When Senator Lindsey Graham, a South Carolina Republican, proposed a nationwide ban on abortions after 15 weeks of pregnancy, the bill sparked controversy across the political spectrum. But little is said about its potential impact on the growing number of women giving birth in their 30s.
The proposed ban would allow exceptions to save a woman’s life and for certain pregnancies resulting from rape and incest, but it notably lacks exceptions for fetal abnormalities. As such, it would significantly limit options for an increasing number of older women who have missed and desired pregnancies – but also come with an increased risk of conditions like Down syndrome.
The average age of childbearing in the United States has increased in recent decades, reaching 30 in 2019, up from 27 in 1990. But older mothers are more likely to carry fetuses with abnormalities more chromosomal and the test most commonly used to detect such disorders can only be done after 15 weeks of pregnancy, beyond the time Mr. Graham recommends for abortion.
Some anatomical anomalies also cannot be diagnosed until pregnancy. Older mothers are also more likely to enter pregnancy with health conditions that may worsen as the pregnancy progresses and may require termination of pregnancy to save the woman’s life or prevent disability.
According to Anne Morse, a survey statistician at the Census Bureau, highly educated American women of all economic backgrounds, races and ethnicities have long delayed having children. The most dramatic changes occurred in black mothers and non-pregnant women in the United States, whose median age of childbearing increased to 28 from 24 and 32 from 27, respectively, over the past 30 years.
“There has been a large drop in fertility rates among women in their 20s in each demographic group,” says Dr. Morse. And every demographic group, with the exception of Native American and Alaskan Native women, saw an increase in birth rates among women ages 35 to 39, she said.
Mr. Graham’s bill, which is not expected to pass in the narrowly Democratic-controlled Congress, has been controversial even among Republicans opposed to abortion, and some senators. Republican senators told reporters it was best for the states to decide.
Only a small percentage of abortions take place after 15 weeks of gestation: In 2019, 95.6% of abortions reported to the Centers for Disease Control and Prevention occurred before week 16.
Most of these rare procedures are done for younger women and those with unplanned pregnancies, low incomes, or limited access to care. But older women who are already planning a pregnancy may be more likely to pursue an abortion after 15 weeks because of the higher risk of fetal abnormalities.
While a woman in her 20s has a one in 500 chance of conceiving a child with a chromosomal abnormality, the risk rises to 1 in 270 for a 30-year-old woman and 1 in 60 for a 40-year-old.
Studies have found that 67% to 85% of women chose to terminate their contract after being diagnosed with Down syndrome, the most common chromosomal abnormality, which leads to a range of physical problems. quality and development.
Amniocentesis, a procedure in which amniotic fluid is removed from the uterus and tested for chromosomal abnormalities in the fetus, and mid-pregnancy ultrasonography, all important for detecting structural abnormalities, can only be performed after 15 weeks and at 20 weeks gestation.
Furthermore, conditions that can pose a risk to pregnancy, such as high blood pressure, asthma, obesity, diabetes, and cardiovascular disease, are more common in older women and cause more problems during pregnancy. progression, putting stress on the heart, lungs and kidneys, some doctors note.
Women with college degrees have children on average seven years later than those without degrees, and the average age of marriage has risen to 28, up from 24 in 1990.
“Many women, myself included, have delayed childbirth to get through at least part of their career trajectory,” says Dr. Y Feinberg of Northwestern University in Chicago said.
“It leaves you in your mid to late 30s and you’re considered high-risk in the world of maternal care,” she added. “You have a higher risk of genetic defects and a greater risk of complications.”
At least 13 states have banned abortion outright, and Georgia banned the procedure at six weeks’ gestation. But of the states where abortion is legal, Florida is the only one with a 15-week statute of limitations. (Utah has an 18-week term, while others allow termination after that.)
Mr. Graham’s rationale for setting 15 weeks was the national deadline included in the title of his law, “Protecting Unborn Child Suffering from the Late Abortion Act.” This measure assumes that after 15 weeks, the fetus will feel pain.
But medical experts say the experience of pain requires the cortex, which does not develop until the end of the second trimester or the beginning of the third trimester – between 24 weeks and 28 weeks.
When asked about the scientific basis of this claim, a spokesperson for Mr. Graham’s office directed reporters to the website of the Charlotte Lozier Institute, the research institute of Susan B. Anthony Pro-Life America, which seeks to find ways. end all abortions.
The entry regarding pain relief is based primarily on an article published in a medical ethics journal, which does not dispute the developmental timeline of the fetal cortex, but suggests that other brain structures develop early. than may suffice for the same experience as pain.
But in an interview, the author of that paper, Stuart Derbyshire, an associate professor at the National University of Singapore, said he had no idea why Mr. Graham’s bill chose the 15-week deadline. The American College of Obstetricians and Gynecologists, which represents about 60,000 providers, calls the gestational age cited in the law arbitrary and unscientific.
Many scientists say the ability to perceive pain depends on consciousness, which Dr. Derbyshire emphasizes, the fetus does not have.
“We have been very clear in this article that we do not Dr Derbyshire said that a fetus in the womb would make a noise, ‘Oh no, that really hurts, damn this is a bad day’. “The fetus doesn’t have the experience of self-reflection that you and I have.”
The proposed bill also requires that if an abortion is performed after 15 weeks, the fetus must be hospitalized and a doctor trained in neonatal resuscitation must be present for care. But the earliest chance of surviving outside the womb is 22 weeks, according to a study published this year, and experts say fetuses born before that won’t survive.
Although technological advances have made it possible to screen for chromosomal abnormalities in pregnancy earlier than in the past, definitive diagnosis depends on prenatal testing: chorionic villus sampling, which involves take a tissue sample from the placenta to check for chromosomal abnormalities, or amniocentesis.
Sampling can be done earlier than amniocentesis, but it cannot be done safely until 10 weeks of pregnancy, and results are not usually known until 12 or 14 weeks. According to Dr. Stephen Chasen, specialist in maternal and fetal medicine at Weill Cornell Medicine, the drug is also not available at all medical centers.
Many centers rely on amniocentesis, which is not performed before the 15th week of pregnancy because the risk of complications is too high.
Ultrasound to check for structural abnormalities of the fetus – unlike chromosomal abnormalities – is done as early as 10 to 12 weeks of pregnancy, but a full anatomical scan Head-to-toe facials were performed at 20 weeks.
“There are many structural abnormalities, including some really serious conditions involving the brain, heart, kidneys and bone structure that are not suspected until the end of the third trimester,” says Dr. two or even the third trimester.
He added: “The vast majority of structural abnormalities will not be diagnosed or suspected before 15 weeks. “The 15-week ban would prevent pregnant women from having the opportunity to consider abortion.”
