Is reproductive health endangered by a “war on women” as Roe vs. Wade turns 41 this month? Some portray the recently passed laws limiting abortion beyond 20 weeks in 13 states and the U.S. House as a devastating salvo. Though these measures have significant public support, are they wise public policy?

Almost everyone can understand the need for abortion when infection, bleeding or illness threaten a mother’s life. But these reasons account for fewer than half of the abortions done beyond 20 weeks’ gestation. How many abortions would a 20-week limit affect?

Around 1 percent of abortions are done after 20 weeks. In Minnesota, of the 10,701 abortions reported in 2012, 74 were done at more than 20 weeks. Nationally, the number done beyond 20 weeks is more than 14,000. An abortion done only 21 to 28 days before an increasing number of babies survive at birth is a serious matter.

The maternal medical issues listed don’t include the tragic situations when a lethal fetal abnormality is discovered by ultrasound. Although there is support for abortion when fatal fetal abnormalities are found, many families increasingly choose perinatal hospice as a life-affirming option ( In a welcome but rare prochoice/prolife collaboration, Minnesota in 2006 became the first state to require an offer of perinatal hospice as part of the informed-consent process.

Perinatal hospice is a healthy option in tragic fetal situations, but more troubling are the large number of abortions done after 20 weeks because a fetus has Down syndrome or another nonlethal anatomic or inherited problem. Beyond concerns about a resurgence of the eugenic impulse, there is an inescapable incongruity in supporting abortion for these challenges in a nation that passed the Americans with Disabilities Act in 1990.

Over the last four decades, abortion has been a chapter in many personal stories. A recent look at my 1972 high school yearbook showed me the faces of 700 senior classmates in Tucson, Ariz. Guttmacher Institute research suggests that more than 100 — a third of my female classmates — will have chosen abortion at some point. Which explains the difficulty of having a calm public policy discussion of abortion.

Looking at my own geeky photo also reminded me that within a decade and a half, I would have my own experiences with abortion as a physician specializing in high-risk pregnancies. I have done abortions beyond 20 weeks in the rare instances when life-threatening complications required the ending of a pregnancy in the window between 20 weeks and viability. In those tragic situations, my intention was to save a woman’s life, not to end the life of an unborn child.

It may offend the sensibilities of some readers, but an abortion at 20 weeks is horrific. To make sure that the procedure is complete, the gruesome assembly of the puzzle pieces of a tiny human on a blue towel is required. It tests the boundaries of nausea. These experiences left me with great admiration for those whose job it is to recover bodies from explosions, plane crashes and battlefields with dignity. It is no wonder that a majority of Americans recoil from most 20-week abortions.

Advocates will say that abortion is 10 times safer than childbirth. This false claim is often repeated as a secular catechism. It compares hand grenades to apples. The Supreme Court relied heavily on this mantra to decide Roe vs. Wade. The recent release of the justices’ papers provides the true background of the 1973 decision — a story well reviewed in the new book “Abuse of Discretion” by Clarke Forsythe.

If it were really true that abortion is 10 times safer than pregnancy, all pregnant women would be offered abortion before prenatal care begins. The public health truth is that the risk is very low — and similar — for dying from a full-term pregnancy compared with an abortion before 15 weeks. The risk of maternal death is increased by 20 times in a 20-week abortion.

Although it declined this week to review Arizona’s 20-week ban, the Supreme Court eventually will weigh in again on this most divisive of social issues. What should guide the justices? Progressives have applauded recent changes in public opinion and law on the death penalty and gay marriage. They have argued for these changes on the basis of justice, shifting poll numbers and personal stories. We should use the same criteria to provide protection for unborn children beyond 20 weeks.

What could be more just than protecting women and their unborn children? Polling confirms this. The June 2013 HuffPost/YouGov poll of 1,000 adults found that 59 percent support a federal ban on most abortions beyond 20 weeks. Opposition to this ban is medically indefensible and morally incoherent. An extreme definition of reproductive rights should not trump safety and basic human rights.

If the death penalty were still imposed in Minnesota, the media would provide 24/7 coverage of a pending execution. Yet more than 70 times a year, a soon-to-be viable baby is aborted in this state — a third of the time paid for with taxpayer dollars.

The GOP establishment may be discomfited by talk of abortion and the DFL may focus on “Cradle to K” programs, but the controversy over abortion continues. It is time to have some hard conversations.


Steve Calvin is a Minneapolis physician.