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Imagine the future of abortion in America.

It could look like this: A woman walks into a pharmacy a few days after she misses a period. She buys two small pills, over the counter, and takes them home. The pills abort her early pregnancy -- weeks before she would have been eligible for a surgical abortion. She never needs to enter a clinic.

Or it could look like this: A new majority of conservative justices on the U.S. Supreme Court reverses Roe v. Wade, ruling that abortion is not a constitutional right protected by the federal government. Immediately, states craft their own laws. In some places, women can get abortions -- and in others, they can't. Congress passes a raft of pro-life legislation.

Either scenario could happen. Neither is certain.

And in 2002, no one -- no matter how passionately he might claim to -- can predict the future of abortion, the touchiest and most emotional issue the United States has faced as a nation since the era of slavery.

A few things, of course, are more likely to occur than others. Medical and educational advances are pointing the way ahead.

For example:

The number of abortions in the United States may well continue to shrink or hold steady at the lower levels seen across the country and in Western New York in the past few years, due to contributing factors such as better education on human sexuality, experts said.

Medical abortions -- those induced by the drug mifepristone -- will likely gain in popularity gradually in the United States, medical experts said.

Abortion clinics will probably remain a flash point for protests, since no one on either side of the issue foresees clinics closing their doors unless major changes in the laws occur.

And, many observers agree, ethical debates over new technologies involving abortion -- such as selective and reductive abortions -- may well cause splits within the monolithic group that today identifies itself as pro-choice.

It's a fact: Abortion in the United States has presented a complex, ever-changing picture in the past 30 years. A lot could happen in the next 30.

Congress and the courts

The most immediate place to look for changes that will shape the future of abortion? Congress and the federal judiciary.

In the wake of elections this month that gave Republicans control of both houses of Congress, both the pro-life and pro-choice camps are looking to the federal level with strong emotions.

Pro-life leaders have high expectations of President Bush. They want to see several significant pieces of pro-life legislation passed in Congress soon -- including bans on partial-birth abortions and cloning -- and they want Bush to fulfill past promises by signing off on the new laws.

Then they want to see conservative pro-life judges appointed to the federal bench -- and, if openings occur, to the U.S. Supreme Court. The Supreme Court currently favors abortion by the slimmest of margins, 5-4. Of the supporters of abortion on the court, two have battled cancer and another, Justice John Paul Stevens, is 82.

"The elections spoke. Abortion is a judicially created right, and it should be overturned," said Phyllis Schlafly, founder of the Eagle Forum, a national conservative watchdog group. "Abortion would then become a matter of state law, which is where it should be."

On the pro-choice side, leaders said they are looking to Congress and the White House with very different emotions -- such as fear and trepidation.

Access to unimpeded abortions will be threatened in coming months, said Vicki Saporta, executive director of the National Abortion Federation, a group that represents abortion providers.

"With the recent elections, we now have both houses of Congress controlled by an anti-choice majority, and we have an anti-choice White House," Saporta said. "I expect any number of pieces of anti-choice legislation to be passed by Congress and signed by the president."

Still, Saporta does not expect a full-scale assault on Roe v. Wade. If that happens, she said, the country can expect to see a "huge backlash."

Shrinking numbers

Two major trends in abortion have emerged in recent years, and both may well continue for some time, shaping the immediate future of the abortion debate, according to observers on both sides of the issue.

First, the number of abortions obtained by women in the United States each year is shrinking. Second, abortions are more and more concentrated among poor women.

In both of these aspects, what's happening in Erie and Niagara counties dramatically mirrors the larger national picture.

Nationwide, there was an 11 percent drop in the number of abortions between 1994 and 2000, but abortion rates increased among women who live in poverty, according to a new study by the Alan Guttmacher Institute in New York City.

Data on abortions obtained by The Buffalo News from the state Department of Health and Erie County shows that:

Over the 10-year period from 1990 to 2000, the number of reported abortions in Erie County declined steadily from more than 7,000 annually to 4,836 -- a drop of nearly 32 percent overall.

In Niagara County, the number of reported abortions in 2000 -- 867 procedures -- is 24 percent lower than the 1990 figure of 1,140 abortions. There were some year-to-year fluctuations during that period, but the number has hovered between 800 and 900 abortions for the last three years for which records are available.

In the last three years for which data on Medicaid coverage of abortions is available, 1997 through 1999, the percentage of poor women in Erie County obtaining abortions through Medicaid increased from slightly less than 34 percent of all abortions to a full 37 percent.

During the same period, the number of poor women in Niagara County obtaining abortions under Medicaid increased from about 25 percent of all abortions in that county to nearly 28 percent.

In Erie County, Medicaid coverage of abortion is split between the state and the county, with each picking up half the tab for an abortion, state Health Department officials said.

Advances in abortion

Despite the declining numbers, no one involved in the debate over abortion thinks that abortion clinics are about to vanish from the American landscape.

Clinics will also survive in the face of new medical advancements, observers said.

"There will always be a need for surgical abortions," said Saporta, at the abortion federation.

Still, some predict that medical advancements in pill-induced abortions will lead more women to choose that option in the future.

Right now, a medical abortion with mifepristone, or the RU-486 pill, involves at least two office visits, doses of two different drugs, heavy cramping and bleeding, and an abortion that takes place at home. It takes about two weeks to know whether the abortion was a success.

Those unappealing aspects are some of the reasons pioneering abortion doctors -- including a Rochester expert, Dr. Eric A. Schaff, who is involved with the clinical trials of RU-486 -- are excited about new advances to the abortion pill currently in the works.

A peek into the future of the abortion pill shows that:

Mifepristone may become an option that is available to women longer, up to nine weeks of pregnancy and beyond, rather than for the seven weeks currently permitted by the federal Food and Drug Administration, which approved the drug in 2000.

Doctors, led by Schaff, are testing a new method of administering the second drug taken in a medical abortion, misoprostol. Instead of inserting the second pill vaginally, as is required now, doctors want to make misoprostol an oral medication -- which they think will be more popular with women.

"These are very good medications," said Dr. Schaff. "We are actually very confident in this. These trials are both very promising."

Splits in pro-choice side

But as abortion technology advances, some people may become uncomfortable with what is suddenly possible, said observers on both sides of the issue.

One example: selective abortion, which means choosing among multiple fetuses for certain characteristics -- such as male or female gender, or to eliminate those with disabilities.

Another example: reductive abortion, which means creating several embryos and then reducing the number by aborting some of them.

Such procedures -- which are already being done, in small numbers -- may ultimately lead to splits among people who up to now have had no trouble labeling themselves pro-choice, experts on both sides said.

Add potential developments like "fetal adoptions" to the mix -- the transplanting of fetuses from women who don't want them to women who do, or to "artificial wombs" -- and the picture gets even murkier.

Dr. Adrienne Asch, a Wellesley College professor who served on the Clinton administration's task force on health care reform, said that some of these coming fractures in the pro-choice movement are already developing.

"There are certainly people who are pro-choice who worry about selective abortion," said Asch. "Many physicians support sex selection because they support a woman's choice, but many feminists oppose sex selection because they don't feel people should be able to select against sexes."

On the other hand, Asch said, "many people who are not pro-choice on other things are for abortion if there is a disability that's been diagnosed."

Carrie Gordon Earll, a bioethicist at Focus on the Family, a national pro-life organization, said that rapid advancements in the technology relating to fetal life are good because they will force people to examine their own views on what is right and what isn't.

"The technical side of abortion will continue to raise ethical questions for those who support the right to abortion," Earll said. "I see a collision course between the humanity of the unborn child ... and the legislatively created right to an abortion."

That means that women's bodies and fetuses will continue to be at the center of what will remain, as all agree, a hotly contested debate.

"Most definitely," said Earll, "you are going to have a continued debate about what's going on in the womb."


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