Bioethics Forum Essay

Should Pro-Choice Advocates Compromise on Abortion?

In a recent New York Times essay, “A Hard but Real Compromise Is Possible on Abortion,” Jon A. Shields suggests that pro-choice advocates should be willing to live with a 15-week limit on access to abortion. He bases his proposal on the fact that, while most Americans say they support Roe v. Wade, most are also in favor of restricting abortion to the first trimester. This is because of a common moral intuition that predisposes most people “to feel more protective of a fetus as it begins to resemble a newborn.” Thus, pro-choice arguments have more weight early in pregnancy and less as the pregnancy develops.

Shields also suggests that the current battle is between those who support absolute bans and those who support unregulated access. If only both sides were willing to compromise, maybe we could put the abortion issue to rest!

I do not dispute Professor Shields’ premises. He’s right that most Americans, whether they are pro-life or pro-choice, regard late abortions as morally more problematic than early ones. He’s also right about the reason why. A late-gestation fetus looks a lot like a newborn and has most of its characteristics, including an ability to experience pain. For this reason,  it inspires the same feelings of protectiveness. This may not be entirely consistent with the view that a new human being, with a right to life, comes into existence at conception, or with the view that fetuses at all stages of development lack moral and legal status, but there it is.

So, should pro-choice advocates be willing to accept a ban on elective abortions after 15 weeks? After all, most abortions in the United States (92.2%, according to the Centers for Disease Control and Prevention) take place at or before 13 weeks. What would be the harm of accepting a legal ban on abortion after 15 weeks?

I’d be happy to go along with such a ban if, but only if, certain conditions accompanied it. The first would be meaningful access to abortion in the first trimester. Restrictive abortion laws compound the existing problem of a dearth of abortion clinics, especially in rural areas. According to the Guttmacher Institute, 38% of women in the United States aged 15 to 44 live in a county without an abortion clinic. They have to travel, often for hours, to find a provider. If they have a job, they need to take time off. If they have children, they need to find someone to look after them.

Then there’s the problem of cost. Abortion is not covered by Medicaid in 34 states and the District of Columbia, except cases of rape, incest, or where the woman’s life is in danger. The cost of the abortion pill depends on where the woman lives. In some states, the cost may be low or even free.  In California, the average cost of a medical abortion is $306. In other states, the cost ranges between $320 and $500. That is cheaper than a surgical abortion, but still out of the reach of many poor women. Moreover, the abortion pill can only be used in the first 10 weeks of pregnancy. After that, a surgical abortion becomes necessary. Depending on where it is performed and at what stage of pregnancy, surgical abortion could be as high as $1,500. All of these barriers cause many women to delay getting an abortion. Anyone serious about reaching a compromise should be willing to ensure that all women who want to terminate their pregnancies, no matter where they live or how much money they have, can get a first-trimester abortion.

However, not all women who choose abortion really do want to end their pregnancies. Rather, abortion seems the best of bad choices. They may already have children they cannot support or an abusive partner on whom they are financially dependent. My second condition for accepting a 15-week ban, therefore, is that it is accompanied by measures that would allow women to keep pregnancies they want, such as a basic family income and universal childcare. One would think that pro-life advocates would enthusiastically support such proposals, although the evidence for this is slim to none.

Finally, there should be a clear understanding of why abortions in the second and even third trimester occur. As I’ve suggested, it’s rare that women are simply unable to make up their minds. However, it isn’t only lack of access that leads to late abortions. Another important reason is that sometimes a fatal defect is detected late in a wanted pregnancy. Sometimes a condition develops in the woman that threatens her life, her health, or her future fertility. Abortions in such cases are often medically indicated. The decision whether to abort should be made by women and their partners, with the advice of their doctors. I would reject any compromise that takes the abortion decision out of their hands.

If these conditions could be guaranteed, I would gladly accept a 15-week ban on elective abortions, and I suspect that many pro-choice individuals would as well. I’m less sanguine about the response of those who are pro-life.

Bonnie Steinbock,  PhD, a Hastings Center fellow, is professor emerita of philosophy at the University at Albany, State University of New York.