Data Lacking on Abortion Method

By David Brown
Washington Post Staff Writer
Thursday, April 19, 2007

The abortion procedure whose ban was upheld yesterday by the Supreme Court accounts for a few thousand of the roughly 1.3 million such procedures done each year in the United States, according to the best available estimates.

Data on abortions -- particularly the types of procedures physicians use -- are among the more incomplete and contested health statistics in the United States. The prevalence of a late-term procedure that opponents call "partial birth" abortion is made murkier by arguments about how to define it.

In the government's most recent estimate of abortion rates, California, New Hampshire and West Virginia reported no data, resulting in a significant undercount. It appears that only one state, Kansas, specifically lists "partial birth procedure" in its survey of practitioners.

The best estimate appears to be by the nonprofit Guttmacher Institute in New York, which researches reproductive health issues. In 2000, the last time it studied the question, the institute estimated there were 1.31 million abortions performed in the United States each year. Of that total, about 2,200, or 0.17 percent, were by "intact dilation and extraction," which is the medical term for the same procedure.

The 2000 report said that about 30 of the nation's 1,800 abortion providers used the controversial technique.

When the issue -- and terminology -- entered public discussion in the mid-1990s, an official at the National Coalition of Abortion Providers estimated that 3,000 to 5,000 of the procedures were done annually. One of the chief proponents of the law banning the procedure does not disagree with that guess.

"There are at least several thousand a year," said Douglas Johnson, legislative director of the National Right to Life Committee. "But nobody really knows how much of the iceberg is visible."

During such a procedure, the physician delivers the fetus feet-first until only the head remains inside. An instrument is used to puncture the skull and its contents are removed, usually by a suction catheter. This allows the skull to collapse and the rest of the fetus to be removed.

Defenders of the technique say it is less traumatic than the most common alternative, in which the fetus is removed piece by piece. If it is later in the term, the alternative removal method can be hazardous to the pregnant woman.

Although many people believe the technique is done only at an advanced gestational age, "most D&X procedures in 2000 were second-trimester, not third-trimester, abortions," Guttmacher demographer Lawrence B. Finer said in an interview yesterday, referring to the dilation and extraction method.

Overall, 88 percent of abortions are performed before the end of the 12th week of gestation -- the first trimester. About 10 percent are done between weeks 13 and 20. About 1 percent are done at week 21 or later. A normal gestation period is 38 weeks, 40 weeks after the last menstrual period.

Some fetuses are able to survive outside the womb as early as 24 weeks, and younger ones can survive for short periods. The ban covers abortions done "both pre-viability and post-viability," yesterday's court opinion noted.

In 1998, Kansas began asking abortion providers whether they did partial-birth procedures. In 1998, 58 were reported, and in 1999, 182. Neither report covered the entire year.

Since then, no one has reported doing them. In last year's report, however, practitioners reported 233 procedures (out of 11,221 abortions statewide) in which they said they thought that the fetus was viable. That is about the same number reported as partial-birth abortions with a viable fetus in 1998 and 1999.

This suggests that abortions defined as "partial birth" a decade ago are not being called that now -- an inference confirmed by an official in the Kansas Department of Health and Environment.

"It is a definitional issue," state registrar Loren A. Phillips said.

The argument over definitions is likely to continue.

A chief fear of abortion providers is that the ban can now be interpreted to cover many abortions, despite the court's effort to define it unambiguously.

"There is definitely a concern that this ruling could come down and really affect procedures done as early as 12 weeks," said Amy Hagstrom Miller, board chairman of the National Coalition of Abortion Providers. "The providers want to know that what we do is okay. We are the kind of people that comply with laws."

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