1. SOC 573: Abortion James G. Anderson Purdue University

2. The Public Debate

4. 1976 Congress passes the Hyde Amendment prohibiting the use of Medicaid funds for abortions 1977 U.S. Supreme Court held that states have no legal obligation to fund abortions for the indigent 1980 U.S. Supreme Court in Harris vs McRae upheld the Hyde Amendment 1980s States pass parental consent laws for teenage abortions

5. The Public Debate

7. Abortions Per Year (AGI) (CDC) 1973 744,600 615,831 1974 898,600 763,476 1975 1,034,200 854,853 1976 1,179,300 988,267 1977 1,316,700 1,079,430 1978 1,409,600 1,157,776 1979 1,497,700 1,251,921 1980 1,553,900 1,297,606 1981 1,577,300 1,300,760 1982 1,573,900 1,303,980 1983 1,575,000 1,268,987 1984 1,577,200 1,333,521 1985 1,588,600 1,328,570 1986 1,574,000 1,328,112 1987 1,559,100 1,353,671 1988 1,590,800 1,371,285 1989 1,566,900 1,396,658 1990 1,608,600 1,429,577 1991 1,556,500 1,388,937 1992 1,528,900 1.359,145 1993 1,500,000 1,330,414 1994 1,431,000 1,267,415 1995 1,363,690 1,210,883 1996 1,365,730 1,221,585 1997 1,365,730 (NRLC estimate) 1998 1,365,730 (NRLC estimate.) 1999 1,365,730 (CIRTL estimate.) 40 MILLION ABORTIONS SINCE 1973 4,000 each day Source: AGI - Alan Guttmacher Institute (Planned Parenthood) CDC - Centers for Disease Control NRLC - National Right To Life Committee CIRTL - Central Illinois Right To Life

8. Number of abortions per state in 1996, with the rate per 1,000 women Alabama 13,826, 14 Alaska 2,139, 15 Arizona 11,016, 11 Arkansas 5,882, 11 California 280,180, 39 Colorado 9,710, 11 Connecticut 14,094, 20 Delaware 4,482, 26 District of Columbia 13,674, NA Florida 80,040, 27 Georgia 35,790, 20 Hawaii 4,916, 19 Idaho 1,022, 4 Illinois 53,613, 20 Indiana 13,341, 10 Iowa 7,602, 12 Kansas 10,685, 19 Kentucky 7,000, 8 Louisiana 11,865, 12 Maine 2,615, 9 Maryland 12,363, 10 Massachusetts 29,293, 21 Michigan 30,208, 14 Minnesota 14,193, 13 Mississippi 4,206, 7 Missouri 11,629, 10 Montana 2,763, 15 Nebraska 5,214, 14 Nevada 6,965, 20 New Hampshire 2,300, 8 New Jersey 31,860, 18 New Mexico 5,033, 13 New York 152,991, 37 North Carolina 33,554, 20 North Dakota 1,291, 9 Ohio 36,530, 15 Oklahoma 6,769, 10 Oregon 13,767, 20 Pennsylvania 38,004, 15 Rhode Island 5,437, 24 South Carolina 9,326, 11 South Dakota 901, 6 Tennessee 17,989, 15 Texas 91,470, 21 Utah 3,639, 8 Vermont 2,139, 16 Virginia 25,770, 16 Washington 26,138, 21 West Virginia 2,470, 6 Wisconsin 13,673, 12 Wyoming 208, 2 Total 1,221,585, 20 Source: Centers for Disease Control and Prevention

9. Abortions per 1,000 Women Age 15-44

10. Vacuum Aspiration (Suction Curettage This is one of the most common first-trimester abortion methods (used within the first three months of pregnancy). A suction machine is used to empty the uterus with a mild suction. The physician may then use a spoon-shaped instrument, called a curettage, to ensure that the abortion is complete. This method is used when a pregnancy is between 6 and 15 weeks. The procedure itself takes between 5 and 10 minutes. Side effects associated with vacuum aspiration include abdominal cramping and vaginal bleeding.

11. Manual Vacuum Aspiration (MVA) MVA is a first trimester abortion method that empties the uterus using non-electric suction instruments. MVA is similar in function to the vacuum aspiration method, but without electricity and the electrical suction noise. Some patients prefer MVA because it is quieter. However, the procedure takes slightly longer and is not as widely available to patients as the electrical version. The method is used when a pregnancy is up to 12 weeks. ). Side effects associated with manual vacuum aspiration include abdominal cramping and vaginal bleeding.

12. Dilation and Evacuation (D&E) Dilation and Evacuation is the most common second trimester abortion procedure. D&E involves vaginally inserting laminaria (sterilized seaweed) into the cervix causing the cervix to gradually dilate or widen. This insertion is typically done one day before the procedure. Once the cervix is sufficiently dilated, a surgical procedure is performed which involves suctioning the uterus by vacuum aspiration. ). After the cervix is dilated, which can take anywhere from a few minutes to 2 days, the surgical procedure itself takes about 10 to 20 minutes to complete.

13. RU 486 Methotrexate is an FDA approved drug used for the treatment of certain cancers and chronic diseases. It has also been used to treat early ectopic (tubal) pregnancies, which are pregnancies that implant outside the uterus. When used in early pregnancy, methotrexate stops the rapidly growing embryonic and placental cells of early pregnancy from growing. We have had much experience and success in using methotrexate for non-surgical abortions and ectopic pregnancies. Misoprostol is a drug that is used to treat peptic ulcers. When used as the second drug during a non-surgical abortion with the abortion pill or injection, it promotes the expulsion of the abnormal early pregnancy, in most cases. Extensive studies have shown that approximately 5% of the time, non-surgical abortions are not successful (compared with less than 0.1% for surgical abortion)

14. Who have abortions?

16. When are Abortions Performed? (Abortions 2001: Gestation period in weeks)

17. Reasons for Abortion 25.5% of women deciding to have an abortion want to postpone childbearing. 21.3% of women cannot afford a baby. 14.1% of women have a relationship issue or their partner does not want a child. 12.2% of women are too young (their parents or others object to the pregnancy.) 10.8% of women feel a child will disrupt their education or career. 7.9% of women want no (more) children. 3.3% of women have an abortion due to a risk to fetal health. 2.8% of women have an abortion due to a risk to maternal health.

18. U.S. Views on Abortion ViewLegalIllegal Woman's’ life is endangered85%11% Woman’s physical health is endangered 77%17% Pregnancy caused by rape or incest76%19% Woman’s mental health is endangered 63%32% Baby may be physically impaired56%37% Baby may be mentally impaired55%39% Woman/family can not afford baby35%61%

19. Points that apply to all Issues in Biomedical Ethics Issues are intractable Conflicts between fundamental moral values One value can be protected or promoted only at the expense of another. (e.g., Right to Life vs Right to Choose) Analysis/Discourse must involve respect for divergent positions

20. Points that apply to all Issues in Biomedical Ethics Law and ethics are not the same Limits of political solutions to social problems At issue, who should have a say in an abortion decision?