Late-term abortion number jumble

Last year when late-term abortion provider George Tiller was killed inside his church, the media devoted many stories to late-term abortions. One of the things that I noted at the time was that I erroneously believed there were only three men in the country willing to abort late-term and full-term fetuses: Tiller, LeRoy Carhart and Warren Hern. This was based on the claims of the men themselves, which were repeated by many in the media.

So, for instance, the Los Angeles Times‘ Robin Abcarian wrote:

Tiller had been the only abortion provider in Wichita, Kan., and his family’s decision to close the facility leaves only two other clinics in the country that perform late-term abortions.

The story repeated the claim. The Washington Post handled it better, I thought, by citing a 2001 survey of a few states saying that only a handful of abortion clinics and doctors were willing to perform late-term abortions.

Today the same reporter — Rob Stein — has a story about one of these doctors offering his services for women whose unborn children are closer to birth in Germantown, Maryland:

A Nebraska doctor who is one of the few in the country to perform abortions late in a pregnancy is planning to begin offering the controversial procedures at a clinic in Germantown, Md., an official said Tuesday. …

Only a handful of doctors perform abortions in late pregnancy, and Carhart has been the target of antiabortion protests.

I had happened to read a link to a much more recent survey than the 2001 cited by Stein in his reports last year. It appeared at the pro-life news site LifeNews. It cited a 2008 report, based on 2005 data, from The Guttmacher Institute. That institute used to be Planned Parenthood’s research arm, although it’s now independent of the country’s largest abortion provider. Anyway, the 2008 study indicates that they found 1,787 abortion doctors. Only 20 percent offer abortions after 20 weeks gestation, and only 8 percent offer abortions after 24 weeks. I think the earliest a baby has survived is around 21 weeks gestation.

Here are the goods from the Guttmacher Institute report:

Gestational limits. Most providers have lower and upper gestational limits for abortion services, and some women may have difficulty finding a provider if they seek an abortion too early or too late in pregnancy. For example, some providers will not perform an abortion if they cannot see the gestational sac on an ultrasound scan, which usually is not possible until 4-5 weeks after a woman’s last menstrual period.

Forty percent of providers in 2005 offered abortions at four or fewer weeks since the woman’s last menstrual period, about the same proportion as in 2001 (37%). The proportion of providers offering services increases with gestation and peaks–at 96%–at eight weeks. Sixty-seven percent of facilities offered at least some second-trimester abortion services (13 weeks or later). Twenty percent of providers offered abortions after 20 weeks, and only 8% at 24 weeks; comparable figures for 2001 were 24% and 13%, respectively.

So that means that some 350 doctors perform abortions after 20 weeks and more than 140 perform after 24 weeks.

LifeNews notes:

Mary Balch, an attorney who handle state legislation for the National Right to Life Committee, says the numbers are important because mainstream media outlets have attempted to make it appear there are very few practitioners willing to do late or late-term abortions.

“In an interview with Colorado abortionist Warren Hern published online November 5, 2010, Time Magazine perpetuated the prevalent myth that there are few, if any abortionists who perform abortions late in pregnancy,” she told LifeNews.com. “The Washington Post‘s Rob Stein also furthered the myth in a November 10 piece saying that Carhart is ‘is one of the few in the country to perform abortions late in pregnancy.’”

“The truth is, abortions in the fifth month of pregnancy and later are widely available,” she added.

It does seem odd. If you have more than 350 doctors performing abortions after 20 weeks and another 140-plus doing it after 24 weeks, that should be mentioned in news stories. And if reporters are using “late-term” to refer to babies who are even closer to birth, that should be clarified, too. I’ve heard of “late-term” referring to abortions after 20 weeks but also to abortions after 12 or 16 weeks. I’m not familiar with it being used to describe abortions on even older fetuses. Anyway, the abortion debate can get awfully euphamistic and it helps to be absolutely clear about what gestational age we’re talking about.

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  • Tyson K

    You’ve got some “name jumble” in the first paragraph of the post, Mollie. As the LA Times excerpt shows, the murdered doctor was not “George Carhart” but George Tiller; one of the two other doctors referred to is Leroy Carhart. There’s no abortion doctor named George Carhart.

    • MZH

      Thank you, Tyson!

    • MZH

      Thank you, Tyson!

  • Ivan

    Is this about religion coverage?

    • Dave

      GetReligion regards abortion and gay marriage as inherently religious, and any story the principals think handles these topics poorly is up for criticism. This includes “cheerleading” contrary to traditional principles.

  • Jerry

    I looked up the 21 weeks number for survival after birth and found it mentioned at http://miscarriage.about.com/od/pregnancyafterloss/a/prematurebirth.htm That site also discusses other factors entering into survival such as birth weight.

    A key table at that web site provides important numbers:

    Length of Pregnancy Likelihood of Survival
    23 weeks 17%
    24 weeks 39%
    25 weeks 50%
    26 weeks 80%
    27 weeks 90%

    So viability of a fetus increases dramatically when entering the third trimester of pregnancy.

    The definition of “late term” is not specified as Wikipedia points out but 20 weeks is often considered the dividing line http://en.wikipedia.org/wiki/Late-term_abortion So where the medical definition is not specific, reporters will not be able to be specific either.

  • Deacon John M. Bresnahan

    There is no more religious issue for the media to cover–and its coverage to be commented and analyzed upon– than the sanctity of human life whether at the start of life or its finish and everything in-between. However, the focus of many religious people on the beginning and the end is because that is where human life is most under assault and attack in the mass media and elsewhere in our nation. In fact, it if it weren’t for religious people of many persuasions –would there be anyone in the media or covered by the media speaking up on behalf of life. Even those few in the media who are the most pro-life seem to have strong religious attachments.
    Imagine a nation where pro-life voices of all types were silenced. Think Soviet Union. Think Nazi Germany (where the medical profession was freed from any moral boundaries– except of their own self-serving devising– as so many are demanding be the case here).

  • Julia

    Why is it that doctors, nurses, physical therapists, et al – all became “providers”?
    Was this switch in media lingo from within or the pressure of insurance companies?

    There was a time when nobody would have known what you were talking about re: “providers”. What caused the shift in terminology?

  • Jeffrey

    It appears they are talking about third-trimester abortions, which has a much smaller number of providers. Not clear from the Guttmacher data is whether providers say they “can” provide abortions at that stage or whether they actually perform them. While hospitals, for instance, may say they can provide them, it may also be true that only a handful of clinics actually do perform them. I agree there needs to be more clarity, but reporters also don’t need to take the pro-life movements spin on this either.

  • Dalea91505

    In accounting, there is a distinction between provider and vendor. Vendors sell things and require a receiving verification. Providers offer services which means a different verification. How this distinction got into the media I don’t know.

    In a prior thread on this topic, I did link to medical terminology which indicated that abortion is more of a lay term than a medical one. Medical terminology is presented in a numerical fashion. So, I suspect that the reason the late term providers are such an elusive group relates to the coding. For example, one common reason seems to be the fetus has no brain and can not live. If coded for the diagnosis of ‘no brain, not viable’, the medical record system would not recognize this as an abortion. There is a lot of room to manuever within medical coding.

  • Julia

    Dalea:

    Thanks for the bit on “provider”. It seemed that references to doctors and nurses disappeared all of a sudden. I had thought maybe “provider” was used for procedures where nurses were starting to do things that used to require a physician.

    “Medical terminology is presented in a numerical fashion.”

    Is this numerical coding for insurance? I sure don’t remember learning number coding in pathology, etc. classes.

  • Julia

    Dalea:

    Thanks for the bit on “provider”. It seemed that references to doctors and nurses disappeared all of a sudden. I had thought maybe “provider” was used for procedures where nurses were starting to do things that used to require a physician.

    “Medical terminology is presented in a numerical fashion.”

    Is this numerical coding for insurance? I sure don’t remember learning number coding in pathology, etc. classes.

    • Chris

      The “coding” Dalea is referring to are the ICD-9 codes, the International Statistical Classification of Diseases and Related Health Problems, version 9. These codes, which are promulgated by the WHO, are used for billing, mortality and morbidity tracking, epidemiologic research, etc. They are used by the insurance industry (including Medicare) as billing codes for procedures and diagnoses. In the electronic medical record, these are used more and more as medical diagnoses, although they are sometimes not specific enough to convey adequate information about the diagnosis for medical purposes, and tend to lag behind medical practice and diagnosis.
      “Providers” is taken from “Licensed Independent Providers”–who may be doctors or nurses–any medical provider who does not require supervision in their area of licensing.
      Not related to “getting religion”, but, I suspect many journalists (and patients) don’t know this.

      • Julia

        Thanks. I’ve always wondered about how & why the lingo changed. Probably a lot of reporters don’t know about this either.

        It would be an interesting project to see how the categories in the ICD-9 codes might be skewing the description of categorization of conditions and maladies.

        I was particularly stunned at this comment by Dalea:

        “For example, one common reason seems to be the fetus has no brain and can not live. If coded for the diagnosis of ‘no brain, not viable’, the medical record system would not recognize this as an abortion. There is a lot of room to manuever within medical coding.”

        Does this mean that if an anencephalic baby is mechanically or medically aborted, that the system doesn’t record it as an abortion? Neat trick to get around brain death norms.

        Future news articles about the rate and types of abortion should take this coding into consideration – or at least mention that this feature of medical recording might affect statistics on abortion.

        • Dalea91505

          Looking at the subject, it seems that there is a distinction made between spontaneous, induced and miscarriages that are the side effect of a treatment for something else. It seems that the induced miscarriages are the only ones counted as abortions. It is quite possible that the coding reads for some condition that results in miscarriage as a side effect. That way it is not induced.

          In medical offices, there are coders who specialize in coding for specific insurance companies. They have learned how to code to get maximum payments from insurers. The amount of fiddling that goes on with codes has consistently amazed me when I have worked in medical situations.

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