Progress Report on Liberalized Abortion

UNTIL 18 months ago an American woman in virtually all the states could get a legal abortion only to save her life, and only after surmounting forbidding legal obstacles. Since then, five states have liberalized their punitive 19th century abortion laws. They now permit therapeutic abortions to be performed if the physical or mental health of the mother is in danger or if the pregnancy resulted from rape or incest. Four of these five states--Colorado, North Carolina, Georgia and Maryland--also authorize abortion if the child is likely to be born defective, as is commonly the case if the mother has had German measles (rubella) within the first three months of pregnancy. California did not sanction this ground because Governor Ronald Reagan threatened to veto any bill that included it.

Two states have now had enough experience, extending over a year or more, to make some conclusions possible. While the number of legal abortions has increased, the increase has not been dramatic, as opponents of liberalization had forecast. No city in a state with a liberalized law has become "the abortion capital of the U.S." In fact, the increase in numbers has been too small even to make an appreciable dent in the number of illegal, dangerously septic abortions, as some proponents of the laws had hoped they would. While the experience of these states offers useful guidelines for other legislatures that will consider liberalizing bills in their next sessions, it contains no simple solution to the abortion problem.

Optional Accessories. Largely because of the patent, wholesale flouting of old punitive laws and the fact that these statutes were endangering the lives of many women, the American Law Institute became concerned in the late 1950s. After careful study, the institute drafted a model abortion law. On April 25, 1967, Colorado became the first state to enact a modern abortion law, on the basic pattern of the A.L.I, model with a few minor optional accessories.

In the twelve-month preceding adoption of the 1967 act there were 51 legal, reported abortions in the state. In the following year there were 407, or 11.6 abortions per 1,000 live births. That compares with about 660 legal abortions per 1,000 live births in Japan (where modern contraceptives such as the pill are illegal), and 85 per 1,000 in Sweden. Colorado's law does not spell out residence requirements, but legal formalities ensure that abortions after rape or incest will be performed only on residents, and Colorado General Hospital has decided not to abort out-of-state patients "except for fetal indications" --meaning that the child is expected to be malformed.

Of Colorado's 52 accredited hospitals, 23 will perform no abortions, in most cases because of religious objections. In the first year, 24 hospitals set up abortion committees, and abortions were performed in 21 of these (three received no applications). A survey by the department of obstetrics and gynecology at the University of Colorado Medical Center showed that of the 407 patients aborted, 278 (or 68%) were Colorado residents. The woman's mental health, not previously admissible as a ground for abortion, was the reason most frequently advanced under the new law-- in 291 cases, or 72%. Next commonest were fetal indications, invoked for 47 patients, and 46 rape cases, of which 32 were statutory and 14 "forcible." Medical reasons involving the woman's physical health accounted for only 23 of the patients.

Typical of the married women who sought (and were granted) an abortion on psychiatric grounds was the 36-year-old wife of a factory foreman, who already had three children. To the hospital board, which included a psychiatrist, she explained: "My last pregnancy was a mistake. My husband and I knew that having another child would strain me to the limit--or beyond. I've already had to have some psychiatric help, partly because our eldest boy is a problem, and I just can't face any more burdens. Another child would shove me over the brink--I don't know what I'd do, but I might do away with myself."

Among unmarried women, a common psychiatric claim was that of girls who concluded that they had simply made a mistake. Said one: "I realized that I couldn't think of marrying him and spending the rest of my life with him, and I refuse to have a temporary marriage just to be able to give birth to a legitimate child. So I'm trapped. There's nowhere to turn. If I can't get an abortion legally and decently, I'll go out of my mind." The glib lay phrase "go out of my mind" by itself would not have im-pressed the psychiatrist, but in this case he was convinced that pregnancy and childbirth might be enough to precipitate severe mental illness.

City Anonymity. The university study group, Dr. E. Stewart Taylor reports, found that 52 of the aborted patients were under 16, and 135 were aged 16 to 21, while 157 were in the 22-35 bracket and 63 were over 35. There were 230 women who had not previously had a child, and 226 were unmarried; 123 had one to three children, and only 54 had four or more children. In addition to the 226 single women, 43 of those aborted were divorced, leaving only 138 currently married.

"The great majority of patients were referred to Denver physicians," Taylor notes. "The hospitals in small-and medium-sized towns are performing very few therapeutic abortions. This trend will probably continue for some time because of the anonymity that a large city provides." In no case did the new legal procedure take long enough to make a safe abortion impossible, and there were no maternal deaths.

California's experience has been comparable. The main difference in principle is the Reagan-dictated exclusion of fetal indications. The numbers are larger, reflecting the difference in the states' populations. In the first half of 1968 there were 2,324 applications for therapeutic abortion, of which 207 were rejected. Of the 2,117 patients who won approval, 92 did not go through with the operation. No fewer than 1,777 of the abortions performed, or 83%, were on the ground that continued pregnancy would gravely impair the woman's mental health, and only 115 because of a threat to her physical health. There were 138 because of rape, and five because of incest. Only 25 operations involved out-of-state patients.

Time to Learn. No one knows how many illegal abortions are performed annually in the U.S. So-called "estimates" are really guesses and range from 200,-000 to 1,500,000. Whatever the true figure may be, it is obvious that legalized therapeutic abortion so far has had negligible, if any, effect on the illegal trade. There are several reasons.

In the first place, say California health officials, it takes time for people to learn when abortions are permitted and how to go about applying for them. Secondly, many women seeking a quick end to an unwanted pregnancy are not interested in the elaborate procedures required for a legal solution. Another factor is cost. Specialists have to be called in to confirm the medical justification advanced, and their fees, added to the usual cost of even minor surgery and a short stay in the hospital, can run the total bill up to $2,000. Many women who can afford such costs prefer to go to Mexico or Puerto Rico, where abortion, although illegal, is easily arranged, with a competent gynecologist performing the operation.

As the state legislatures reconvene next January, many will be asked to modernize their laws along the A.L.I, line followed by Colorado. Even if all 50 states were to do so, the problem of illegal abortion, with its high infection rate and considerable risk of death--especially for the poor--would remain.

At the same time, there will be a continuing campaign for "abortion on demand" on the ground that this is "every woman's birthright." This campaign, in the opinion of Dr. Alan F. Guttmacher, president of Planned Parenthood-World Population, will fail because "the public does not want abortion on demand and is not prepared to accept it." A more realistic approach to reducing the demand for illegal abortion, Guttmacher believes, is to make effective contraception far more widely available.

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