by legislative action. Notes also are used when the series references are either too numerous or too complex to bear further adjustment. However, the note does not mean that the section not added to a series or a chapter is any less the law. The note is intended only to remind the user that definitions, penalties and other references to the series should be examined carefully to determine whether they apply to the noted section.

[261] Report: “The State of Abortion in the United States.” National Right to Life Committee, January 23, 2023. <www.nrlc.org>

Page 42:

During the 2015 state legislative session, Kansas* and Oklahoma* became the first two states to enact the Unborn Child Protection from Dismemberment Abortion Act. D&E dismemberment abortions of living unborn babies are as brutal as the partial-birth abortion method, which is now illegal in the United States. Eleven more states (Alabama*, Arkansas*, Indiana, Kentucky*, Louisiana*, Mississippi, Nebraska, North Dakota, Ohio, Texas, and West Virginia^) have enacted laws to protect unborn children from this brutal abortion procedure.

*not in effect pending litigation

^Law rendered ineffective with passage of the Unborn Child Protection Act W. Va. Code § 16-2R-1 et seq.

[262] Report: “The State of Abortion in the United States.” National Right to Life Committee, January 23, 2023. <www.nrlc.org>

Page 42:

During the 2015 state legislative session, Kansas* and Oklahoma* became the first two states to enact the Unborn Child Protection from Dismemberment Abortion Act. D&E dismemberment abortions of living unborn babies are as brutal as the partial-birth abortion method, which is now illegal in the United States. Eleven more states (Alabama*, Arkansas*, Indiana, Kentucky*, Louisiana*, Mississippi, Nebraska, North Dakota, Ohio, Texas, and West Virginia^) have enacted laws to protect unborn children from this brutal abortion procedure.

*not in effect pending litigation

^Law rendered ineffective with passage of the Unborn Child Protection Act W. Va. Code § 16-2R-1 et seq.

[263] Alabama Code Title 26, Chapter 23G, Section 3: “Dismemberment Abortion Prohibited Unless Necessary to Prevent Serious Health Risk to Mother of Unborn Child.” Accessed July 6, 2019 at <law.justia.com>

(a) Notwithstanding any other provision of law, it shall be unlawful for any individual to purposely perform or attempt to perform a dismemberment abortion and thereby kill an unborn child unless necessary to prevent serious health risk to the unborn child’s mother.

(b) An individual accused in any proceeding of unlawful conduct under subsection (a) may seek a hearing before the State Board of Medical Examiners on whether the dismemberment abortion was necessary to prevent serious health risk to the unborn child’s mother. The findings of the board are admissible on that issue at any trial in which such unlawful conduct is alleged. Upon a motion of the individual accused, the court shall delay the beginning of the trial for not more than 30 days to permit the hearing to take place.

(c) No woman upon whom an abortion is performed or attempted to be performed shall be thereby liable for performing or attempting to perform a dismemberment abortion. No nurse, technician, secretary, receptionist, or other employee or agent who is not a physician but who acts at the direction of a physician, and no pharmacist or other individual who is not a physician but who fills a prescription or provides instruments or materials used in an abortion at the direction of or to a physician, shall be thereby liable for performing or attempting to perform a dismemberment abortion.

(d) This chapter does not prevent abortion for any reason including rape and incest by any other method, unless otherwise prevented by law.

(Act 2016–397, §3.)

[264] Ruling: West Alabama Women’s Center v. Miller. U.S. Court of Appeals for the Eleventh Circuit. August 22, 2018. Decided 3–0. Majority: Carnes, Dubina. Concurring: Abrams. <media.ca11.uscourts.gov>

Ed Carnes, Chief Judge:

This case involves a method of abortion that is clinically referred to as Dilation and Evacuation (D & E). Or dismemberment abortion, as the State less clinically calls it. That name is more accurate because the method involves tearing apart and extracting piece-by-piece from the uterus what was until then a living unborn child. …

At that stage of pregnancy, it is settled under existing Supreme Court decisions that the State of Alabama cannot forbid this method of abortion entirely. … Recognizing that, the State has instead sought to make the procedure more humane by enacting the Alabama Unborn Child Protection from Dismemberment Abortion Act, which forbids dismembering a living unborn child.

Under the Act, the one performing the abortion is required to kill the unborn child before ripping apart its body during the extraction. See Id. Killing an unborn child and then dismembering it is permitted; killing an unborn child by dismembering it is not. …

The plaintiffs are the West Alabama Women’s Center, the Alabama Women’s Center, and the medical directors of both clinics.³ In 2016 the plaintiffs sued on behalf of themselves and their present and future patients, claiming that the Act was unconstitutional on its face.⁴

They then moved for a preliminary injunction barring enforcement of the Act. After holding an evidentiary hearing the district court entered an order preliminarily enjoining enforcement of the Act. In the course of doing so, the court issued an opinion with findings that there are no safe and effective ways for abortion practitioners to comply with the Act by killing the unborn child before dismembering it. …

The Supreme Court has interpreted the Fourteenth Amendment to bestow on women a fundamental constitutional right of access to abortions. See Roe v. Wade…. About twenty years after a majority of the Court had discovered that right lurking somewhere in the “penumbras of the Bill of Rights” as illuminated by the “concept of ordered liberty” … a majority of the Court devised an “undue burden” test to go with it, see Planned Parenthood of Se. Pa. v. Casey…. The Court’s most recent articulation of that test goes like this:

[T]here exists an undue burden on a woman’s right to decide to have an abortion, and consequently a provision of law is constitutionally invalid, if the purpose or effect of the provision is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability. …

Over the past couple of decades the Supreme Court has issued several decisions drawing and redrawing the contours of the undue burden standard. Three of those decisions bear on the outcome of this case. …

Nearly 93% of abortions performed in Alabama occur before 15 weeks, at which time dismemberment abortion is unnecessary because the unborn child is small enough for practitioners to use other methods that the Act does not prohibit. For the 7% of abortions that occur after 15 weeks, 99% of them are by dismemberment. That’s because at that later stage of pregnancy dismemberment abortion is simpler and safer than other methods, with major complications arising less than 1% of the time. Of those post-15 week dismemberment abortions, one year hospitals performed 7 and clinics performed about 500. Those 500 dismemberment abortions occurred at only two clinics: the West Alabama Women’s Center and the Alabama Women’s Center. So the plaintiffs are the only clinics in Alabama that perform abortions at or after the 15-week mark.

With those background facts in mind, we turn to the State’s proposed fetal demise methods. The State contends that practitioners can cause fetal demise without much difficulty, so the Act does not effectively prohibit dismemberment abortions and thereby impose an undue burden on women seeking abortions. But the State conceded at oral argument: “[I]f there [is] no safe and effective way to cause fetal demise before [dismemberment,] … this law would be unconstitutional.” … As a result, this case turns on whether the fetal demise methods are feasible, which in this context means safe, effective, and available. The State proposes three methods: (1) injecting potassium chloride into the unborn child’s heart; (2) cutting the umbilical cord in utero; and (3) injecting digoxin into the amniotic fluid. The district court found each to be infeasible. …

All of those findings about the fetal demise methods––their attendant risks; their technical difficulty; their untested nature; the time and cost associated with performing them; the lack of training opportunities; and the inability to recruit experienced practitioners to perform them—support the conclusion that the Act would “place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.” Id. (emphasis and quotation marks omitted). So does the fact that every court to consider the issue has ruled that laws banning dismemberment abortions are invalid and that fetal demise methods are not a suitable workaround. …

In our judicial system, there is only one Supreme Court, and we are not it. As one of the “inferior Courts,” we follow its decisions. U.S. Const. art. III, § 1 (“The judicial Power of the United States, shall be vested in one supreme Court, and in such inferior Courts as the Congress may from time to time ordain and establish.”). The primary factfinder is the district court, and we are not it. Our role is to apply the law the Supreme Court has laid down to the facts the district court found. The result is that we affirm the judgment of the district court.

Joel F. Dubina, Circuit Judge, concurring specially:

I concur fully in Chief Judge Carnes’s opinion because it correctly characterizes the record in this case, and it correctly analyzes the law. I write separately to agree on record with Justice Thomas’s concurring opinion in Gonzales v. Carhart … with whom then Justice Scalia also joined. Specifically, Justice Thomas wrote, “I write separately to reiterate my view that the Court’s abortion jurisprudence, including Casey … and Roe v. Wade … has no basis in the Constitution…. The problem I have, as noted in the Chief Judge’s opinion, is that I am not on the Supreme Court, and as a federal appellate judge, I am bound by my oath to follow all of the Supreme Court’s precedents, whether I agree with them or not.

[265] 2019 Indiana Code, Title 16, Article 18, Chapter 2: “Definitions: Dismemberment Abortion.” Accessed October 21, 2023 at <law.justia.com>

Sec. 96.4. (a) “Dismemberment abortion” means an abortion with the purpose of killing a living fetus in which the living fetus is extracted one (1) piece at a time from the uterus through clamps, grasping forceps, tongs, scissors, or another similar instrument that, through the convergence of two (2) rigid levers, slices, crushes, or grasps a portion of the fetus’s body to cut or rip it off.

(b) “Dismemberment abortion” does not include an abortion that uses suction to dismember a fetus by sucking fetal parts into a collection container.

[266] Order: Bernard v. Individual Members of Indiana Medical Licensing Board. U.S. District Court, Southern District of Indiana. June 28, 2019. <caselaw.findlaw.com>

Conclusion and Order

HEA [House Enrolled Act] 1211 prohibits physicians from utilizing the most common, safest, often most cost effective, and best understood method of second trimester abortion, requiring instead resort to alternatives that are medically riskier, more costly, less reliable, and in some instances simply unavailable, while accomplishing little more than expressing hostility towards the constitutionally fundamental right of women to control their own reproductive lives as established in Roe.

For this reason and the others given above:

Plaintiff’s motion for a preliminary injunction is GRANTED.

Defendants are PRELIMINARILY ENJOINED from enforcing HEA 1211, Act of April 24, 2019 … prohibiting the knowing or intentional performance of a “dismemberment abortion” as defined therein. NO BOND is required of Plaintiff.

IT IS SO ORDERED. …

Sarah Evans Barker, Judge

[267] Webpage: “American Medical News.” American Medical Association. Accessed September 6, 2008 at <bit.ly>

American Medical News is the newspaper for America’s physicians. Published since 1958, it is one of the most widely read publications in the United States on news affecting the medical profession. From Medicare and managed care to public health and practice management, no other source covers the same range of current events affecting medical practice.

American Medical News is published by the American Medical Association and is intended to serve as a credible forum for information affecting physicians and their practices. The content of articles and the opinions expressed in AMNews are not necessarily endorsed by the AMA [American Medical Association].

[268] Article: “Veto-Proof Majority in House Votes to Prohibit Late-Term Procedure.” By Diane M. Gianelli. American Medical News, November 20, 1995. <www.nrlc.org>

“Partial birth” abortions, also called “intact D&E” (for dilation and evacuation), or “D&X” (dilation and extraction) are done by only a handful of U.S. physicians, including Martin Haskell, MD, of Dayton, Ohio, and, until his recent death, James T. McMahon, MD, of the Los Angeles area. Dr. McMahon said in a 1993 AMNews interview that he had trained about a half-dozen physicians to do the procedure.

The procedure usually involves the extraction of an intact fetus, feet first, through the birth canal, with all but the head delivered. The surgeon forces scissors into the base of the skull, spreads them to enlarge the opening, and uses suction to remove the brain.

[269] Entry: “abortion, partial-birth.” Melloni’s Illustrated Medical Dictionary (4th edition). Parthenon Publishing Group, 2002.

Page 2: “Common term for termination of a late pregnancy with a breech presentation. Labor is induced by conventional methods; the cervix is widely dilated and delivery is expedited by evacuation the cranial contents with a suction catheter, then compressing the cranium.”

[270] Article: “2nd Trimester Abortion: An Interview with W. Martin Haskell, MD.” Cincinnati Medicine, Fall 1993. Pages 18–19. <www.nrlc.org>

Page 19:

The D & X Procedure—Dilation and Extraction (D & X), a method for second trimester abortion up to 26 weeks, was developed in 1992 by Cincinnati physician W. Martin Haskell, MD. It is a modification of Dismemberment and Extraction (D & E) which has been used in the US since the 1970s. Haskell has performed more than 700 D & X procedures in his office.

Step One—The patient’s cervix is dilated to 9–11 mm over a period of two days using Dilapan hydroscopic dilators. The patient remains at home during the dilation period.

Step Two—In the operating room, patients are given Valium, the Dilapan are removed and the cervix is scrubbed. anesthetized and grasped with a tenaculum. Membranes are ruptured.

Step Three—The surgical assistant scans the fetus with ultrasound, locating the lower extremities.

Step Four—Using a large forcep, the surgeon opens and closes its jaws to firmly grasp a lower extremity. The surgeon turns the fetus if necessary and pulls the extremity into the vagina.

Step Five—The surgeon uses his fingers to deliver the opposite lower extremity, then the torso, shoulders, and upper extremities.

Step Six—The skull lodges at the internal cervical os [hole at the center of the cervix]. Usually there is not enough dilation for it to pass through. The fetus is spine up.

Step Seven—A right-handed surgeon slides the fingers of his left hand along the back of the fetus and hooks the shoulders of the fetus with the index and ring fingers (palm down). He slides the tip of his middle finger along the spine towards the skull while applying traction to the shoulder and lower extremities. The middle finger lifts and pushes the anterior cervical lip out of the way.

Step Eight—While maintaining this tension, the surgeon takes a pair of blunt curved scissors in the right hand. He advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger. The surgeon forces the scissors into the base of the skull and spreads the scissors to enlarge the opening.

Step Nine—The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents.

Step Ten—With the catheter still in place, he applies traction to the fetus, removing it completely from the patient, then removes the placenta.

[271] Presentation: “Dilation and Extraction for Late Second Trimester Abortion.” By Martin Haskell. National Abortion Federation, September 13, 1992. <operationrescue.org>

Page 1:

The surgical method described in this paper [partial-birth abortion] differs from classic D&E [dilation and evacuation] in that it does not rely upon dismemberment to remove the fetus. Nor are inductions or infusions used to expel the intact fetus.

Rather, the surgeon grasps and removes a nearly intact fetus through an adequately dilated cervix. The author has coined the term Dilation and Extraction or D&X to distinguish it from dismemberment-type D&E’s.

This procedure can be performed in a properly equipped physician’s office under local anesthesia. It can be used successfully in patients 20–26 weeks in pregnancy.

The author has performed over 700 of these procedures with a low rate of complications.

NOTE: Pages 2–5 describe the procedure in greater detail.

[272] Webpage: “Summary of House Resolution 1833: Partial-Birth Abortion Ban Act of 1995.” U.S. House of Representatives, 104th Congress (1995–1996). Accessed April 15, 2017 at <www.congress.gov>

Sponsor: Canady, Charles T. [R-FL] (Introduced 06/14/1995) …

Subjects any physician who knowingly performs a partial-birth abortion in or affecting interstate or foreign commerce to a fine or imprisonment for not more than two years or both, except where such an abortion is necessary to save the life of a mother endangered by a physical disorder, illness, or injury, provided that no other medical procedure would suffice.

Defines: (1) “partial-birth abortion” as an abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery; and (2) “physician” as a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the doctor performs such activity, or any other individual legally authorized by the State to perform abortions.

Permits the father (if married to the mother at the time she receives a partial-birth abortion procedure) and (if the mother has not attained the age of 18 at the time of the abortion) the maternal grandparents to obtain, through a civil action, relief which would include money damages for all psychological and physical injuries and statutory damages equal to three times the cost of the partial-birth abortion, unless the pregnancy resulted from the plaintiff’s criminal conduct or the plaintiff consented to the abortion.

[273] Webpage: “Cosponsors of House Resolution 1833: Partial-Birth Abortion Ban Act of 1995.” U.S. House of Representatives, 104th Congress (1995–1996). Accessed April 21, 2017 at <www.congress.gov>

“Sponsor: Canady, Charles T. [R-FL] … Cosponsor statistics: 115 current [96 Republicans, 19 Democrats]”

[274] Calculated with data from:

a) Vote 94: “Partial-Birth Abortion Ban Act of 1995.” U.S. House of Representatives, March 27, 1996. <clerk.house.gov>

b) Vote 596: “Partial-Birth Abortion Ban Act of 1995.” U.S. Senate, December 7, 1995. <www.senate.gov>

Combined vote totals from both Houses of Congress:

[275] Webpage: “Actions on House Resolution 1833: Partial-Birth Abortion Ban Act of 1995.” U.S. House of Representatives, 104th Congress (1995–1996). Accessed April 21, 2017 at <www.congress.gov>

[276] Calculated with data from the footnote above and the report: “Veto Override Procedure in the House and Senate.” By Elizabeth Rybicki. Congressional Research Service, March 2019. <crsreports.congress.gov>

According to Article 1, Section 7, of the Constitution, when the President chooses not to sign a bill¹ and instead returns it to the chamber that originated it, the chamber shall enter the message of the President detailing the reasons for the veto in its Journal and then “proceed to reconsider” the bill.² A vetoed bill can become law if two-thirds of the Members voting in each chamber agree, by recorded vote, a quorum being present, to repass the bill and thereby override the veto of the President.

CALCULATION: 98 Voting Members × 2/3 = 65.3

[277] Webpage: “Summary of House Resolution 1122: Partial-Birth Abortion Ban Act of 1997.” U.S. House of Representatives, 105th Congress (1997–1998). Accessed April 21, 2017. <www.congress.gov>

Sponsor: Solomon, Gerald B. H. [R-NY] (Introduced 03/19/1997) …

Amends the Federal criminal code to prohibit any physician from knowingly performing a partial-birth abortion in or affecting interstate or foreign commerce, unless it is necessary to save the life of the mother. Prescribes penalties.

Defines a “partial birth abortion” as an abortion in which a person, deliberately and intentionally, partially vaginally delivers a living fetus before killing the fetus and completing the delivery.

Authorizes the father, if married to the mother at the time of the abortion, and the maternal grandparents of the fetus, if the mother is under 18 years of age, to obtain specified relief in a civil action, unless the pregnancy resulted from the plaintiff’s criminal conduct or the plaintiff consented to the abortion.

Authorizes a defendant accused of an offense under this Act to seek a hearing before the State Medical Board on whether the physician’s conduct was necessary to save the life of the mother.

Prohibits the prosecution of a woman upon whom a partial-birth abortion is performed for conspiracy to violate this Act or under provisions regarding punishment as a principal or an accessory or for concealment of a felony.

[278] Calculated with data from:

a) Vote 500: “Partial-Birth Abortion Ban Act of 1997.” U.S. House of Representatives, October 8, 1997. <clerk.house.gov>

b) Vote 71: “Partial-Birth Abortion Ban Act of 1997.” U.S. Senate, May 20, 1997. <www.senate.gov>

Combined vote totals from both Houses of Congress:

[279] Webpage: “Actions on House Resolution 1122: Partial-Birth Abortion Ban Act of 1997.” U.S. House of Representatives, 105th Congress (1997–1998). Accessed April 21, 2017 at <www.congress.gov>

[280] Calculated with data from the footnote above and the report: “Veto Override Procedure in the House and Senate.” By Elizabeth Rybicki. Congressional Research Service, March 2019. <crsreports.congress.gov>

According to Article 1, Section 7, of the Constitution, when the President chooses not to sign a bill¹ and instead returns it to the chamber that originated it, the chamber shall enter the message of the President detailing the reasons for the veto in its Journal and then “proceed to reconsider” the bill.² A vetoed bill can become law if two-thirds of the Members voting in each chamber agree, by recorded vote, a quorum being present, to repass the bill and thereby override the veto of the President.

CALCULATION: 100 Voting Members × 2/3 = 66.7

[281] Webpage: Summary of Senate Bill S.3: Partial-Birth Abortion Ban Act of 2003.” U.S. Senate, 108th Congress (2003–2004). Accessed April 21, 2017 at <www.congress.gov>

Sponsor: Santorum, Rick [R-PA] (Introduced 02/14/2003) …

Amends the Federal criminal code to prohibit any physician or other individual from knowingly performing a partial-birth abortion, except when necessary to save the life of a mother whose life is endangered by a physical disorder, illness, or injury.

Defines a “partial-birth abortion” as an abortion in which the person performing the abortion: (1) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the mother’s body, or, in the case of a breech presentation, any part of the fetal trunk past the navel is outside the mother’s body; and (2) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus.

Authorizes the father, if married to the mother at the time of the abortion, and the maternal grandparents of the fetus, if the mother is under 18 years of age, to obtain specified relief in a civil action, unless the pregnancy resulted from the plaintiff’s criminal conduct or the plaintiff consented to the abortion.

Authorizes a defendant accused of an offense under this Act to seek a hearing before the State Medical Board on whether the physician’s conduct was necessary to save the life of the mother.

Prohibits the prosecution of a woman upon whom a partial-birth abortion is performed for conspiracy to violate this Act or under provisions regarding punishment as a principal or an accessory or for concealment of a felony.

[282] Webpage: “Cosponsors of Senate Bill S.3: Partial-Birth Abortion Ban Act of 2003.” U.S. Senate, 108th Congress (2003–2004). Accessed April 21, 2017 at <www.congress.gov>

“Cosponsor statistics: 45 current [2 Democrats, 43 Republicans]”

[283] Calculated with data from:

a) Vote 530: “Partial-Birth Abortion Ban Act of 2003.” U.S. House of Representatives, October 2, 2003. <clerk.house.gov>

b) Vote 402: “Partial-Birth Abortion Ban Act of 2003.” U.S. Senate, October 21, 2003. <www.senate.gov>

Combined vote totals from both Houses of Congress:

[284] Webpage: “Actions on Senate Bill 3: Partial-Birth Abortion Ban Act of 2003.” U.S. Senate, 108th Congress (2003–2004). Accessed April 21, 2017 at <www.congress.gov>

[285] Senate Bill 3: “Partial-Birth Abortion Ban Act of 2003.” U.S. Senate, 108th Congress (2003–2004). Accessed April 21, 2017 at <www.congress.gov>

Sec. 1531. Partial-birth abortions prohibited

(a) Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both.

[286] Ruling: Gonzales v. Carhart. United States Supreme Court, April 18, 2007. Decided 5–4. Majority: Kennedy, Roberts, Scalia, Thomas, Alito. Concurring: Thomas, Scalia. Dissenting: Ginsburg, Stevens, Souter, Breyer. <caselaw.findlaw.com>

Majority:

[Section] IV (B): “In addition the Act’s prohibition only applies to the delivery of ‘a living fetus.’ … If the [partial-birth abortion] procedure is truly necessary in some circumstances, it appears likely an injection that kills the fetus is an alternative under the Act that allows the doctor to perform the procedure.”

[287] Ruling: Gonzales v. Carhart. United States Supreme Court, April 18, 2007. Decided 5–4. Majority: Kennedy, Roberts, Scalia, Thomas, Alito. Concurring: Thomas, Scalia. Dissenting: Ginsburg, Stevens, Souter, Breyer. <caselaw.findlaw.com>

Majority:

In No. 05-380 (Carhart) respondents are LeRoy Carhart, William G. Fitzhugh, William H. Knorr, and Jill L. Vibhakar, doctors who perform second-trimester abortions. These doctors filed their complaint against the Attorney General of the United States in the United States District Court for the District of Nebraska. They challenged the constitutionality of the Act and sought a permanent injunction against its enforcement.

[288] Ruling: Gonzales v. Carhart. United States Supreme Court, April 18, 2007. Decided 5–4. Majority: Kennedy, Roberts, Scalia, Thomas, Alito. Concurring: Thomas, Scalia. Dissenting: Ginsburg, Stevens, Souter, Breyer. <caselaw.findlaw.com>

Majority:

In No. 05-380 (Carhart) respondents are LeRoy Carhart, William G. Fitzhugh, William H. Knorr, and Jill L. Vibhakar, doctors who perform second-trimester abortions. These doctors filed their complaint against the Attorney General of the United States in the United States District Court for the District of Nebraska. They challenged the constitutionality of the Act and sought a permanent injunction against its enforcement. …

Respondents have not demonstrated that the Act, as a facial matter, is void for vagueness, or that it imposes an undue burden on a woman’s right to abortion based on its overbreadth or lack of a health exception. For these reasons the judgments of the Courts of Appeals for the Eighth and Ninth Circuits are reversed.

[289] Article: “McCain Promises Judges Like Roberts, Alito.” Associated Press, May 6, 2008. <www.cbsnews.com>

“Obama, on the other hand, voted against Roberts and Alito.”

[290] Article: “Obama, McCain Talk Issues at Pastor’s Forum.” By Ed Hornick. CNN, August 17, 2008. <www.cnn.com>

“Neither candidate shied away from a question about which current Supreme Court justice they would not have nominated. Obama’s reply: Clarence Thomas.”

[291] Article: “Obama: I Would Not Have Nominated Clarence Thomas.” By Sam Stein. Huffington Post, August 16, 2008. <www.huffingtonpost.com>

[Quoting Obama:] “I would not have nominated Justice Scalia….”

[292] Senate Bill 1173: “Freedom of Choice Act.” U.S. Senate, 110th Congress (2007–2008). Accessed April 22, 2017 at <www.congress.gov>

In the Senate of the United States

April 19, 2007

Mrs. Boxer (for herself, Mrs. Murray, Ms. Stabenow, Mr. Bingaman, Mr. Menendez, Mr. Lautenberg, Mr. Cardin, Mr. Schumer, Mrs. Clinton, Mrs. Feinstein, Ms. Mikulski, Mr. Baucus, and Ms. Cantwell) introduced the following bill; which was read twice and referred to the Committee on the Judiciary …

To protect, consistent with Roe v. Wade, a woman’s freedom to choose to bear a child or terminate a pregnancy, and for other purposes. …

Sec. 4. Interference with Reproductive Health Prohibited. …

(b) Prohibition of Interference—A government may not—

(1) deny or interfere with a woman’s right to choose—

(A) to bear a child;

(B) to terminate a pregnancy prior to viability; or

(C) to terminate a pregnancy after viability where termination is necessary to protect the life or health of the woman; or

(2) discriminate against the exercise of the rights set forth in paragraph (1) in the regulation or provision of benefits, facilities, services, or information. …

Sec. 6. Retroactive Effect.

This Act applies to every Federal, State, and local statute, ordinance, regulation, administrative order, decision, policy, practice, or other action enacted, adopted, or implemented before, on, or after the date of enactment of this Act.

[293] House Resolution 1964 IH: Freedom of Choice Act.” U.S. House of Representatives, 110th Congress (2007–2008). Accessed April 22, 2017 at <www.congress.gov>

In the House of Representatives

April 19, 2007

Mr. Nadler (for himself, Mr. Abercrombie, Mr. Ackerman, Mr. Allen, Mr. Arcuri, Ms. Baldwin, Ms. Berkley, Mr. Berman, Mr. Blumenauer, Mr. Boucher, Mrs. Capps, Mr. Cohen, Mr. Conyers, Mr. Davis of Illinois, Mrs. Davis of California, Mr. DeFazio, Mr. Ellison, Mr. Emanuel, Mr. Farr, Mr. Fattah, Mr. Filner, Mr. Frank of Massachusetts, Mr. Grijalva, Ms. Harman, Ms. Hirono, Mr. Holt, Mr. Honda, Mr. Inslee, Ms. Jackson-Lee of Texas, Mr. Jackson of Illinois, Mr. Kucinich, Mr. Lantos, Mr. Larsen of Washington, Ms. Lee, Mr. Loebsack, Mrs. Lowey, Ms. Matsui, Ms. McCollum of Minnesota, Mr. McDermott, Mrs. Maloney of New York, Mr. Miller of North Carolina, Mr. Moran of Virginia, Mr. Olver, Mr. Porter, Ms. Linda T. Sánchez of California, Ms. Schakowsky, Mr. Shays, Ms. Slaughter, Ms. Solis, Mr. Stark, Ms. Sutton, Mr. Thompson of California, Mr. Towns, Ms. Watson, Mr. Waxman, Mr. Weiner, Mr. Wexler, and Ms. Woolsey) introduced the following bill; which was referred to the Committee on the Judiciary …

To protect, consistent with Roe v. Wade, a woman’s freedom to choose to bear a child or terminate a pregnancy, and for other purposes. …

Sec. 2. Findings. …

(9) Further threatening Roe, the Supreme Court recently upheld the first-ever Federal ban on abortion, which has no exception to protect a woman’s health. The majority decision in Gonzales v. Carhart and Gonzales v. Planned Parenthood Federation of America permits the government to interfere with a woman’s right to choose to terminate a pregnancy and effectively overturns a core tenet of Roe v. Wade by abandoning more than 30 years of protection for women’s health. …

Sec. 4. Interference with Reproductive Health Prohibited.

(a) Statement of Policy—It is the policy of the United States that every woman has the fundamental right to choose to bear a child, to terminate a pregnancy prior to fetal viability, or to terminate a pregnancy after fetal viability when necessary to protect the life or health of the woman.

(b) Prohibition of Interference—A government may not—

(1) deny or interfere with a woman’s right to choose—

(A) to bear a child;

(B) to terminate a pregnancy prior to viability; or

(C) to terminate a pregnancy after viability where termination is necessary to protect the life or health of the woman; or

(2) discriminate against the exercise of the rights set forth in paragraph (1) in the regulation or provision of benefits, facilities, services, or information. …

Sec. 6. Retroactive Effect.

This Act applies to every Federal, State, and local statute, ordinance, regulation, administrative order, decision, policy, practice, or other action enacted, adopted, or implemented before, on, or after the date of enactment of this Act.

[294] Open letter from Kim Gandy (President, National Organization for Women). April 20, 2007. <www.now.org>

Yesterday [April 19, 2007] I was pleased to stand with Senator Barbara Boxer, Representative Jerrold Nadler and many members of Congress as they announced the reintroduction of this important act, which would legislatively reverse the Court’s damaging decision [in Gonzalez v. Carhart] and will enshrine in federal law our right to safe, legal abortion.

[295] Introduction of Bills and Joint Resolutions: S.1173. Congressional Record, May 11, 2007. Page S6017. <www.govinfo.gov>

Page S6017: “At the request of Mrs. BOXER, the name of the Senator from Illinois (Mr. OBAMA) was added as a cosponsor of S. 1173, a bill to protect, consistent with Roe v. Wade, a woman’s freedom to choose to bear a child or terminate a pregnancy, and for other purposes.”

[296] Speech: “Barack Obama before Planned Parenthood Action Fund.” July 17, 2007. Transcribed by Laura Echevarria. <bit.ly>

“Well, the first thing I’d do as President is, is sign the Freedom of Choice Act. … That’s the first thing that I’d do.”

[297] Transcript: “The President’s News Conference.” Administration of Barack H. Obama, April 29, 2009. <www.govinfo.gov>

[President Obama:] …

Now, the freedom of choice act is not my highest legislative priority. I believe that women should have the right to choose, but I think that the most important thing we can do to tamp down some of the anger surrounding this issue is to focus on those areas that we can agree on. And that’s where I’m going to focus.”

[298] Article: “2nd Trimester Abortion: An Interview with W. Martin Haskell, MD.” Cincinnati Medicine, Fall 1993. <www.nrlc.org>

Page 19:

The D & X Procedure—Dilation and Extraction (D & X), a method for second trimester abortion up to 26 weeks, was developed in 1992 by Cincinnati physician W. Martin Haskell, MD. It is a modification of Dismemberment and Extraction (D & E) which has been used in the US since the 1970s. Haskell has performed more than 700 D & X procedures in his office.

Step One—The patient’s cervix is dilated to 9–11 mm over a period of two days using Dilapan hydroscopic dilators. The patient remains at home during the dilation period.

Step Two—In the operating room, patients are given Valium, the Dilapan are removed and the cervix is scrubbed. anesthetized and grasped with a tenaculum. Membranes are ruptured.

Step Three—The surgical assistant scans the fetus with ultrasound, locating the lower extremities.

Step Four—Using a large forcep, the surgeon opens and closes its jaws to firmly grasp a lower extremity. The surgeon turns the fetus if necessary and pulls the extremity into the vagina.

Step Five—The surgeon uses his fingers to deliver the opposite lower extremity, then the torso, shoulders, and upper extremities.

Step Six—The skull lodges at the internal cervical os [hole at the center of the cervix]. Usually there is not enough dilation for it to pass through. The fetus is spine up.

Step Seven—A right-handed surgeon slides the fingers of his left hand along the back of the fetus and hooks the shoulders of the fetus with the index and ring fingers (palm down). He slides the tip of his middle finger along the spine towards the skull while applying traction to the shoulder and lower extremities. The middle finger lifts and pushes the anterior cervical lip out of the way.

Step Eight—While maintaining this tension, the surgeon takes a pair of blunt curved scissors in the right hand. He advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger. The surgeon forces the scissors into the base of the skull and spreads the scissors to enlarge the opening.

Step Nine—The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents.

Step Ten—With the catheter still in place, he applies traction to the fetus, removing it completely from the patient, then removes the placenta.

[299] Letter: “Barbara Bolsen (Editor, American Medical News) to Charles T. Canady (Chairmen, Subcommittee on the Constitution, Judiciary Committee, U.S. House of Representatives).” July 11, 1995. <www.congress.gov>

Page H1063:

We have full documentation of these interviews, including tape recordings and transcripts. …

Haskell: And I’ll be quite frank: most of my abortions are elective in that 20–24 week range … In my particular case, probably 20% are for genetic reasons. And the other 80% are purely elective….

NOTE: This statement was made in an interview conducted for an article published on July 5, 1993. That Haskell was referring to partial-birth abortion is demonstrated in the next two footnotes.

[300] Presentation: “Dilation and Extraction for Late Second Trimester Abortion.” By Martin Haskell. National Abortion Federation, September 13, 1992. <operationrescue.org>

Page 1:

The surgical method described in this paper differs from classic D&E [dilation and evacuation] in that it does not rely upon dismemberment to remove the fetus. Nor are inductions or infusions used to expel the intact fetus.

Rather, the surgeon grasps and removes a nearly intact fetus through an adequately dilated cervix. The author has coined the term Dilation and Extraction or D&X to distinguish it from dismemberment-type D&E’s. …

Page 2: “The author routinely performs this procedure on all patients 20 through 24 weeks LMP [last menstrual period] with certain exceptions.”

[301] Article: “Shock-Tactic Ads Target Late-Term Abortion Procedure: Foes Hope Campaign Will Sink Federal Abortion Rights Legislation.” By Diane M. Gianelli. American Medical News, July 5, 1993. <www.congress.gov>

Pages S16794–S16795:

But Dr. Haskell and another doctor who routinely use the [partial-birth] procedure for late term abortions told AMNews that the majority of fetuses aborted this way are alive until the end of the procedure. …

Dr. Haskell said he performs abortions “up until about 25 weeks’ ” gestation, most of them elective.

[302] House report 104-267: “Partial-Birth Abortion Ban Act of 1995.” Judiciary Committee, U.S. House of Representatives, September 27, 1995. <www.govinfo.gov>

Page 8:

The writings of both Dr. Haskell and Dr. McMahon advocate partial-birth abortion as the method they prefer for all late-term abortions.²² Dr. Haskell told the AMNews that the vast majority of the partial-birth abortions he performs are elective. He stated, “And I’ll be quite frank: most of my abortions are elective in that 20–24 week range. … In my particular case, probably 20% are for genetic reasons. And the other 80% are purely elective. …”²³

Dr. McMahon uses the partial-birth abortion method through the entire 40 weeks of pregnancy. He claims that most of the abortions he performs are “non-elective,” but his definition of “non-elective” is extremely broad. Dr. McMahon sent a letter to the Constitution Subcommittee in which he described abortions performed because of the mother’s youth or depression as “non-elective.”²⁴

²² Haskell, supra note 4 at 27; Letter from James T. McMahon, M.D., to the Subcomm. on the Constitution of the House Comm. on the Judiciary (June 6, 1995) (on file with the Subcomm. on the Constitution of the House Comm. on the Judiciary).

²³ Letter from Barbara Bolsen, supra note 17.

²⁴ Letter from James T. McMahon, M.D., supra note 20.

[303] Letter from 53 Organizations to U.S. Congressman Christopher Smith, October 2, 1995.

October 2, 1995

The Honorable Christopher H. Smith

U.S. House of Representatives

2370 Rayburn House Office Building

Washington, DC 20515

Dear Representative Smith:

As organizations which support full access to safe, legal abortion services, we urge you to oppose H.R. 1833, legislation that would ban a particular type of abortion procedure, known to abortion providers as intact D&E [dilation and evacuation] or D&X [dilation and extraction]. The technique has been sensationalized by anti-abortion advocates, who inaccurately refer to the surgery as a “partial birth” abortion—a term unknown in the medical community, and invented solely for this legislation. …

This surgical procedure is used only in rare cases, fewer than 500 per year. It is most often performed in the case of wanted pregnancies gone tragically wrong, when a family learns late in pregnancy of severe fetal anomalies or a medical condition that threatens the pregnant woman’s life or health. …

Sincerely,

Advocates for Youth

The Alan Guttmacher Institute

American Association of University Women

American Civil Liberties Union

American Humanist Association

American Jewish Committee

American Jewish Congress

Americans for Democratic Action

Americans for Religious Liberty

Association of Reproductive Health Professionals

The Center for Reproductive Law and Policy

Center for Women’s Policy Studies

Clara Bell Duvall Education Fund

Coalition of Labor Union Women

Disciples for Choice

The Feminist Majority

Hollywood Women’s Political Committee

Human Rights Campaign Fund

Institute for Research on Women’s Health

International Projects Assistance Service

Medical Students for Choice

Michigan Welfare Rights League

National Abortion Federation

National Abortion and Reproductive Rights Action League

National Asian Women’s Health Network

National Association of Nurse Practitioners

National Black Women’s Health Project

National Center for the ProChoice Majority

National Council of Jewish Women

National Family Planning and Reproductive Health Association

National Latina Institute for Reproductive Health

National Organization for Women

National Republican Coalition for Choice

National Women’s Health Network

National Women’s Law Center

Native American Women’s Health Education Resource Center

NOW Legal Defense and Education Fund

People For the American Way Action Fund

Planned Parenthood Federation of America

Population Action International

ProChoice Resource Center

Religious Coalition for Reproductive Choice

Society of Physicians for Reproductive Health and Choice

Union of American Hebrew Congregations

United Church Board for Homeland Ministries

Voters For Choice

Women of Reform Judaism, The Federation of Temple Sisterhood

Women’s Institute for Freedom of the Press

Women’s Law Project

Women’s Legal Defense Fund

Women’s Rabbinic Network

YWCA of the USA

Zero Population Growth

[304] Press release: “Aiming at the Right to Abortion, Congress Votes to Ban a Medical Procedure That Saves Women’s Lives.” PR Newswire, November 1, 1995. <www.prnewswire.com>

Distribution: To National and Health/Medical Editors …

Planned Parenthood Federation of America issued the following:

In an unprecedented intrusion by Congress into medical decisions, the U.S. House of Representatives today voted to ban a late abortion procedure designed to save women’s lives. The procedure, dilation and extraction (D&X), is extremely rare and done only in cases when the woman’s life is in danger or in cases of extreme fetal abnormality.

[305] Article: “Medicine Adds to Debate on Late-Term Abortion: Abortion Rights Leader Urges End to ‘Half Truths.’ ” By Diane M. Gianelli. American Medical News, March 3, 1997.

Page 3: “When [Ron] Fitzsimmons criticizes his movement for its handling of this issue, he points the finger at himself first. In November 1995, he was interviewed by Nightline … telling the reporter that women had these abortion only in the most extreme circumstances of life endangerment or fetal anomaly.”

[306] Article: “An Abortion Rights Advocate Says He Lied About Procedure.” By David Stout. New York Times, February 26, 1997. <www.nytimes.com>

Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, said he intentionally misled in previous remarks about the procedure … because he feared that the truth would damage the cause of abortion rights. …

Mr. Fitzsimmons … appeared on Nightline on ABC and … said the procedure was used rarely and only on women whose lives were in danger or whose fetuses were damaged.

[307] On September 4, 2008, Just Facts contacted the ABC News Store to obtain a copy of this transcript and was told that the program aired on 11/7/95, was entitled “Late-Term Abortions,” and ABC’s legal department has not approved it for release. This was confirmed by a search of their archives which revealed that this episode is missing and that the shows surrounding it on 11/06/95 and 11/09/95 are available [<abcnewsstore.go.com>].

[308] Press release: “Capitol Hill Hearing Testimony, March 21, 1996, Diana Zuckerman, National Policy Director of Planned Parenthood to the House Judiciary Committee on the Constitution, Partial-Birth Abortion.” Planned Parenthood Federation of America, March 21, 1996.

We at Planned Parenthood are outraged that Congress is continuing to intrude into difficult and private medical decisions best left to women, families, and doctors. The attempt to ban dilation and extraction (D&X), a late abortion procedure that is used very rarely and in the most tragic circumstances, places women’s lives in jeopardy. …

The truth is that the D&X procedure is only used when the woman’s life or health is in danger or in cases of extreme fetal anomaly.

[309] Article: “The Facts on Partial-Birth Abortion; Both Sides Have Misled the Public.” By Ruth Padawer. Bergen Record, September 15, 1996. <northjersey.newspapers.com>

Doctors at Metropolitan Medical in Englewood estimate that their clinic alone performs 3,000 abortions a year on fetuses between 20 and 24 weeks, of which at least half are by intact dilation and evacuation. …

“I always try [a partial-birth abortion first],” said a Metropolitan Medical gynecologist, who, like every other provider interviewed for this article, spoke on condition of anonymity for fear of retribution. …

“We have an occasional amnio abnormality, but it’s a minuscule amount,” said one of the doctors at Metropolitan Medical, an assessment confirmed by another doctor there. “Most are Medicaid patients, black and white, and most are for elective, not medical, reasons: people who didn’t realize, or didn’t care, how far along they were. Most are teenagers.”

NOTE: This article alleges that “abortion foes” have also misled in this debate. Most of the points made to substantiate this statement are addressed in House report 104-267. One that is not is this statement: “In reality, only about 600, or 0.04 percent, of abortions of any type are performed after 26 weeks, according to the latest figures from Guttmacher.” Compare that with the following from American Medical News:

Accurate figures on second- and third-trimester abortions are elusive because a number of states don’t require doctors to report abortion statistics. For example, one-third of all abortions are said to occur in California, but the state has no reporting requirements. …

There is a particular debate over the number of third-trimester abortions. Former Surgeon General C. Everett Koop, MD, estimated in 1984 that 4,000 are performed annually. The abortion federation puts the number at 300 to 500. Dr. Haskell says that “probably Koop’s numbers are more correct.” [Article: “Shock-Tactic Ads Target Late-Term Abortion Procedure: Foes Hope Campaign Will Sink Federal Abortion Rights Legislation.” By Diane M. Gianelli. American Medical News, July 5, 1993.]

[310] Letter to the editor and response: “Abortion Numbers Questioned.” From the Management of Metropolitan Medical Associates, September 23, 1996. Bergen Record, October 2, 1996. <northjersey.newspapers.com>

The editor replies: The Record stands behind the story and rebuts the claims in Metropolitan Medical’s unsigned letter. …

Metropolitan Medical’s letter contradicts what two prominent staff physicians at the clinic, one of whom is also a high-ranking administrator, told Staff Writer Ruth Padawer independently of each other. The first physician said the clinic each week performs 60 to 100 abortions at 20 weeks gestation or later, or 3,000 to 5,000 a year. The second physician told Padawer that the clinic handles 3,000 such cases a year.

Both physicians also independently told Padawer that at least half the post-20 week abortions performed at the clinic were by the intact D&E [dilation and evacuation] method. …

As for the Metropolitan Medical’s claim that a quotation by one of its doctors was “erroneous”: Padawer read back to him all of his quotations, including the one about the Medicaid patients. She also read him the paragraph preceding and following the quotations. He confirmed the accuracy and context of each quotation.

[311] Article: “An Abortion Rights Advocate Says He Lied About Procedure.” By David Stout. New York Times, February 26, 1997. <www.nytimes.com>

Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, said he intentionally misled in previous remarks about the procedure … because he feared that the truth would damage the cause of abortion rights. …

… Mr. Fitzsimmons recalled the night in November 1995, when he appeared on “Nightline” on ABC and “lied through my teeth” when he said the procedure was used rarely and only on women whose lives were in danger or whose fetuses were damaged. …

In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along, Mr. Fitzsimmons said.

[312] Article: “Medicine Adds to Debate on Late-Term Abortion: Abortion Rights Leader Urges End to ‘Half Truths.’ ” By Diane M. Gianelli. American Medical News, March 3, 1997.

What abortion rights supporters failed to acknowledge, Fitzsimmons said, is that the vast majority of these abortion are performed in the 20-plus week range on healthy fetuses and healthy mothers. “The abortion rights folks know it, the anti-abortion folks know it, and so, probably, does everyone else,” he said.

He knows it, he says, because when the bill to ban it came down the pike, he called around until he found doctors who did them.

“I learned right away that this was being done for the most part in cases that did not involve those extreme circumstances,” he said. …

[Quoting Fitzsimmons:] “When you’re a doctor who does these abortions and the leaders of your movement appear before Congress and go on network news and say these procedures are done in only the most tragic of circumstances, how do you think it makes you feel? You know they’re primarily done on healthy women and healthy fetuses, and it makes you feel like a dirty little abortionist with a dirty little secret.”

[313] Article: “Abortion: Activists Lied: Pro-Choice Advocates Admit to Deception.” Bergen Record, February 27, 1997. <www.nrlc.org>

“The spin out of Washington was that it was only done for medical necessity, even though we knew it wasn’t so,” said Renee Chelian, president of the National Coalition of Abortion Providers and a member of the National Abortion Federation who runs three abortion clinics in the Detroit area, “I kept waiting for the NAF [National Abortion Federation] to clarify it and they never did. I got caught up: What do we do about this secret? Who do we tell and what happens when we tell? But frankly, no one was asking me, so I didn’t have to worry.

[314] Article: “Possible Ban on Abortion Technique Leaves Doctors Uneasy.” By Mary Duenwald. New York Times, April 22, 2003. <www.nytimes.com>

One aspect of the debate has changed. When it began, some opponents of the ban said the targeted form of abortion was used only when a fetus had extreme abnormalities or a mother’s health was endangered by pregnancy. Now, both sides acknowledge that abortions done late in the second trimester, no matter how they are conducted, are most often performed to end healthy pregnancies because the woman arrived relatively late to her decision to abort.

A Guttmacher study from 1987 indicates that only 2 percent of abortions done after 16 weeks of pregnancy are done because of fetal abnormalities.

[315] Editorial: “Anti-Abortionists on Trial.” By the Editorial Board. New York Times, July 25, 2012. <www.nytimes.com>

“The overwhelming number of abortions occur well before 20 weeks; later abortions mostly often involve severely troubled pregnancies that pose risks to a woman’s health or life.”

[316] Transcript: “Meet the Press.” NBC News, September 1, 2024. <www.nbcnews.com>

Kristen Welker:

Now, less than 1% of abortions happen at 21 weeks or later, and usually because of catastrophic health risks or lethal fetal abnormalities. …

And just to be clear, abortions later in pregnancy, 21 weeks and after, are extremely rare [and] usually only take place the case of a health emergency.

[317] Article: “ ‘Executing Babies’: Here Are the Facts Behind Trump’s Misleading Abortion Tweet.” By Denise Grady. New York Times, February 26, 2019. <www.nytimes.com>

“Less than 1 percent of all abortions are done after 24 weeks, and many are performed because the fetus has a fatal condition or the pregnant woman’s life or health is at severe risk.”

[318] Article: “ ‘Four Takeaways From the DeSantis-Crist Debate in Florida’s Governor Race.” By Patricia Mazzei and Maggie Astor. New York Times, October 24, 2022. <www.nytimes.com>

He [Ron DeSantis] accused Mr. Crist of supporting abortion “up until the moment of birth.” That is a common Republican claim, but abortion until the moment of birth doesn’t exist, even in states without gestational limits. He also said Mr. Crist supported “dismemberment abortions,” a pejorative term for procedures performed later in pregnancy that, when they do happen, are often prompted by medical emergencies or severe fetal abnormalities.

[319] Article: “Trent Franks Expands His DC Abortion Ban Nationwide.” By Laura Bassett. Huffington Post, May 17, 2013. <www.huffpost.com>

“According to the Centers for Disease Control and Prevention, late-term abortions are very rare. Slightly more than 1 percent of abortions are conducted after 24 weeks, and most of those cases result from a severe fetal anomaly or a health threat to the mother.”

[320] Webpage: “Facts are Important: Abortion Care Later in Pregnancy is Important to Women’s Health.” American College of Obstetricians and Gynecologists, February 2019. <bit.ly>

Many abortions that occur later in pregnancy involve fetal anomalies incompatible with life, such as anencephaly, the absence of the brain and cranium above the base of the skull, or limb-body wall complex, when the organs develop outside of the body cavity.ⁱⁱ In these cases, where death is likely before or shortly after birth, patients may decide whether to continue the pregnancy and deliver a nonviable fetus or have an abortion.

ⁱⁱ <rarediseases.info.nih.gov> †

NOTES:

• † This source describes a “rare disease” called “limb-body wall complex.” It does not say that many late-term abortions involve this disease and doesn’t use the terms “abortion,” “terminate,” or “termination.”
• For more facts about how the American College of Obstetricians and Gynecologists has been untruthful about abortion, click here.

[321] Article: “Separating Fact From Fiction in Abortion Talking Points.” By Meg Kelly. Washington Post, June 12, 2019. <www.washingtonpost.com>

“For women that are really in that difficult position, so-called late-term abortions—some people try to make [it as though] that commonly happens. That happens when a woman’s life is being threatened and the viability of the fetus as well is compromised.”

— Sen. Cory Booker (D-N.J.), in a town hall, April 16, 2019

[322] Statement of U.S. Senator Jeanne Shaheen (D-NH). Congressional Record, February 25, 2019. Page S1418. <www.congress.gov>

“We must always remember that abortions that are performed later in pregnancy are most often done as the result of severe fetal diagnoses and the serious risks that pregnancy poses to the life of the mother.”

[323] Video: “Pete Buttigieg Explains Why He’s Pro-Choice.” The View, February 6, 2020. <youtu.be>

Time marker 4:38:

If this is a late-term situation, then by definition, it’s one where a woman was expecting to carry the pregnancy to term. Then she gets the most, perhaps, devastating news of her life. We’re talking about families that may have picked out a name, may be assembling a crib, and they learn something excruciating, and are faced with this terrible choice.

[324] Transcript: Face the Nation. Hosted by John Dickerson. CBS, September 20, 2015. <www.cbsnews.com>

Dickerson: This week, the Senate is going to vote to impose a federal ban on late-term abortions. Do you support a federal limit on abortion at any stage of pregnancy?

Clinton: This is one of those really painful questions that people raise. And, obviously, it’s really emotional. I think that the kind of late-term abortions that take place are because of medical necessity. And, therefore, I would hate to see the government interfering with that decision. I think that, again, this gets back to whether you respect a woman’s right to choose or not. And I think that is what this whole argument once again is about.

[325] Article: “Julian Castro Calls for Surge in Federal Spending to End Homelessness.” By Michael Finnegan. Los Angeles Times, June 17, 2019. <www.latimes.com>

“Democratic presidential candidate Julian Castro called for a sharp rise in federal spending on housing for millions of Americans who are living on the street or struggling to pay rent.”

[326] Article: “Separating Fact From Fiction in Abortion Talking Points.” By Meg Kelly. Washington Post, June 12, 2019. <www.washingtonpost.com>

“The evidence over many years shows that to the extent that an abortion is performed after 20–24 weeks those are very very limited circumstances and necessary for the life of the mother or for other reasons.”

— Former housing and urban development secretary Julián Castro, on Meet the Press Daily, June 7, 2019

[327] Statement of U.S. Representative Diana DeGette (D-CO). Congressional Record, October 3, 2017. Page H7717. <www.congress.gov>

Madam Speaker, I rise for my former district director Chris and his wife, Bridget. This is their story. Bridget was pregnant with their very much-wanted second child. After the 20th week, they were stunned to learn that the brain stem of the fetus was not attached, and if the baby even survived, then the newborn would likely die within hours. …

… Ninety-nine percent of abortions are conducted before the 20-week mark. Virtually all the rest are just like this situation.

[328] Article: “Abortion Bill Draws GOP Outrage Against Va. Gov. Northam, Democratic Legislators.” By Gregory S. Schneider and Laura Vozzella. Washington Post, January 30, 2019. <www.washingtonpost.com>

Ofirah Yheskel, a spokeswoman for Northam, said the Republicans were mischaracterizing his remarks.

“No woman seeks a third-trimester abortion except in the case of tragic or difficult circumstances, such as a nonviable pregnancy or in the event of severe fetal abnormalities, and the governor’s comments were limited to the actions physicians would take in the event that a woman in those circumstances went into labor,” she said.

[329] Article: “Method to End 20-Week Pregnancies Stirs a Corner of the Abortion Debate.” By Tamar Lewin. New York Times, July 5, 1995. <www.nytimes.com>

“We only know of two physicians who do this,” said Vicki Saporta, executive director of the National Abortion Federation, “and combined they do 450 a year.” …

This procedure is not taking place on live fetuses, the way it’s being portrayed,” Ms. Saporta said. “The fetal demise has already occurred, and most of these fetuses have severe abnormalities and were never healthy to start with.

[330] Article: “2nd Trimester Abortion: An Interview with W. Martin Haskell, MD.” Cincinnati Medicine, Fall 1993. <www.nrlc.org>

Page 19:

The D & X Procedure—Dilation and Extraction (D & X), a method for second trimester abortion up to 26 weeks, was developed in 1992 by Cincinnati physician W. Martin Haskell, MD. It is a modification of Dismemberment and Extraction (D & E) which has been used in the US since the 1970s. Haskell has performed more than 700 D & X procedures in his office.

Step One—The patient’s cervix is dilated to 9–11 mm over a period of two days using Dilapan hydroscopic dilators. The patient remains at home during the dilation period.

Step Two—In the operating room, patients are given Valium, the Dilapan are removed and the cervix is scrubbed. anesthetized and grasped with a tenaculum. Membranes are ruptured.

Step Three—The surgical assistant scans the fetus with ultrasound, locating the lower extremities.

Step Four—Using a large forcep, the surgeon opens and closes its jaws to firmly grasp a lower extremity. The surgeon turns the fetus if necessary and pulls the extremity into the vagina.

Step Five—The surgeon uses his fingers to deliver the opposite lower extremity, then the torso, shoulders, and upper extremities.

Step Six—The skull lodges at the internal cervical os [hole at the center of the cervix]. Usually there is not enough dilation for it to pass through. The fetus is spine up.

Step Seven—A right-handed surgeon slides the fingers of his left hand along the back of the fetus and hooks the shoulders of the fetus with the index and ring fingers (palm down). He slides the tip of his middle finger along the spine towards the skull while applying traction to the shoulder and lower extremities. The middle finger lifts and pushes the anterior cervical lip out of the way.

Step Eight—While maintaining this tension, the surgeon takes a pair of blunt curved scissors in the right hand. He advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger. The surgeon forces the scissors into the base of the skull and spreads the scissors to enlarge the opening.

Step Nine—The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents.

Step Ten—With the catheter still in place, he applies traction to the fetus, removing it completely from the patient, then removes the placenta.

[331] Article: “Method to End 20-Week Pregnancies Stirs a Corner of the Abortion Debate.” By Tamar Lewin. New York Times, July 5, 1995. <www.nytimes.com>

Dr. Haskell, whose paper on how to perform the procedure was distributed to other doctors by the National Abortion Federation, said in a letter to Mr. Canady’s subcommittee: “Statements that fetuses are not dead until nearly the end of the procedure are not accurate. Death occurs early in the procedure if not before. Representations that fetuses are living, conscious, feeling pain, wiggling, kicking or trying to escape are totally fictitious.”

[332] Article: “Shock-Tactic Ads Target Late-Term Abortion Procedure: Foes Hope Campaign Will Sink Federal Abortion Rights Legislation.” By Diane M. Gianelli. American Medical News, July 5, 1993. <www.congress.gov>

Page S16795:

A letter to the Star-Tribune said the procedure shown “is only performed after fetal death when an autopsy is necessary or to save the life of the mother.” And the Morrisville, Vt., Transcript … quoted the abortion federation as providing similar information. “The fetus is dead 24 hours before the pictured procedure is undertaken,” the editorial stated.

But Dr. Haskell and another doctor [McMahon] who routinely use the procedure for late term abortions told AMNews that the majority of fetuses aborted this way are alive until the end of the procedure.

[333] Article: “Veto-Proof Majority in House Votes to Prohibit Late-Term Procedure.” By Diane M. Gianelli. American Medical News (a publication of the American Medical Association), November 20, 1995. <bit.ly>

Page 3 (of PDF):

Frequently quoted is testimony of a nurse, Brenda Shafer, RN, who witnessed three of these procedures in Dr. Haskell’s clinic and called it “the most horrifying experience of my life.

“The baby’s body was moving. His little fingers were clasping together. He was kicking his feet.” Afterwards, she said, “he threw the baby in a pan.” She said she saw the baby move. “I still have nightmares about what I saw.”

[334] Article: “Method to End 20-Week Pregnancies Stirs a Corner of the Abortion Debate.” By Tamar Lewin. New York Times, July 5, 1995. <www.nytimes.com>

“But anti-abortion groups point to statements in earlier news accounts, including a 1993 article in the American Medical News, a publication of the American Medical Association, that quoted the two doctors as saying, ‘The majority of fetuses aborted this way are alive until the end of the procedure.’ ”

[335] House report 104-267: “Partial-Birth Abortion Ban Act of 1995.” Judiciary Committee, U.S. House of Representatives, September 27, 1995. <www.gpo.gov>

Pages 5–6:

Dr. Martin Haskell and Dr. James McMahon, two abortionists who use the partial-birth abortion method, were interviewed by the American Medical News in 1993. These doctors “told the AMNews that the majority of fetuses aborted this way are alive until the end of the procedure.”¹⁴

Dr. Haskell and the National Abortion Federation disputed the accuracy of the AMNews article after the “Partial-Birth Abortion Ban Act” was introduced this year, claiming that out-of-context quotes were used.¹⁵ …

¹⁴ Diane M. Gianelli, “Shock-Tactic Ads Target Late-Term Abortion Procedure: Foes Hope Campaign Will Sink Federal Abortion Rights Legislation,” American Medical News, July 5, 1993, at 3, 21.

[336] Article: “Veto-Proof Majority in House Votes to Prohibit Late-Term Procedure.” By Diane M. Gianelli. American Medical News, November 20, 1995. <www.nrlc.org>

“The accuracy of the article was challenged, two years after publication, by Dr. Haskell and the National Abortion Federation, who told Congress the doctors were quoted ‘out of context.’ ”

[337] Letter: “Barbara Bolsen (Editor, American Medical News) to Charles T. Canady (Chairmen, Subcommittee on the Constitution, Judiciary Committee, U.S. House of Representatives).” July 11, 1995. <www.congress.gov>

Page H10633:

We have full documentation of these interviews, including tape recordings and transcripts. Enclosed is a transcript of the contested quotes that relate to the allegations of inaccuracies made against AMNews.

Let me also note that in the two years since publication of our story, neither the organization nor the physician who complained about the report in testimony to your committee has contacted the reporter or any editor at AMNews to complain about it. AMNews has a longstanding reputation for balance, fairness and accuracy in reporting, including reporting on abortion, an issue that is as divisive within medicine as it is within society in general. We believe that the story in question comports entirely with that reputation. …

AMN: Let’s talk first about whether or not the fetus is dead beforehand …

Haskell: No, it’s not. No, it’s really not. A percentage are for various numbers of reasons. Some just because of the stress—intrauterine stress during, you know, the two days that the cervix is being dilated. Sometimes the membranes rupture and it takes a very small superficial infection to kill a fetus in utero when the membranes are broken. And so in my case, I would think probably about a third of those are definitely are (sic) dead before I actually start to remove the fetus. And probably the other two-thirds are not.

AMN: Is the skull procedure also done to make sure that the fetus is dead so you’re not going to have the problem of a live birth?

Haskell: It’s immaterial. If you can’t get it out, you can’t get it out.

AMN: I mean, you couldn’t dilate further? Or is that riskier?

Haskell: Well, you could dilate further over a period of days.

AMN: Would that just make it … would it go from a 3-day procedure to a 4- or a 5-?

Haskell: Exactly. The point here is to effect a safe legal abortion. I mean, you could say the same thing about the D procedure. You know, why do you do the D procedure? Why do you crush the fetus up inside the womb? To kill it before you take it out?

Well, that happens, yes. But that’s not why you do it. You do it to get it out. I could do the same thing with a D procedure. I could put dilapan in for four or five days and say I’m doing a D procedure and the fetus could just fall out. But that’s not really the point. The point here is you’re attempting to do an abortion. And that’s the goal of your work, is to complete an abortion. Not to see how do I manipulate the situation so that I get a live birth instead.

AMN, wrapping up the interview: I wanted to make sure I have both you and (Dr.) McMahon saying “No” then. That this is misinformation, these letters to the editor saying it’s only done when the baby’s already dead, in case of fetal demise and you have to do an autopsy. But some of them are saying they’re getting that information from NAF [National Abortion Federation]. Have you talked to Barbara Radford or anyone over there? I called Barbara and she called back, but I haven’t gotten back to her.

Haskell: Well, I had heard that they were giving that information, somebody over there might be giving information like that out. The people that staff the NAF office are not medical people. And many of them when I gave my paper, many of them came in, I learned later, to watch my paper because many of them have never seen an abortion performed of any kind.

AMN: Did you also show a video when you did that?

Haskell: Yeah. I taped a procedure a couple of years ago, a very brief video, that simply showed the technique. The old story about a picture’s worth a thousand words.

AMN: As National Right to Life will tell you.

Haskell: Afterwards they were just amazed. They just had no idea. And here they’re rapid supporters of abortion. They work in the office there. And … some of them have never seen one performed….

[338] House report 104-267: “Partial-Birth Abortion Ban Act of 1995.” Judiciary Committee, U.S. House of Representatives, September 27, 1995. <frwebgate.access.gpo.gov>

Page 6:

In a letter to the Honorable Charles T. Canady, Dr. James McMahon, an abortionist who uses the partial-birth abortion method, implies that large doses of analgesia kill the baby before the doctor begins delivery. He states:

The fetus feels no pain through the entire series of procedures. This is because the mother is given narcotic analgesia at a dose based upon her weight. The narcotic is passed, via the placenta, directly into the fetal bloodstream. Due to the enormous weight difference, a medical coma is induced in the fetus. There is a neurological fetal demise. There is never a live birth.¹⁸ …

¹⁸ Letter from James T. McMahon, M.D., to Congressman Charles T. Canady (June 23, 1995) (on file with the Subcomm. on the Constitution of the House Comm. on the Judiciary).

[339] Newsletter: “Washington Report.” By Michael Scott. American Academy of Anesthesiologists, May 1996. <www.asahq.org>

On March 21, ASA [American Academy of Anesthesiologists] President Norig Ellison, M.D., testified before a subcommittee of the House Judiciary Committee on the issue of the effect of anesthetics on the fetus in late-term abortions. Also participating in the hearing were David J. Birnbach, M.D., President-Elect of the Society for Obstetric Anesthesia and Perinatology and Professor of Anesthesiology at St. Luke’s Roosevelt Medical Center, New York, New York; David H. Chestnut, M.D., Chair of the Department of Anesthesiology, University of Alabama Birmingham Hospital, Birmingham, Alabama; and Jean A. Wright, M.D., Associate Professor, Department of Pediatrics and Anesthesiology, Emory University, Atlanta, Georgia.

Testimony of all the anesthesiology witnesses was consistent, disputing at length the claim that anesthesia given to the mother during a late-term abortion caused neurological demise of the fetus. All of the witnesses expressed concern that widespread dissemination of this false claim by the media has caused many women to question whether to undergo necessary surgery during pregnancy, for fear of injuring the unborn child.

[340] Transcript: “Testimony of Jill L. Stanek, Mokena, IL.” Subcommittee on the Constitution, Judiciary Committee, U.S. House of Representatives, July 20, 2000. Pages 34–39. <commdocs.house.gov>

Pages 35–36:

My name is Jill Stanek, and I am a registered nurse who has worked in the Labor and Delivery Department at Christ Hospital in Oak Lawn, Illinois, for the past 5 years. Christ Hospital performs abortions on women in their second or even third trimesters of pregnancy. Sometimes the babies aborted are healthy, and sometimes they are not. …

… It is not uncommon for a live aborted baby to linger for an hour or two or even longer. One of these babies was known to live for almost an entire 8-hour shift.

In the event that a baby is aborted alive, he or she receives no medical assessments or care, but is given only what the Christ Hospital calls “comfort care.” Comfort care is defined as keeping the baby warm in a blanket until he or she dies, although even this so-called compassion is not always provided. It is not required that these babies be held during their short lives.

One night, a nursing co-worker was taking an aborted Down’s syndrome baby who was born alive to our Soiled Utility Room because his parents did not want to hold him and she did not have time to hold him. I could not bear the thought of this suffering child dying alone in a Soiled Utility Room, so I cradled and rocked him for the 45 minutes that he lived. …

Other co-workers have told me upsetting stories about live aborted babies whom they have cared for. I was told about an aborted baby who was supposed to have spina bifida, but was delivered with an intact spine. Another nurse is haunted by the memory of an aborted baby who came out weighing much more than expected—almost 2 pounds. She is haunted because she doesn’t know if she made a mistake by not getting that baby any medical help. A support associate told me about a live aborted baby who was left to die on a counter in our Soiled Utility room wrapped in a disposable towel. This baby was accidentally thrown in the garbage. Later, when they were going through the trash trying to find the baby, the baby fell out of the towel and onto the floor.

I was recently told about a situation by a nurse who said, “I can’t stop thinking about it.” She had a patient who was 23-plus weeks pregnant, and it did not look as if her baby would continue to be able to live inside of her. The baby was healthy and had up to a 39 percent chance of survival, according to our national statistics. But the patient chose to abort. The baby was born alive. … After delivery, the baby, who showed early signs of thriving—her Apgars improved—was merely wrapped in a blanket and kept in the Labor and Delivery Department until she died two and a half hours later.

[341] Transcript: “Testimony of Allison Baker, Charlottesville, VA.” Subcommittee on the Constitution, Judiciary Committee, U.S. House of Representatives, July 20, 2000. Pages 40–43. <commdocs.house.gov>

Pages 40–41:

I am also an RN. I worked at Christ Hospital for a year between the time of August 1998 to August 1999. I am now presently a pediatric nurse in Charlottesville.

During this time, I witnessed three cases. When I first started, I was on day shift. I walked into the Soiled Utility Room to throw something away, and laying on the metal part of the table with nothing underneath, there was a fetus, a baby, moving vigorously, just laying there.

I went out to find the nurse who was responsible for this baby, and she said that the mother had been what they call a therapeutic abortion, as Jill had explained, and that she just didn’t have time to do anything with the baby at the time, and that if I could, could I wrap the baby and put the baby in a warmer.

So I went to the Soiled Utility Room, wrapped the baby, and held the baby and found a warmer and placed the baby in the warmer. And for about two and a half hours, the baby maintained a heartbeat, the baby was alive. …

The next case that I actually participated in was I had come on to shift and there was a patient that had delivered a baby, a 20-week fetus who had spina bifida. The baby, once again, was alive and the baby had a heartbeat. It took an hour and 45 minutes for this baby to finally expire. …

The last case that I experienced while I was there was a 16-week fetus that was aborted, and the baby was supposed to have had Down’s. And the baby at 16 weeks was born with a heartbeat, and the parents thought that the baby would die right away because it was so early. The baby ended up living for approximately 45 minutes, and during this time, the parents were very upset and kept questioning me and other nurses: how come their baby wasn’t dead, when was their baby going to die, why was their baby alive?

[342] Article: “Bill Proposes Care for Fetus After Abortion.” By Dave McKinney. Chicago Sun-Times. March 31, 2001. <chicago.suntimes.com>

“A spokesman for Christ Hospital’s parent, Advocate Health Care, said it provides ‘compassionate care’ for its patients and estimated that between 10 percent and 20 percent of fetuses with genetic defects that are aborted survive for short periods outside the womb.”

[343] Calculated with data from the paper: “Termination of Pregnancy for Fetal Anomaly: A Population-Based Study 1995 to 2004.” By M. Wyldes. BJOG [British Journal of Obstetrics and Gynaecology], April 2007. Pages 639–642. <obgyn.onlinelibrary.wiley.com>

Page 639:

Termination of pregnancy for fetal anomaly (TOPFA) is a rare outcome of pregnancy and a principal element of fetal medicine. It is an important option for women in the UK undergoing screening for fetal anomalies during pregnancy and commonly chosen when a lethal or seriously handicapping condition is diagnosed prenatally. The 1990 amendment to the Abortion Act has no gestation limit defined for cases of TOPFA following prenatal diagnosis (category E).

The Office for National Statistics publishes an annual reference volume of data on legally induced abortions in England and Wales. Data are collected using the notification of abortion form (Form HSA4) on cases performed under the Abortion Act 1967. Cases are categorised by the statutory grounds on which they are undertaken. Category E is the most relevant for identifying TOPFA and refers to cases “where there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.” The only subanalysis of this group within the annual reference volume is to give details of the type of congenital malformation or other condition. …

The West Midlands Congenital Anomaly Register (WMCAR) was setup in June 1994 and is administered by the West Midlands Perinatal Institute.

Page 640:

The study population was births to West Midlands residents delivered between 1995 and 2004. …

For the purposes of this study, a TOPFA is defined as a legally induced termination regardless of gestation or out-come following a prenatal diagnosis of a congenital anomaly. …

There were 3189 cases of TOPFA notified to the WMCAR and born to West Midlands residents between 1995 and 2004. …

There were 646 342 registered births and 808 236 conceptions during this period in the West Midlands. The prevalence of TOPFA was 49.3 per 10 000 (1 in 203) registerable births and 39.5 per 10 000 (1 in 253) conceptions.

Gestations of TOPFAs ranged from 8 to 40 weeks, median 19 weeks. …

Thirty-nine percent of TOPFAs were for chromosomal anomaly; 25% for malformations of multiple systems; 23%for neural tube defects; 5% for renal problems; and 5% for cardiac defects. …

Of the 102 live births, the gestation ranged from 17 to 33with a median of 21 weeks. The survival duration for liveborn TOPFAs was a median of 80 minutes. Thirty-seven cases survived for 1 hour or less and six cases survived 6 hours or more.

Page 641: “Within our study 3.2% of TOPFAs result in a live birth.”

CALCULATIONS:

• 37 newborns who survived for an hour or less / 102 live births = 36%
• 6 newborns who survived for six hours or more / 102 live births = 6%

[344] Article: “Abortion: Every Sixth Foetus Showed Signs of Life: Midwives’ Chairwoman Says ‘a Sorrowful Situation.’ ” Edited by Julian Isherwood. Politiken, December 14, 2012. <politiken.dk>

Previously, conventional wisdom has suggested that 10 per cent of foetuses gasped or showed other signs of life following a late term abortion between the 12th and 22nd week of pregnancy.

But statistics from Denmark’s second largest maternity clinic at the Aarhus University Hospital Skejby show that out of 70 late terminations between August 2011 and November 2012, 11—or 16 per cent—showed signs of life.

[345] Report: “Mortality Records with Mention of Termination of Pregnancy.” U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, April 11, 2016. <www.cdc.gov>

The information presented below comes from the National Vital Statistics System (NVSS) Mortality Data. Data available for 2003 and subsequent years includes not only causes of death coded to ICD [International Classification of Diseases]-10, but also the original text describing the causes of death as reported on the death certificate by the cause-of-death certifier (usually a physician, medical examiner or coroner). With regard to infant deaths, the NVSS Mortality Data only include deaths occurring to those infants born alive; fetal deaths (stillbirths) are not included. The legal definition of live birth includes any sign of life, e.g., breath, heartbeat, pulsation of the umbilical cord, or definite movement of voluntary muscles. …

Infant deaths for the 12 year period 2003–2014 assigned to code ICD-10 code P96.4—Termination of pregnancy, affecting fetus and newborn were reviewed. During this period there were 315,392 infant deaths and 49,126,572 live births. The purpose of this analysis is to provide some additional information regarding infant deaths with this cause of death code. This category includes both spontaneous terminations of pregnancy and induced terminations of pregnancy. Analysis of the text as reported by the cause-of-death certifier show that of 588 deaths with mention of P96.4, 143 (24.3%) could definitively be classified as involving an induced termination. A list of the terms on which this number is based is shown below. Most of the remaining deaths are clearly spontaneous. However, it is possible that this number (143) underestimates the total number of deaths involving induced termination. In some cases, when a vague term such as “termination of pregnancy” was reported as due to a severe congenital anomaly or maternal complication, it was impossible to determine whether the pregnancy terminated spontaneously as the result of the anomaly or complication, or whether the mother elected to terminate because of the anomaly or complication. …

The distribution of age at death for deaths involving induced terminations are as follows:

[346] Article: “Fetus.” By Frank D. Allan. Encyclopedia of Human Biology (Volume 3). Academic Press, 1997.

Page 962:

Attempts to suckle have been seen in utero and in aborted fetuses of 3 months. …

Reflexes that develop during the third month involve the mouth and the head…. Electrical activity of the nervous system is discernible at the same time, but periods of electrical silence can occur up to midterm.

[347] Paper: “An Infant Who Survived Abortion and Neonatal Intensive Care.” By P. Clarke & others. Journal of Obstetrics and Gynaecology, January 2005. Pages 73–74. <www.tandfonline.com>

Page 73: “A 24-week gestation male infant was born alive in November 2002, several days after repeated attempts at medical termination of pregnancy.”

[348] Article: “Boy Is Aborted 3 Times and Lives.” By Lois Rogers and Sarah-Kate Templeton. London Times, February 13, 2005. <www.thetimes.co.uk>

“A baby survived at least three attempts to abort it from the womb and was born alive at 24 weeks old. … Now two years old and healthy, he is the first long-term abortion survivor to have been born so prematurely.”

[349] Article: “We’re Twinseparable! Happy with His Brother, the Boy Who Refused to Die.” By Lucy Laing. London Daily Mail, November 3, 2007. <www.dailymail.co.uk>

When doctors found that Gabriel was weaker than his brother, with an enlarged heart, and believed he was going to die in the womb, his mother Rebecca Jones had to make a heartbreaking decision. …

Mrs. Jones decided to let doctors operate to terminate Gabriel’s life.

Firstly they tried to sever his umbilical cord to cut off his blood supply, but the cord was too strong.

They then cut Mrs. Jones’s placenta in half so that when Gabriel died, it would not affect his twin brother. …

But at her 20-week scan, doctors had some devastating news. One of the boys was half the size of his brother. …

Then doctors said his heart was three times normal size….

… When Mrs. Jones reached 31 weeks doctors carried out a caesarian to deliver the twins. … Both were kept in hospital, but since going home they have thrived. At seven months, Ieuan weighs 15lb and Gabriel 12lb 6oz.

[350] Article: “Mother’s Anger Turns to Delight After Her Baby Survives an Abortion.” By Liz Hull. London Daily Mail, June 5, 2008. <www.dailymail.co.uk>

[T]heir first son had died of the condition and the second was born with serious kidney damage.

So when Finley’s mother … became pregnant while on the Pill, she and her fiance … made the agonising decision to abort this child. …

“Deciding to terminate at eight weeks was just utterly horrible but I couldn’t cope with the anguish of losing another baby,” …

… Eventually her doctor sent her for a scan—and she discovered she was 19 weeks pregnant. …

Her first baby, Thane, had lived for only 20 minutes….

Her second son … was born with a similar condition. He survives on one kidney.

[D]octors told the couple … that this child was likely to survive, so they decided he deserved a chance.

And in November, Finley was born three weeks premature….

He had minor kidney damage but is expected to lead a normal life.

[351] Article: “In Debate on Abortion, 2 Girls Make It Real.” By Tamar Lewin. New York Times, October 27, 1991. <www.nytimes.com>

Ms. DePaul will not identify Gianna’s birth mother, the doctor who performed the abortion, the clinic or the nurse who, she said, rescued Gianna by transferring her to a hospital nursery. But to support her story she released some of the medical records from the adoption, including a section called “Complications of Birth,” which has the notation, “Born during saline abortion. “

[352] Transcript: “Testimony of Gianna Jessen.” Subcommittee on the Constitution, Judiciary Committee, U.S. House of Representatives, July 20, 2000. <commdocs.house.gov>

Page 54: “I … was delivered alive on April 6, 1977, at 6 a.m. in a southern California abortion clinic.”

[353] Article: “ ‘I Survived an Abortion Attempt.’ ” By Jane Elliott. BBC News, December 6, 2005. <news.bbc.co.uk>

“She has cerebral palsy as a direct result of the procedure carried out on her in the womb. … She started to walk with leg braces and by the age of four was walking with the aid of a walker—now she walks without any assistance.”

[354] Webpage: “Gianna Jessen.” Accessed August 2008 at <www.giannajessen.com>

“On April 30, 2005 she completed her first 26.2 mile marathon…. On April 23, 2006 she completed the London Marathon as well. … In fact she has run a marathon, is an accomplished singer and writer and travels the world to campaign against abortion.”

[355] Born-Alive Infants Protection Act of 2001. Congressional Record, March 12, 2002. Pages 792–797. <www.govinfo.gov>

Page 796:

The SPEAKER pro tempore (Mr. STEARNS). The question is on the motion offered by the gentleman from Wisconsin (Mr. SENSENBRENNER) that the House suspend the rules and pass the bill, H.R. 2175 [Born-Alive Infants Protection Act].

The question was taken.

The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of those present have voted in the affirmative.

[356] Born-Alive Infants Protection Act of 2001. Congressional Record, July 18, 2002. Page 7084. <www.gpo.gov>

Page 7084:

There being no objection, the Senate proceeded to consider the bill.

Mr. REID. Mr. President, I ask unanimous consent that the bill be read the third time and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the RECORD.

The PRESIDING OFFICER. Without objection, it is so ordered.

The bill (H.R. 2175) was read the third time and passed.

[357] Public Law 107-207: “Born-Alive Infants Protection Act of 2002.” 107th United States Congress. Signed into law by President George W. Bush on August 5, 2002. <www.congress.gov>

An Act

To protect infants who are born alive. [H.R. 2175] …

(a) In determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the words “person”, “human being”, “child”, and “individual”, shall include every infant member of the species homo sapiens who is born alive at any stage of development.

(b) As used in this section, the term “born alive”, with respect to a member of the species homo sapiens, means the complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.

(c) Nothing in this section shall be construed to affirm, deny, expand, or contract any legal status or legal right applicable to any member of the species homo sapiens at any point prior to being “born alive” as defined in this section.

[358] House Resolution 962: “Born-Alive Abortion Survivors Protection Act.” U.S. House of Representatives, 116th Congress (2019–2020). Accessed July 6, 2019 at <www.congress.gov>

Sponsor: Rep. Wagner, Ann [R–MO–2] (Introduced 02/05/2019)

(a) Requirements for health care practitioners.—In the case of an abortion or attempted abortion that results in a child born alive:

(1) Degree of Care Required; Immediate Admission to a Hospital.—Any health care practitioner present at the time the child is born alive shall—

(A) exercise the same degree of professional skill, care, and diligence to preserve the life and health of the child as a reasonably diligent and conscientious health care practitioner would render to any other child born alive at the same gestational age; and

(B) following the exercise of skill, care, and diligence required under subparagraph (A), ensure that the child born alive is immediately transported and admitted to a hospital.

(2) Mandatory Reporting of Violations.—A health care practitioner or any employee of a hospital, a physician’s office, or an abortion clinic who has knowledge of a failure to comply with the requirements of paragraph (1) shall immediately report the failure to an appropriate State or Federal law enforcement agency, or to both.

(b) Penalties.—

(1) In General.—Whoever violates subsection (a) shall be fined under this title, imprisoned for not more than 5 years, or both.

(2) Intentional Killing of Child Born Alive.—Whoever intentionally performs or attempts to perform an overt act that kills a child born alive described under subsection (a), shall be punished as under section 1111 of this title for intentionally killing or attempting to kill a human being.

(c) Bar to prosecution.—The mother of a child born alive described under subsection (a) may not be prosecuted for a violation of this section, an attempt to violate this section, a conspiracy to violate this section, or an offense under section 3 or 4 of this title based on such a violation.

[359] Senate Bill 311: “Born-Alive Abortion Survivors Protection Act.” U.S. Senate, 116th Congress (2019–2020). Accessed July 6, 2019 at <www.congress.gov>

Sponsor: Sen. Sasse, Ben [R–NE] (Introduced 01/31/2019) …

(a) Requirements for health care practitioners.—In the case of an abortion or attempted abortion that results in a child born alive:

(1) Degree of Care Required; Immediate Admission to a Hospital.—Any health care practitioner present at the time the child is born alive shall—

(A) exercise the same degree of professional skill, care, and diligence to preserve the life and health of the child as a reasonably diligent and conscientious health care practitioner would render to any other child born alive at the same gestational age; and

(B) following the exercise of skill, care, and diligence required under subparagraph (A), ensure that the child born alive is immediately transported and admitted to a hospital.

(2) Mandatory Reporting of Violations.—A health care practitioner or any employee of a hospital, a physician’s office, or an abortion clinic who has knowledge of a failure to comply with the requirements of paragraph (1) shall immediately report the failure to an appropriate State or Federal law enforcement agency, or to both.

(b) Penalties.—

(1) In General.—Whoever violates subsection (a) shall be fined under this title, imprisoned for not more than 5 years, or both.

(2) Intentional Killing of Child Born Alive.—Whoever intentionally performs or attempts to perform an overt act that kills a child born alive described under subsection (a), shall be punished as under section 1111 of this title for intentionally killing or attempting to kill a human being.

(c) Bar to prosecution.—The mother of a child born alive described under subsection (a) may not be prosecuted for a violation of this section, an attempt to violate this section, a conspiracy to violate this section, or an offense under section 3 or 4 of this title based on such a violation.

[360] Calculated with data from vote 27: “Cloture on the Motion to Proceed: Born-Alive Abortion Survivors Protection Act.” U.S. Senate, February 25, 2019. <www.senate.gov>

Required For Majority: 3/5 … Vote Result: Cloture on the Motion to Proceed Rejected …

[361] Calculated with data from vote 29: “Born-Alive Abortion Survivors Protection Act.” U.S. House of Representatives, January 11, 2023. <clerk.house.gov>

[362] Webpage: “Cosponsors of Senate Bill 204: Born-Alive Abortion Survivors Protection Act.” U.S. Senate, 118th Congress (2022–2023). Accessed October 5, 2023 at <www.congress.gov>

“Cosponsor statistics: 38 current … Republican [=] 38”

[363] Webpage: “Actions Overview: S.204 — Born-Alive Abortion Survivors Protection Act.” U.S. Senate, 118th Congress (2022–2022). Accessed October 5, 2023 at <www.congress.gov>

“02/01/2023 — Introduced in Senate”

[364] Senate Bill 1095: “An Act Concerning Infants Who Are Born Alive.” State of Illinois, 92nd General Assembly, 2001. <www.ilga.gov>

(a) In determining the meaning of any statute or of any rule, regulation, or interpretation of the various administrative agencies of this State, the words “person”, “human being”, “child”, and “individual” include every infant member of the species homo sapiens who is born alive at any stage of development.

(b) As used in this Section, the term “born alive”, with respect to a member of the species homo sapiens, means the complete expulsion or extraction from its mother of that member, at any stage of development, who after that expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.

(c) A live child born as a result of an abortion shall be fully recognized as a human person and accorded immediate protection under the law.

[365] Senate Bill 1662: “An Act Concerning Infants Who Are Born Alive.” State of Illinois, 92nd General Assembly, 2002. <www.ilga.gov>

NOTE: The operative language is the same as the bill quoted in the footnote above.

[366] Vote on Senate Bill 1095: “An Act Concerning Infants Who Are Born Alive.” State of Illinois Senate, 92nd General Assembly, March 30, 2001. <www.ilga.gov>

“34 Yeas … 5 Nays … 13 Present … P[resent] Obama”

NOTE: In the Illinois legislature, a vote of ‘Present” has the same effect as a vote against a bill. This was implicitly stated by Obama in a debate with Alan Keyes on October 12, 2004 when he asserted that “21 other senators, Democrat and Republican … objected to the bill.” As shown in this vote record and the next, only by counting the “Present” votes can the number of 22 be reached.

[367] Vote on Senate Bill 1662: “An Act Concerning Infants Who Are Born Alive.” State of Illinois Senate, 92nd General Assembly, April 4, 2002. <www.ilga.gov>

“30 Yeas … 12 Nays … 10 Present … N[ay] Obama”