The planned airing of film-maker Julia Black's documentary, My Foetus on ABC Television's August 8 Compass religious program has sparked a media storm. Should a documentary showing a suction abortion and foetal remains be shown on the ABC? Should there be limits to the gestational age at which foetuses can be aborted? Conservative politicians, medical establishment figures, and pro- and anti-choice campaigners are all having a go.
Not surprisingly, the call to open the debate has been "welcomed" by a NSW Right to Life spokesperson.
"It is an ugly business", anti-choice health minister Tony Abbott was quoted as saying by the July 10 Sydney Morning Herald. Of course, most people wouldn't find watching a dental extraction or the removal of a ruptured appendix "pretty" but would be hard-pressed to argue from that to the desirability or otherwise of either procedure — in general, or in particular instances. Why should abortion be treated differently?
What has been more disappointing has been the call from 1970s pro-choice campaigners Eva Cox and Wendy McCarthy for a public debate on the issue of the cut-off gestational age at which abortions should be allowed. Quoted in the July 12 Australian, they cited advances in medical technology and viability of "potential babies" as a reason for public discussion on a 20-week cut-off point.
Apparently the documentary raises this question. But even the publicity that has been aired so far shows one of the pitfalls of focusing on this issue. Several media reports claim the documentary will show the abortion of a "four-week old foetus". The standard medical conventions relating to the dating of a pregnancy use the first day of the last normal menstrual period as the beginning of the "gestation". On average, conception will take place about two weeks after this (anywhere up to around five days from the sex act that causes the pregnancy), and implantation of the blastocyst (a ball of cells not yet referred to as an embryo, much less a foetus) at four weeks from the onset of the last period.
At this four-week point, the woman may miss her first period, and may have a positive pregnancy test. (She may get some slight bleeding from the implantation of the cells into her womb, and a pregnancy test may remain negative for a few more days, depending on the test). An ultrasound won't pick up the pregnancy, and may not reveal it even at five weeks. Abortion providers will usually wait until a gestational age of six weeks before performing an abortion, to be able to ensure they can identify the pregnancy sac and confirm the procedure has been completed.
The convention for determining gestational age is straightforward, and ultrasound dating where it is not clear when the last period was, is pretty accurate (within 10 days). But inconsistencies remain in the public discussion, with different people using the same terms to mean different things — a recipe for confusion.
Similarly, "late term" pregnancy can mean just about anything, depending on the user of the term. (In medical jargon, "term" merely refers to the 40-42 weeks from pregnant woman's last period, when the foetus is due to be born.) Although according to pro-choice researcher Leslie Cannold, 95% of abortions in Australia occur before 14 weeks, anti-choice campaigners use what they call "late-term" abortions to build up opposition to the right to choose abortion at all.
What makes the raising of this issue most disturbing is that it suggests that there is some cut-off date, after which a pregnant woman should no longer be in control of her own body.
"My foetus" remains "my foetus" whether it has been gestating for 12 or 22 weeks. The impact of pregnancy and childbirth on a woman's life is as much hers to evaluate and make decisions about before as after any ever-shifting line of the timing of medical heroics.
There is no question that the techniques used to perform abortion change, and the risks to the woman increase, with increasing gestational age. More needs to be done to ensure that women who do not wish to continue a pregnancy have timely access to termination services, so that it can be performed as early as possible. And the risks to the woman need to be properly assessed and clearly explained to her, so that she can take them into account in making her decision. As well, proper training needs to be available to ensure doctors performing later abortions do so as safely as possible. But none of this can be taken to mean that any woman wanting an abortion should not be able to do so as late as necessary.
Kamala Emanuel
[The author is the Socialist Alliance candidate for the federal seat of Denison and is a family planning doctor who has worked in several abortion clinics and participated in campaigns for women's right to access to abortion services.]
From Green Left Weekly, July 21, 2004.
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