Commentary Abortion

New Attacks on Second-Trimester Abortions, Same Old Playbook (Updated)

David Grimes & Carole Joffe

In the 1990s, abortion opponents coined the term "partial-birth abortion" to convince lawmakers to ban an uncommon method. Now, they're trying the same strategy—this time, on a procedure used in almost every second-trimester abortion.

UPDATE, February 20, 12:05 p.m.: On Friday morning, the South Dakota House of Representatives amended their proposed bill, which would ban dilation and evacuation procedures, to read only that the state “recognizes the sanctity of human life.” The House passed the new bill 65-3.

It’s déjà vu all over again. In the 1990s, abortion opponents seized on an uncommon method of abortion used after the first trimester of pregnancy, known in medical circles as “intact dilation and extraction.” They coined a new term—“partial-birth abortion”—that had appeared nowhere in medical literature. Next, they relentlessly spread grisly details of the procedure, replete with graphics, in public smear campaigns and on the floor of the U.S. Senate.

Ultimately, Congress banned the method (the first time that body had restricted a particular medical procedure) and President George W. Bush signed the bill. When the case came before the Supreme Court in Gonzales v. Carhart, lawyers opposing the ban drew on the testimony of abortion providers who argued that in certain medical situations, the contested procedure was the safest option. By contrast, the “experts” who provided testimony in support of the ban included doctors who had never performed this procedure—and even one who had never performed any abortions. Still, the Supreme Court upheld the ban. For the first time in abortion jurisprudence, the Court did not permit an exception for the health of the pregnant woman, though it did permit one for life-threatening situations.

This “partial-birth abortion” ban was a public-relations success for the anti-abortion movement. Now, that same playbook is being used again in Kansas, Oklahoma, and South Dakota in a new campaign to outlaw yet another second-trimester abortion method, “dilation and evacuation” (D and E). Once again, the medical term for this procedure has been replaced by a garish one, “dismemberment abortion,” and once again, abortion opponents are hoping that dwelling on the details of this procedure will lead lawmakers to ban it. Ironically, the justices writing the majority opinion in the Gonzales v. Carhart decision took pains to show they were not banning all methods of second-trimester abortions: D and E procedures, they wrote, would still be permitted.

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This new campaign, if successful, will be far more damaging to women than the previous one. Though no precise figure is available, the number of intact dilations and extractions performed annually before the ban was very low. In contrast, the D and E procedure is used in nearly all second-trimester abortions in the United States: about 140,000 a year. If D and E were to be banned, women would have only labor induction or hysterotomy (a mini-cesarean section) as options for second-trimester abortions. These archaic methods were largely abandoned decades ago in the United States.

For both medical and non-medical reasons, D and E abortion quickly emerged after its introduction as the standard of care for second-trimester abortion. High-quality studies, including three randomized controlled trials and a large comparative study by the Centers for Disease Control and Prevention, established that D and E abortion was safer for women than alternative methods.

Women also began to choose D and E in large numbers for other reasons. As an outpatient procedure, it was less expensive than being hospitalized for labor induction or hysterotomy. It was more convenient: The duration of a labor-induction abortion was unpredictable, but a D and E procedure could be scheduled with precision. D and E abortions were less painful than labor-and-delivery or an abdominal operation. They were more compassionate as well; women did not need to undergo the emotional stress of labor. As one of us, Dr. David Grimes, has written, “D&E shifts the emotional burden of the procedure from the woman to the physician, and that is entirely appropriate. One of our most important roles as physicians is to ease suffering, both physical and emotional.”

The specifics of abortion methods can be unpleasant to the lay public. However, this is true of most operations that remove tissue from the body. Surgeons choose operations based on what is safest and most appropriate for the patient, not on what is pleasant for the surgeon. The same professional standard applies to abortion.

Even if it is an effective strategy for anti-choice activists, considering these methods separately from the women who need abortion care is wrong. D and E abortion should not become a political football. D and E abortion is not a problem, any more than a mastectomy is a problem. Both are solutions to a problem.

States do not allow politicians without medical training, credentialing, and licensing to perform surgery; indeed, practicing without a license is a crime. Why should these same laypersons be allowed to dictate the surgical practice of physicians and their patients?

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