Abortion access is back on the ballot this November. Anti-abortion groups will claim the best way to reduce late-term abortions is to ban them. They are wrong.
During the first 12 weeks of pregnancy, there is zero fetal viability outside the uterus. There is also zero indication of neural development for pain or perception by the fetus. Accordingly, over 91% of abortions are accessed during this time. A remaining 7.7% of terminations occur between 12-20 weeks, also prior to fetal viability (about 24 weeks). After 21 weeks only 1.2% of abortion procedures are initiated. These rare terminations are often accompanied by gut-wrenching stories of women and their partners who wanted a child. In 2019, a Pew Research poll showed over 61% of Americans support near universal termination access.
Proposition 115, which proposes a 22-week abortion ban in Colorado, is particularly problematic. As defined, the only exception is risk of maternal death. It does not permit exceptions for ongoing maternal physical and emotional health, fetal abnormalities, rape or incest. The exclusion of fetal abnormalities is notable, as some rare and fatal genetic conditions are not detectable until after 22 weeks. If passed, Colorado women would be forced to travel out-of-state, increasing the risk of complications. Additionally, Proposition 115 calls for the criminalization of medical practitioners who engage in terminating a fetus after 22 weeks, including possible suspension of medical licenses. This opens a Pandora’s box of legal risks to the medical profession, placing the burden squarely on doctors and women.
An alternative to Proposition 115 is to safely promote women’s health and still reduce the need for abortions by implementing evidence-driven preventative measures. Such measures are twofold. The first strategy works to reduce overall unwanted pregnancies by providing increased sexual health education, access to birth control and contraceptives, and ongoing access to women’s health care, family planning and genetic screening services. In Colorado, the success of this approach was illustrated when access to IUDs prompted a 64% drop in teen abortion rates and an estimated $70 million saved in associated health care costs.
The second strategy applies when preventative measures are no longer possible. With documented correlations between early prenatal screening and earlier gestation termination, ensuring first and second trimester prenatal care is paramount to reducing late second and third trimester abortions. This not only appeals to abortion opponents, but it helps women, the rare common ground. The American College of Obstetricians and Gynecologists emphasizes the need to provide optional access to all women for prenatal genetic screening, as well as chorionic villi sampling, amniocentesis, and, in instances of structural abnormalities, chromosomal microarray. These tests require first trimester access to genetic counseling and detailed ultrasounds. In combination, they may mitigate the need of many terminations after about 20 weeks.
Unfortunately, these tests are often denied or delayed by insurers, including Colorado Medicaid, which requires medical necessity authorizations, which carry up to 10-day delays. Such delays can compound throughout a pregnancy, adding days or weeks to decision making. Delays are often cited by women as reasons for later terminations, and gestational age bans, such as Proposition 115, exacerbate the impacts.
Women, particularly women of color and those who earn a low income or live in rural or anti-abortion regions, experience many additional barriers to preventative care. Without funds for ongoing health care access, many women forgo prenatal care altogether until the second trimester. Or, as in 14 of Colorado’s 64 counties, abortion services don’t exist at all, forcing extensive travel. These obstacles lead to unnecessary delays, increased costs and medical risks, thereby increasing the likelihood of second and third trimester abortions. The Hyde Amendment also contributes to delays by preventing federal funding for procedures. While 15 states provide compensatory funds, Colorado lacks additional state provisions.
As is too often the case in politics, ideology can, regrettably, supersede facts. But in policy making, ideology should not reign. Anti-abortion groups have spent so much time imposing their moral ideology on all women that they have forgotten the goal — to reduce abortions. If these were good faith efforts, initiatives would focus on evidence-driven prevention, not risky gestational bans. Instead, anti-abortion groups refute such evidence and work to deny access to care, simultaneously raking in millions of lobbyist dollars per year. This prolonged battle emphasizes partisanship over effective solutions.
It is clear that in leveraging public health research we can achieve mutually beneficial outcomes for women and society that transcend ideology. This November, trust women, their doctors and science. Vote “no” on Proposition 115.
Editor’s note: This story has been updated to reflect that Initiative 120 is now known as Proposition 115.