Sunday, July 01, 2012

Are Third Trimester Abortions Performed for Non-Medical Reasons in Canada? YES!

It is often affirmed that abortions are never performed past 24 weeks except for dire medical necessity.

Not true.

I'm not suggesting that there are large numbers of third trimester abortions performed for non-medical reasons.

But they happen.

Exhibit A: Evidence from Ste. Justine Hospital

A 2007 document produced the the Bioethics Committee at Ste. Justine Hospital. (My English Summary.)

Title: Third Trimester Abortion for Fetal Anomaly (Interruption de grossesse du troisième trimestre pour anomalie foétale)

Ste. Justine is a children's and maternity university hospital centre in Montreal that offers abortion services.

While the document focuses almost exclusively on abortion for fetal anomalies, on page 9, the authors let slip that third trimester abortions are performed for non-medical reasons (translation to follow):

Au CHU Sainte-Justine, le Comité de mortalité foetale et néonatale assure la révision des dossiers concernant les interruptions de grossesse du troisième trimestre. Les données montrent qu’à ce stade, les interruptions ont été pratiquées presque exclusivement pour des raisons médicales. On rapporte également certains motifs différents, par exemple lors d’interruptions qui font référence à des situations « précises » associées à des conditions « sociales » particulières.

At CHU Ste. Justine, the Fetal and Neonatal Mortality Committee assures the revision of files related to third trimester abortions. The data shows that at that stage, the abortions were almost exclusively performed for medical reasons. Different motives were also reported, such as abortions that concern "precise" situations associated with particular "social" conditions.

So if they're ALMOST exclusively done for medical reasons, then some third trimester abortions are not performed for medical reasons. Unfortunately, the authors are cryptic about the kinds of "social situations" that would justify them. One can guess.

Exhibit B: From the Woman Who Arranges Late-Term Abortions in Montreal

This document is a set of speaking notes for a presentation that was given on February 3rd, 2010 by Suzanne Carrière, Director of “Specific Services” of the CSSS Jeanne-Mance, Montreal. This CSSS includes CLSC des Faubourgs, which is known for organizing tax-paid abortion trips to the United States. As head of  "Specific Services" (cryptic, isn't it?) she would have a hand in organizing those trips.

Her speech was delivered during a conference entitled Twenty Years After the Supreme Court’s Morgentaler Decision: Where are we Now? 

(Highlights of the document in English).

 On page 9 of the document, she raises the issue of why women are sent to the United States to obtain abortions after 24 weeks. And in the context of this discussion she says (translation to follow):
Malgré la disponibilité, la bonne volonté des quelques médecins impliqués dans cette pratique,nous sommes encore dans l’obligation de référer aux États-Unis des femmes, lorsque la grossesse est plus de 24 semaines.

À ce stade de grossesse, seules les femmes qui ont un problème d’immigration, les toxicomanes,les femmes qui ont un dossier criminel ou les femmes qui ont un foetus ayant une malformation congénitale, peuvent obtenir une IVG au Québec ne pouvant traverser la frontière américaine pour les raisons précitées.


In spite of availability and the good will of a few physicians involved in this practice, we are obligated to refer women to the United States when the pregnancy is past 24 weeks

At that stage of pregnancy, only women with immigrations problems, addiction issues, a criminal record or with a fetus with a congenital malformation can obtain an abortion in Quebec, since they cannot cross the American border for precisely those reasons.

[I don't think she really means that women with congenital malformations can't cross the border... just to be clear, but that's how the paragraph reads.]

So women with issues other than a compromised fetus or a serious health issue do obtain third trimester abortions in Canada.
Note how her statement corroborates the statement in the document from Ste. Justine about there being third trimester abortions for precise social situations.   

Exhibit C: Margaret Somerville's Personal Experience as  a Bioethicist

Margaret Somerville related to me in an email her story about having been consulted for third trimester abortions.

The case in question involved a married couple - man and woman - who had conceived naturally, the woman was 34 weeks pregnant and the scan showed the baby had a cleft palate. They requested an abortion, because they did not want to have a "defective baby".

In another case, a 29 year old graduate student from [OMITTED] was 32 weeks pregnant and wanted an abortion for social reasons. I was consulted on the case and later followed up to see what happened. The answer I received was that "You don't want to know", said in such a way it was clear an abortion had been undertaken.

I've also been consulted on late term selective reduction of multiple pregnancy in which one or more fetuses are killed in utero with a lethal injection of potassium chloride into their heart and the dead fetus(es) delivered at term with the living one(s). In two cases I know of involving twins, one twin was killed. In fact, I wrote in the New England Journal of Medicine on an early case in which this was done because the woman did not want to have twins and said she would abort both babies unless one was killed.

And in case you think that Margaret Somerville is some kind of pro-life spokesperson, it should be known that she favours legal abortion in the first trimester. [UPDATE JULY 5, 2012: Received information to the effect that Margaret Somerville is not in favour of abortion, but that she does not believe a law can effectively police 1st trimester abortions.]

In the document by Suzanne Carrière, it is mentioned that immigrant women are able to obtain abortions past 24 weeks in Quebec. The above quote corroborates that statement, as a woman from another country was able to obtain that abortion at 32 weeks.

These three testimonies, taken together, show that non-medical abortions in Canada do happen past 24 weeks on fetuses who are either healthy or suffer from non-lethal medical issues.