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Antiabortion laws take hold in US

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6956.687a (Published 17 September 1994) Cite this as: BMJ 1994;309:687
  1. J Roberts

    Supporters of abortion rights in the US may be losing a war of attrition against the Catholic church and other antiabortion groups, even though the federal government still considers abortion to be an issue of a woman's right to privacy. In July a doctor who performed abortions was shot dead in Pensacola, Florida - the second to be killed in a year. But violence other than shooting has grown more common. According to the National Abortion Federation, more than 2500 violent incidents were carried out against abortion clinics in 1993, nearly four times the number in 1990.

    The war against abortion often focuses on Washington, but the battles are carried to virtually every state government and abortion clinic in the country. In 1973 the US Supreme Court legalised abortion in the famous case of Roe v Wade. The court made first trimester abortions generally available, although it also said that the state could regulate the practice, especially during the second and third trimesters. Numerous requests for a more explicit ruling followed, and the court now says that a state may regulate abortions so long as it does not impose an “undue burden” on pregnant women.

    That phrase, “undue burden,” has unleashed scores of new laws in virtually every state as well as in the capital itself. According to a report from Planned Parenthood, a proabortion group:

    ¢ 15 of the 50 states have laws that require a women to wait for a period between the time she first seeks abortion and the time it is carried out. Seven states - Kansas, Mississippi, Nebraska, North Dakota, Ohio, Pennsylvania, and Utah - enforce delays that range from eight to 24 hours

    ¢ 36 states have adopted laws that require pregnant minors to obtain consent from their parents before receiving abortions. At least 25 of those states have begun to enforce the laws

    ¢ Only 15 states provide full abortion services for poor women who otherwise qualify for Medicaid, the government assistance programme. The US Congress requires that states offer abortion to the poor women whose lives are threatened or who have become pregnant as a result of rape or incest, but seven states - Arkansas, Colorado, Louisiana, Michigan, North Dakota, Oklahoma, and Pennsylvania - are challenging the federal law.

    But even without these state laws abortion is becoming rarer, although at 1. 4 million operations a year it remains the commonest surgical operation in the US. According to expert doctors and clinic staff, the “hassle” from protesters is forcing providers to quit the business. The Alan Guttmacher Institute, which follows trends in abortion, reports that about 2500 hospitals, clinics, and doctors' offices today provide abortion services, about 12% less than a decade ago. Moreover, a shortage exists of doctors willing to do abortions.

    The “hassle” begins in medical school. After Dr David Gunn was shot to death last year, 33 000 medical students received 14 page pamphlets from a Texas publisher with “jokes” inside, including:

    “Q. What would you do if you found yourself in a room with Hitler, Mussolini, and an abortionist, and you had a gun with only two bullets?

    A. Shoot the abortionist twice.”

    In 1986, 22% of medical schools and residency programmes offered to teach trainees how to perform abortions. By 1991 the proportion had fallen to 12%. According to Dr David Grimes, vice chairman of obstetrics and gynaecology at the University of California at San Francisco, young doctors may not have the necessary experience to make abortion a “mission.”

    As a result of the shortage of doctors Dr Grimes and his 34 000 colleagues in the American College of Obstetricians and Gynecologists are supporting a proposal to train non-doctors to perform abortions. A study of 2500 first trimester abortions done in a Vermont clinic in 1986 showed no difference in the rates of complications between those performed by doctors and those by physician assistants.

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