Anti-Abortion Congressional Republicans Are Going After Dilation and Evacuation

This procedure is typically chosen by patients who have developed life-threatening complications. Most of these pregnancies are wanted pregnancies that cannot be carried to term.
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Publish date:
September 18, 2015
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abortion, reproductive justice, abortion procedures

At this point, I'm starting to feel like I need to start a weekly variety show: This Week in Losing Your Reproductive Rights! While I do my best to keep up, between the latest Congressional shenanigans and state-by-state measures, it's easy to fall behind — take, for example, this disturbing map of the state of medication abortion in the U.S. This week, we're seeing not just our old friend the Pain-Capable Unborn Child Protection Act, which Congress is currently trying to fast track, but a hip new up and comer: the Dismemberment Abortion Ban Act.

Yikes! Dismemberment abortion! That sounds terrible! And super-inefficient, because I feel like there's a better way to terminate a pregnancy than tearing the patient limb from limb to get to the fetus!

I pulled out my Babykiller's Dictionary to find out more, but I had trouble finding it. What I did find was dilation and evacuation, a common choice for second and third trimester terminations, but an extremely rare procedure statistically speaking (seeing as how less than ten percent of abortions take place after 12 weeks). So what's dilation and evacuation?

Once a pregnancy enters the second trimester, medication abortion isn't an option. Surgical abortion using a simple vacuum aspirator isn't available either. Patients and caregivers have a choice between an induction abortion — in which providers induce labor with medications — or dilation and evacuation, in which the patient's cervix is dilated to allow the provider to introduce instruments, including an aspirator, to remove the fetus. The procedure involves the use of forceps and a curette to remove the fetal tissue, and the fetus is typically not removed intact.

This procedure is typically chosen by patients who have developed life-threatening pregnancy complications, or in cases where a fetal diagnosis indicates that a fetus is dead — or may die — in the uterus, or when it becomes apparent that the fetus has incompatibilities with life that will likely lead to a very short and painful life after delivery. In other words: Most of these pregnancies are wanted pregnancies, and the procedure is emotionally stressful for patients.

Multiple states have attacked D&E, not to be confused with dilation and extraction (D&X), in which the care provider delivers the fetus intact — a choice that can be made for a number of reasons, including the desire to say goodbye, to donate fetal material to research, or simply because it's the best choice medically or personally. You may hear D&X referred to as "partial birth abortion" by the right, because that, like "dismemberment abortion," sounds like something awful and scary.

H.R. 3515, copycat legislation borrowed from a template helpfully provided by the National Right to Life Committee, would ban: "knowingly dismembering a living unborn child and extracting such unborn child one piece at a time from the uterus through the use of clamps, grasping forceps, tongs, scissors or similar instruments."

On its face, this legislation is wrong. Impeding reproductive rights is unacceptable in any way, shape, or form. Patients deserve access to abortion on demand and without apology, and they deserve to be able to make choices about their pregnancies in consultation with their physicians. For some patients, D&E is the most suitable option, for a variety of reasons, and they should be able to pursue the procedure in safe, supportive environments with trained health care providers.

Notably, we are developing a shortage of abortion providers in the United States because it's getting outright dangerous to perform or assist with abortions, and procedures like D&E and D&X require advanced training. Patients already can't access D&E at all in Oklahoma, and bans are on the table in many other states, and this would make the procedure completely illegal in the United States.

But the problem isn't just with this bill. Republican efforts to limit access to abortion are going to push patients into getting abortions later and later. That's because they need to scrape together funds, travel to an area where it's available, and find a health care provider. Notably, the issue stretches even further back: People provided with comprehensive sexual education and access to sexual health services (like those provided by, oh, say, Planned Parenthood) are less likely to experience unintended pregnancies. People who can get abortions when they want them won't have to wait into the second semester as they try to secure care.

And, of course, it bears underscoring that this procedure is commonly used to save lives.

There's no such thing as the "justified" abortion. Patients don't need to explain or excuse themselves for opting to get abortions, but the fact of the matter is that D&E is often used when the lives of pregnant people are at risk — as, for example, if they are having miscarriages and they need a D&E to ensure that all pregnancy-related material is expelled so they don't develop potentially fatal infections. Being willing to risk the lives of patients over "the unborn" is a harsh reminder that pregnant people don't matter to the right: Only their fetuses do. And in the haste to "defend life," they're willing to allow patients (and, incidentally, their pregnancies) to die, though they don't give a fig for a fetus once it emerges from the womb and becomes a baby.

This ban will endanger patients, as in so many other abortion bans and restrictions, like the targeted regulation of abortion providers (TRAP) laws deliberately intended to make it impossible to practice without actively banning abortion. It's bad for medicine, and ultimately, it's bad for families — many people who have abortions go on to have children (and some already have children). Abortion is a private medical decision, and it's a powerful tool when it comes to making choices about family planning and looking after family welfare.

The fact that we are still debating this, and that the right is still introducing abortion bans in Congress, is a deeply disturbing testimony to the state of reproductive rights politics in the United States.

Photos: Gage Skidmore, Gage Skidmore, Gage Skidmore (seriously, Gage, if we ever meet at a party, drinks on me). Flickr/CC