Abortion Is Legal, but What Percentage of Ob-gyns Will Provide One?

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A new study released by the American College of Obstetrics and Gynecology, from main author Debra Stulberg, surveys 1,144 ob-gyns (1,800 were initially approached) to see how many provide abortion services. Though legal, abortion is much harder to come by than one might expect: while 97% of ob-gyns reported having encountered women seeking an abortion, only 14% said they were willing to perform the service.

The authors further break down willing abortion providers based on gender, location, and religious affiliation. Here’s the abstract:

OBJECTIVE: To estimate prevalence and correlates of abortion provision among practicing obstetrician–gynecologists (ob-gyns) in the United States.

METHODS: We conducted a national probability sample mail survey of 1,800 practicing ob-gyns. Key variables included whether respondents ever encountered patients seeking abortions in their practice and whether they provided abortion services. Correlates of providing abortion included physician demographic characteristics, religious affiliation, religiosity, and the religious affiliation of the facility in which a physician primarily practices.

RESULTS: Among practicing ob-gyns, 97% encountered patients seeking abortions, whereas 14% performed them. Female physicians were more likely to provide abortions than were male (18.6% compared with 10.6%, adjusted odds ratio 2.54, 95% confidence interval 1.57–4.08), as were those in the youngest age group, those in the Northeast or West, those in highly urban postal codes, and those who identify as being Jewish. Catholics, Evangelical Protestants, non-Evangelical Protestants, and physicians with high religious motivation were less likely to provide abortions.

CONCLUSION: The proportion of U.S. ob-gyns who provide abortions may be lower than estimated in previous research. Access to abortion remains limited by the willingness of physicians to provide abortion services, particularly in rural communities and in the South and Midwest.

Jezebel.com includes the numbers on abortion providers by religion:

40.2 percent of Jewish doctors say yes, compared with
1.2 percent of Evangelical Protestants
9 percent of Roman Catholics or Eastern Orthodox
10.1 percent of Non-Evangelical Protestants
20 percent of Hindus
26.5 percent of doctors who said they had no religious affiliation

This year has seen a huge spike in abortion restrictions from state legislatures.  According to a Guttmacher Institute survey, of the 162 reproductive health provisions passed in the first six months of 2011, 80 restrict abortion, twice the number from 2005.

 

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COMMENTS: 42


  1. Jalapa says:

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    • Diana says:

      It’s a real stretch for me to compare the mass murder of six million men, women and children with a medical procedure. Particularly considering that some abortions are necessary to preserve the health of the mother or end an otherwise unviable pregnancy.

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      • Jalapa says:

        Diana,

        The key difference is that what you call a “medical procedure” is considered something far more dire to conservatives. With no disrespect, this might be the equivalent of the Orwellian renaming of the Holocaust as some sort of “solution.”

        Indeed, SOME abortions are necessary. But that doesn’t serve as a justification for the 90% that are not, does it?

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      • Captain Oblivious says:

        The reason for the conflict over abortion seems so clear to me, but it amazes me how many people seem to overlook it. People disagree about the procedure because they start with different assumptions, not because they follow different chains of logic. Arguing the logic pretty much never changes anyone’s mind (and in fact often hardens people’s positions).

        To some people it’s a personal decision, which no one else should have any say in. If you start by assuming that a fetus does not deserve the rights of an already-born person, this makes perfect sense.

        To others abortion is murder, and should be abolished in most or all cases. If you start by assuming that a fetus does deserve the rights of a already-born person, this makes perfect sense.

        Slogans like “Aren’t you glad your mother didn’t abort you?” or “If you don’t like abortion, don’t have one” are not a constructive part of the debate, because they don’t address the fundamental divide from which the disagreements spring.

        P.S. I have to say my personal favorite is the politician’s fence-straddling line of “I’m opposed to abortion, but I don’t think it’s my place to impose my beliefs on anyone else”. I’ve always wondered how those people felt about armed robbery? Does anyone say “I’m opposed to armed robbery, but it’s a private decision between a man and his gun dealer and it’s not my place to intervene”? Why or why not?

        —-

        Full disclosure: I’m reluctantly pro-choice. Except for cases of medical necessity or rape, it’s pretty much always a Bad Thing. But it’s not quite as bad as forcing women to bear children against their will. In an imperfect world, we sometimes have to choose the least-bad option.

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      • Jimmy says:

        I consider myself pro-life, not for religious reasons (full-disclosure I’m an atheist), but for the reasons you stated above. Having said that, I’ve never seen the arguments for both sides so logically laid out anywhere else. Thank you.

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      • erica says:

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      • Daniel H. says:

        It’s not such a stretch for those who consider abortion to be murder. If you take out the cases where the procedure is performed because of maternal medical problems (usually estimated around 3%), that would leave over 50 million murders since 1973.

        Now obviously, if you don’t consider an unborn baby to be a human life, those numbers aren’t going to mean much to you. But if you fail to understand why those who consider them to be human lives see a parallel with other mass murders, you’re just being obtuse.

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    • Julie says:

      As a Jew, I’d like to respond to this. Jewish law actually makes a distinction that does not exist within Christian belief/law: the life of an unborn fetus is considered a “potential” life, compared to the actual life of the mother. So if there were complications in a pregnancy, such that it endangered the mother’s life, the mother would be not only allowed but encouraged to have an abortion.

      The roots of this thinking are historical. Until very recently, it was uncertain whether a newborn would survive long enough to become an adult. Disease, famine, and accidents all struck infants and toddlers much harder. I’ve read that the chances of a newborn baby dying before it reached adulthood might have been as high as 30% or more in the middle ages. So if you have to choose between a fetus (who might never actually grow up to have an adult life) and a mother (who is ALREADY an adult and who can get pregnant again), the choice is clear. You choose the mother.

      I would hope that in cases of medical complications, where a mother’s life is at stake, some of those “I never perform abortions” doctors might consider performing the procedure. Because otherwise, they’re guilty of REAL murder — of an adult. (Imagine someone who’s about to fall out the window of a high building. You could reach out and grab them, but you don’t. Are you guilty of murder? At the very least you’re guilty of negligent homocide.)

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      • Liz says:

        This is an excellent explanation of the Jewish philosophy which I believe is very pro-life.

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      • Nathan says:

        Your analogy of murder or negligent homicide falls short. In your scenario where someone is about to fall out of a window, presumably if you are close enough to catch them then most likely other people are not that close or capable.

        If a woman wants an abortion she can get one. There are doctors willing and able to perform this operation to any woman who requests it. It is not reasonable to tell someone they are a murderer for not performing this operation for them.

        Hot debate. What do you think? Thumb up 8 Thumb down 12
      • jphd says:

        The point of the article was that doctors who are trained to do such a procedure generally WON’T do it.

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      • Jalapa says:

        Indeed, even in Christian circles there is discussion about some of the Mosaic verses that indicate that the life is in the blood, which seems to lead to the thought that conception is not some magical moment.

        Also, there is scripture that speaks of a pregnant woman who is, injured by two men fighting, loses her unborn child. The ancient Jews apparently did not consider this murder, for the guilty man was no stoned.

        There is room for debate, indeed.

        However, the great variation in the percentages shown above surely cannot be explained by such nuanced thinking?

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      • Juli says:

        “However, the great variation in the percentages shown above surely cannot be explained by such nuanced thinking?”

        I believe the great variation is well explained by Captain Oblivious’ comment above about underlying assumptions. Pro-lifers generally believe that fetuses deserve the rights of an already-born person, while pro-choicers generally believe that, at least early in the pregnancy, they don’t. If you stem out from those assumptions, I think that’s where most of the variation in percentages comes in.

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  2. Kel says:

    I wouldn’t label it an entirely religious issue, either. As somebody with pretty strong pro-choice leanings who’s lived in a rural area for most of my life, I’d be hesitant to offer abortions if I went into this field, just because of the side effects it would have on my personal life. Like the chance of a drunk guy trying to beat my window in with a shotgun at 3 AM because his girlfriend got an abortion.

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  3. BL1Y says:

    Maybe the study deals with this question, but are all ob-gyns even capable of performing an abortion, or is some further training required?

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    • Julie says:

      I sincerely hope that all those doctors who refuse to perform abortions (and the populace that agree with them) support socialized medicine (so the new babies can have proper medical care if the mothers have no insurance), daycares in high schools (so teenage mothers can finish their degrees), expanding the welfare system (so unemployed single mothers can take care of their children), and a full sex-ed curriculum in high school (so fewer teenagers are getting pregnant in the first place — abstinence-only education doesn’t work).

      Also, I hope that they all have adopted children in their homes — because if a mother is forced to have a child he or she doesn’t want, SOMEONE has to take that child, and the foster-care system is laughable.

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      • Captain Oblivious says:

        Do you also believe that those opposed to armed robbery should support increases in welfare, subsidized housing, food stamps, etc, as well as donating a large portion of their incomes to poor people?

        Or is there still some room for personal responsibility in the world?

        Hot debate. What do you think? Thumb up 18 Thumb down 18
      • Julie says:

        Absolutely there’s room for personal responsibility. If you want people to be responsible in using birth control (and thus not getting pregnant in the first place), you must teach young people how to use condoms, oral contraceptives, and other birth control methods, and you must make them available or free for them to use.

        If you want people to be responsible in knowing that they cannot financially afford to raise children, or do not have the maturity to do so, you should allow women to abort the fetus as soon as they know about they’re pregnant, so that they are not forced to raise children they don’t want.

        And if you insist that women carry babies to term that they do not want and may not be able to afford, you must also support the institutions that support those babies (and their mothers) once they’re born.

        I believe that people who are opposed to armed robbery should support an efficiently-funded and well-trained police force, just criminal courts, and prison systems that aim to reintegrate criminals back into normal life after they’ve served their terms, in an attempt to decrease recidivism.

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      • Bridgeport Guy says:

        Julie,

        Your line of thinking wreaks of “relativism”. Your way of thinking goes: “If the child is wanted and will be able to grow up in a good home with lots of love, then he or she should be allowed to live. If not, then he or she should be aborted.” What about kids growing up in poor situations in the ghetto where their parents or guardians are irresponsible, on drugs, having multiple boyfriends/girlfriends coming through their homes? That’s terrible for any kid to grow up in that situation, but do you think we should kill these kids too since they aren’t growing up in ideal situations? No, the right to life trumps everything else. You can’t have liberty and the right to the pursuit of happiness unless you are first given the right to live. And FYI, there are many fine families and organizations out there that aid in finding adoptive parents for children who are given the chance to live rather than die. One group in NJ has an annual Christmas party at which several hundred of the several thousand lives that have been saved by loving men and women who become dear friends of women (or teens) in crisis pregnancy situations and who offer them tremendous help. The one thing that’s so noticeable at these gatherings is the smiles on the faces of the women and children. Despite the financial, emotional, and other hardships faced, they are all in agreement that it’s much better for these children to have been given life than to have been aborted.

        Julie, in one of your posts, you mention this thing about a potential life. A 5-yr old girl is a potential nurse, doctor, homemaker, teacher, etc. But what she is now is a little girl. Regardless of whether her life will pan out to everyone’s hopes and dreams, at this very moment she is a beautiful, innocent child. In the situation of an unborn child who’s as big as a period at the end of this sentence, yes he/she will potentially develop into a man or woman later in life. But at this very moment, he or she is at a stage at which all of us have been – the earliest point of life for any human being. For all your babbling about mothers being more important than these unborn children, I hold in high esteem St. Gianna Beretta Molla, a wife, mother and physician who during the 1960′s chose to abstain from treatment that would have removed a cancerous tumor in order to preserve the life of her unborn child. This “potential life” – as you call it – was born thanks to St. Gianna’s selfless sacrifice. The child developed into a fine young lady who followed in her mother’s footsteps and became a doctor (still active in Italy today).

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      • Julie says:

        Bridgeport Guy, you make excellent points. I would just like to touch on the last one you mentioned, St. Gianna Beretta Molla. I think what she did is admirable and a huge sacrifice. I think she was extremely brave.

        And I believe — to the very core of my being — that a choice like hers must continue to be a CHOICE. Specifically, the choice of the mother, in consultation with whoever she thinks would be most helpful to her in making it (husband, parents, doctor, religious adviser, etc.). I think that forcing a woman to continue a dangerous pregnancy that could result in her own death is cruel.

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      • anonomyssy says:

        Captain Oblivious, wouldn’t abortion BE taking personal responsibilitly??? If a female becomes pregnant, and can’t care for the child, for whatever reason, isn’t NOT having the child, the responsible thing to do???

        Most today do NOT remember orphanages or poor houses, things long gone.

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    • jphd says:

      If you want to be an ob-gyn you are trained to do an abortion– as far as I know.

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      • anonomyssy says:

        The medical term would be a “D&C”…and is sometimes done for reasons other than pregnancy termination.

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  4. Dave says:

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    • SomeotherJew says:

      Dave,

      The Jewish doctors who perform abortions are acting within the confines of halachah, at least in certain circumstances. See, e.g., http://www.jewishvirtuallibrary.org/jsource/Judaism/abortion.html. Since the question is merely whether or not the doctors being surveyed perform abortions, without probing further, it’s hard to picture a Jew who takes halachah seriously refusing to perform an abortion to save the mother’s life, as it would go against the laws of our fathers to do so.

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  5. Clancy says:

    What’s the correlation with religion after controlling for the other factors measured? I’d wager there’s a higher percentage of Jewish doctors in urban/blue state areas where abortions are more common, and Evangelical Protestants not so much.

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    • Bridget says:

      It would definitely be interesting to see things broken out a little more. I’m surprised that Jewish doctors are more prone to perform abortions than even non-religious doctors. Is this mainly because of where the Jewish doctors are geographically, like Clancy pointed out? Or maybe, like Kel mentioned, there could be a lot of non-religious doctors in small, conservative communities, where everybody knows everybody, and they just want to avoid any social backlash.

      I would be interested, also, in the numbers of abortions for life-threatening versus non-life-threatening pregnancies. Would the Jewish doctors balance out more with the non-religious doctors? Is it about the same? Are the overall percentages for life-threatening abortions higher; are more doctors across the board are willing to perform these? And the gap comes in mainly when the pregnancy is not life-threatening? Or are all these same doctors reluctant to perform any abortions, period?

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  6. Eric says:

    As an evangelical Christian we try to rely on biblical principles to guide our daily lives. We are, of course, still prone to every human temptation and often fail in our aim. However, biblical truth is our gold standard (notwithstanding the economic arguments against a gold standard!). In Psalms 139: 13-16 it clearly reads that God knows us even as unborn children. I can’t fault an unbeliever for thinking abortion is simply a rational choice but as believers we are to love what God loves and hate what God hates. I am pretty sure that God is grieved at the destruction of what He considers to be people. However, i am also pretty sure that God does not hate a person that has an abortion as they are also his creation.

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  7. n. says:

    “97% encountered patients seeking abortions, whereas 14% performed them”

    I am shocked by these figures. Don’t get me wrong, not all women seeking an abortion should get one, but this is a way too large gap. Consider the consequences of an unwanted child and compare those to the abortion of a (non-viable) fetus. I’m not saying it is an easy decision (trust me I know) and it shouldn’t be taken lightly but in this modern age in which we can (e.g. it is technically possible) make such a decision we should be able and supported in making that decision.

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    • Enter your name says:

      Would you be surprised to hear that this is true for far less political issues. I would not be the least bit surprised to hear that statistics like these:

      97% of primary care doctors have encountered someone who wanted allergy shots, but that far less than 14% of them were willing to provide this service.

      97% of primary care physicians have encountered someone who is pregnant and not looking for an abortion, but that far less than 14% of them deliver babies.

      97% of primary care physicians have encountered patients looking for major surgery, but that far less than 14% of them perform major surgery themselves.

      Many gynecologists are primary care physicians who specialize in adult women. Why should we be surprised that abortions are sent to specialists, just like everything else?

      Why is it horrifying to see that most ob-gyns do not personally perform abortions, but not horrifying to hear that most ob-gyns do not perform normal surgical procedures (like hysterectomies) in patients with even slightly complicated health, or that 20% of ob-gyns (up to 40% in some areas) do not deliver babies, even for long-standing, low-risk patients?

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      • Julie says:

        If you look at the abstract, it says that the survey related to ob-gyns, not primary care doctors. Only 14% of the SPECIALISTS are willing to perform abortions, compared to 97% who encounter patients asking for one!

        To follow up on your example, I WOULD be horrified to find out that only 14% of ob-gyns performed deliveries or only 14% of surgeons performed hysterectomies!

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      • Enter your name says:

        A sizeable proportion of people in this study have arranged their practice so that they *are* primary care physicians. Being board-eligible or board-certified in gynecology does not mean that you are not a PCP. So you can take 20% off the top of this difference (and up to 40% in some regions): at least 20% of those “ob-gyns” aren’t the kind of physician you think they are.

        And you should prepare to be horrified: It is likely that far less than 14% of surgeons perform hysterectomies.

        More than two-thirds of surgeons have specialized in some other type of surgery, and many general surgeons refuse hysterectomies. A gynecologic surgeon is uncommon outside of teaching hospitals.

        Most hysterectomies, especially in urban areas, and almost all complicated hysterectomies—but almost no oncology-related hysterectomies—are performed by a relatively small number of gynecologists who have chosen to have a surgical focus, rather than by surgeons. In a mid-sized practice, it would not be unusual for all hysterectomies to be performed by the same ob-gyn—and it would be perfectly normal for that person to deliver zero babies.

        This is not a bad thing. If you do the same surgery a thousand times, your patients have better outcomes. It doesn’t matter whether the surgery is an abortion or a hysterectomy or a C-section or a hernia repair. Your best option is the person who does that specific surgery multiple times every week, not the person who does it a couple of times a year, if they happen to encounter a patient who wants it.

        What matters is whether you can find someone to do the surgery competently, not whether the very first physician you approach is willing and able to attempt it.

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      • n. says:

        I might have misread it due to the fact that I’m not a native English speaker and automatically assumed that the ob-gyms were the specialists. Nonetheless it is not that relevant for my point.

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  8. BSK says:

    I think the data needs to be parsed more. As the study notes, many states have far more restrictions on abortion than others. My hunch is that these states have a higher proportion of Christian/Catholic OBGYNs than Jewish ones. If that is the case, there may be Christian/Catholic OBGYNs who might otherwise have performed the procedure if they were in a less restrictive state. Of course, it’s equally possible that the state is so restrictive because of the prevalence of Christians and Catholics, OBGYNS among them.

    Regardless, it is alarming that so few offer it. I don’t know if there are other options for women beyond OBGYNS but, if not, this is woeful. Regardless of your position on abortion, the fact is that women retain a legal right to use the procedure if they feel it necessary. I don’t think that doctors should be compelled to perform the procedure (though I’d be curious to see what rights doctors have to refuse to participate in other procedures or refuse treatment to patients under other circumstances). But with the limited options most people already have with doctors and the further limits that insurance companies put on them, such limited accessibility is a defacto restriction on all abortions.

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    • Enter your name says:

      Doctors have the same rights to refuse any patient or any procedure as they do to refuse to perform abortion. Actually, in some places, they may have more rights to refuse non-abortion/non-contraception work.

      You may reject any patient for any personal reason (but not for race, religion, national origin, etc.) or for any professional reason. So you can refuse or fire the lawyer whose specialty is suing doctors for malpractice if his professional activities make you nervous (and such lawyers often have difficulty finding healthcare providers), and you can fire the patient who screams at you or physically assaults your staff. You may even legally fire patients over their political beliefs, if you think your own personal dislike of their politics might make you ineffective. An African-American physician would not be required to accept the head of the local KKK chapter as a patient (nor is that patient required to choose any African-American as his physician).

      On professional grounds, you may (and should) fire a patient whose care is more complicated than you feel comfortable handling, and you may fire patients over the equivalent of “irreconcilable differences”, such as the person who believes that organic food is an adequate treatment for tuberculosis, or a diabetic patient who absolutely refuses either to take any medication or to control his diet. (The hope there is that the next physician will prove more persuasive.)

      Additionally, you may (indeed, must) refuse to perform any procedure that you believe is unethical. For example, if you believe that a particular surgery is inappropriate for a given patient’s situation (for example, ‘keyhole’ surgery does not produce an effective repair for certain kinds of hernias), then you must refuse to perform that surgery.

      But you may not simply abandon the patient; you must give the patient notice and a reasonable opportunity to find another healthcare provider. You can’t leave patients to die or become disabled while they look for a replacement. You have to give reasonable notice, and you have provide reasonable care while they search for a new healthcare provider. You don’t have to be on the hook forever (even if they do not or can not find a replacement), but you do have to give them a fair chance.

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      • BSK says:

        Thanks. Do you have to offer references to a doctor that can or is more likely to meet their needs?

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  9. 164 says:

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  10. Enter your name says:

    Leaving aside the fact that “not personally providing an abortion to all comers” is not the same as “not telling the patient where and how to get an abortion”, I wonder how many of them do not provide abortions because of worries about market-based effects on their practice.

    A person strongly opposed to abortion should not be forced to choose an abortion-providing physician, just like a racial bigot’s health is better served by not forcing him to see a physician of the race he despises. I have trouble imagining that a woman who truly believes that abortion is murder would freely choose an abortionist to take care of her health. If the case of a threatened miscarriage (an event not known for producing stable emotions), even a person with rather moderate views might have some trouble trusting that an abortionist would do everything possible to save the life of her baby.

    It’s entirely possible that if you performed abortions, you would lose the bulk of your non-abortion practice, especially if you work in an area dominated by pro-life sentiments.

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  11. AaronS says:

    To resolve the abortion debate, only a very little movement is needed from both sides. The pro-lifers need to admit that something no bigger than the period at the end of this sentence is not of the same emotional value as a newborn child or a grown adult. Yes, it has the POTENTIAL to become a child, but if it’s REALLY murder to abort something at that stage, then will you agree that the mother should be imprisoned and executed?

    This is where the rubber meets the road. Most of them know girls who have had abortions…and, no, they don’t think we need to get THAT serious about it. But if it’s really murder…. So you see their problem

    On the pro-choice side, they need to quit acting like taking away partial birth abortion is a reduction in human rights. We are all emotionally repulsed by a method that kills a fully-formed, living baby inside the womb in order to avoid any charges of infanticide by killing it once it is born. To protect that in the name of abortion rights is as repugnant as protecting slavery in the name of State’s Rights–maybe worse.

    So the moves are simple: The pro-lifers need to agree that in return for no abortions (except in the case of literal and immediate danger to the mother) after, say, six weeks, the pro-choicers will agree to the same thing, therby giving up partial birth abortion.

    BUT IT WILL NEVER HAPPEN!

    Why? Because if we settle this, pro-lifers will not be able to raise money to save children. Politicians will not be able to attract the votes of those for whom abortion is the most important issue on the ballot. Planned Parenthood would lose support in trying to protect “a woman’s right to choose.”

    THEY DON’T WANT TO FIX IT!

    George W. Bush, a Republican President, had a Republican Congress, yet we still have abortion. You don’t want to pass any laws about abortion when you depend on abortion to keep the religious folks voting for you instead of the Democrats. After all, if there’s no abortion to fight over, those religious folks might start thinking that the Democrats have a pretty good program to try to feed the poor and all the other stuff that Jesus seems to be for.

    I am such a cynic.

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    • Enter your name says:

      “no bigger than the period at the end of this sentence”

      You are incorrectly assuming that most induced abortions are performed within days of the first missed period. The median abortion (US statistics) is performed at least a full month after this, when the embryo is one-half to three-quarters inch long.

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      • Julie says:

        I think you could rewrite the original sentence to be: “The pro-lifers need to admit that something no bigger than 3/4″ long is not of the same emotional value as a newborn child or a grown adult.” Even phrased like this, it’s still valid.

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