Are Abortion Clinics Giving Women the Information They Need?

A service of Project REACH

“The bottom line is no woman is going to want to get an abortion after she sees a sonogram.”  —Abortion provider on Long Island, quoted in the New York Times, Feb. 24, 2002.

Do woman entering abortion facilities receive adequate information about the risks associated with the surgical procedure and the development of the fetus they are carrying? Does information given in abortion clinics fulfill medical and legal requirements for informed consent that is routine in other surgical procedures?

            Why are abortion advocates allowed to tell a pregnant woman that her well-formed fetus that has a beating heart is no more than a “clump of cells,” while the U.S. Supreme Court has ruled that accurate information on fetal development may be vital to the abortion decision?

            Why are the physical and emotional side effects of abortion routinely played down or addressed inadequately in counseling or consent forms used by clinics?

            Why are abortion clinics, which nationwide perform one of the most frequent forms of surgery, so loosely regulated and so lightly scrutinized?

            These questions are being asked more frequently as the number of medical malpractice suits against abortion clinics grows and as the tide of women injured physically and psychological by abortion rises. The voices of these women are beginning to be heard, and the evidence indicates that  many women who have had abortions were not given the information necessary for them to make an informed and educated choice before they were led to the operating table.

THE VOICES OF WOMEN

            Project REACH reaches out to many of these women through the pro-life pregnancy centers it serves. Women in the New York metropolitan area come to pregnancy centers with sad stories about past abortions. They tell of technicians turning sonogram screens away from them so they wouldn’t see the true human development of the child in their wombs. They say they were told that the fetus was just a clump of blood and tissue, and that they felt betrayed and deceived when they learned later the truth about fetal development.

             “I didn’t know. Why wasn’t I told?” they say, as they struggle to accept the loss of the aborted child whom they will never hold.

            As a service to these women who underwent abortion without knowing what was being done to them and their unborn child, and to prevent other women from suffering in the same way, Project REACH explores the issue of informed consent. Through legal research, and a balanced presentation of the facts of fetal development and the medical risk factors, we hope to give women the information they need to demand their right to informed consent about a serious procedure.

            We begin with an interview with Thomas Strahan, a lawyer and researcher who has written extensively on the issue of informed consent. He is editor of the Research Bulletin of the Association for Interdisciplinary Research in Values and Social Change.

THE LAW FAVORS INFORMATION FOR WOMEN

Q. Mr. Strahan, why is informed consent such an important issue?

A: Informed consent law requires that a medical professional disclose to a patient the reasonably foreseeable risks and benefits of a proposed medical procedure in order that the patient can make a knowledgeable evaluation. Part of the proof of lack of informed consent is that the patient would not have undergone the medical procedure if she had been fully informed and that the lack of information caused the injury or condition for which recovery is sought. Because of respect for the patient’s right of self-determination, the standard is set by law for medical professionals rather than by doctors regulating themselves.

Q: What has the U.S. Supreme Court said on informed consent in the abortion context?

A: The necessity of an informed consent prior to undergoing an induced abortion is recognized by the U.S. Supreme court. In a 1976 decision, the Court upheld the constitutionality of a Missouri law which provided that a woman seeking an abortion during the first 12 weeks of pregnancy must certify in writing, prior to the abortion, that her consent is informed and fully given and not the result of coercion. In upholding this law, the Court said “the decision to abort is an important, and often a stressful one, and it is desirable and imperative that it be made with full knowledge of its nature and consequences.” (Planned Parenthood of Central Missouri v. Danforth)

            In Akron v. Akron Center for Reproductive Services (1983), the Court said that it is  “primarily the responsibility of the physician to ensure that appropriate information is conveyed to his patient, depending upon her particular circumstances.” In this same case the Court said that “a state may require that a physician make certain that his patient understands the emotional and physical implications of having an abortion.”

            In Planned Parenthood v. Casey (1992) the Supreme Court upheld a Pennsylvania law requiring a doctor or a counselor, prior to abortion, to offer the woman an opportunity to see materials designed to inform her of the probable anatomical and physiological characteristics of the unborn child at two-week increments from fertilization to full term, and any relevant information on the possibility of the unborn child’s survival outside the womb at the current point of development. It was required that these materials be realistic and appropriate to the woman’s stage of pregnancy, and designed  to convey only accurate scientific information.

            In rendering this decision, the Court recognized an important state interest in “potential life” and further said, “it cannot be questioned that psychological well-being is a facet of health. Nor can it be doubted that most women considering an abortion would deem the impact on the fetus relevant, if not  dispositive, to the decision. In attempting to ensure that a woman apprehend the full consequences of her decision, the state furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating consequences, that her decision was not fully informed. Requiring that the woman be informed of the availability of information related to fetal development is a reasonable measure to insure an informed choice, one which might cause the woman to choose childbirth over abortion.”

ACCURATE INFORMATION ON FETAL DEVELOPMENT

Q. Is accurate information on fetal development essential to informed consent?

A: Yes. As just quoted, the U.S. Supreme Court has identified accurate information on fetal development as “relevant, if not dispositive” to the decision regarding bearing a child or having an abortion. Probably the best way to obtain this information is from an accurate sonogram or ultrasound. It appears that a large percentage of pregnant women want a prenatal sonogram. Fetal images via use of ultrasound have been linked to the “personification of the fetus” and appear to increase attachment and bonding between the woman and unborn life in her womb. Some women, and especially young women, who may consider abortion are in various stages of denial about their pregnancy. Viewing a fetal image would be likely to break down some or all of her denial. Other women with low self-esteem may consider life in her womb as an aspect of her “bad self” that should be eliminated. Viewing a fetal image may help her to see that the life inside of her is separate and distinct from herself. Still others may be ignorant about the development of human life in the womb. Ultrasound fetal images can assist in the educational process.

            Some pro-life pregnancy service centers have reported that a majority of women who have a sonogram will decide to carry their unborn child to term. A recent report by a pregnancy service center in a large urban area on the east coast, reported that 75 percent or more of pregnant women who were considered at-risk for abortion decided to carry the child to term after viewing ultrasound images. Prior to the use of ultrasound, only about 25-30 percent of women at-risk for abortion opted for childbirth after counseling only.

ABORTION RISK FACTORS

Q. What  does your research disclose about the reasonably foreseeable risks from abortion?

A: The reasonably foreseeable physical, emotional and reproductive risks from abortion vary greatly depending upon a woman’s reproductive history, including the number of prior abortions, whether or not she has preexisting bacteria or viruses present at the time she has an abortion, whether or not she has a history of depression or other psychological or psychiatric problems, her beliefs about abortion and whether or not she is violating these beliefs by undergoing an abortion, her degree of attachment to the unborn life in her womb, her attitude toward herself and others such as her own mother or the child’s father, as well as other factors. A review article written by researchers who favor legalized abortion identified younger and unmarried women without children, women whose culture or religion prohibits abortion, those who attend church frequently, women who have second trimester abortions, and those with more meaningfulness and attachment to the pregnancy are more likely to have negative psychological reactions compared to women who do not have these characteristics.

MISREPRESENTATION OF RISK FACTORS BY CLINICS

Q: Your research  indicates that not only are women not getting the information they need, but in some cases they are receiving misinformation from abortion clinics. Could you explain.

A: An important reason for lack of information or misinformation is lack of individualized counseling at abortion facilities. Frequently women are counseled in groups, if at all, and if there is any individualized counseling, it is of only a very short duration. Medical and social histories of women, when obtained, contain only minimal information. Many abortion facilities also use standardized information and consent forms that are given to virtually every woman who seeks an abortion. Frequently, possible risks are omitted or understated. Because of the individual needs and circumstances of women, this does not meet the requirements of an informed consent because of the widely varying risks from abortion.

            Another reason for lack of information is failure of abortion facilities to diagnose preexisting conditions such as bacteria or viruses which would significantly increase the likelihood of postabortion infections such as upper genital tract infections that may complicate future pregnancies, or pelvic inflammatory disease, a major cause of infertility.

            The need for counseling based upon the particular circumstances of each woman was recognized by the U.S. Supreme Court in Akron v. Akron Center for Reproductive Services (1982). The standards of the National Abortion Federation adopted in 1986, state “patients must be supplied with materials that accurately pertain to their circumstances.” The American Psychological Association also stated in a friend of the court brief filed in Planned Parenthood v. Casey (1992) that, “Pregnant  women approach the possibility of abortion with widely varying backgrounds, attitudes, levels of knowledge, and familial and social support systems. To be effective, the content of the counseling must be tailored to those individual differences and needs.”

TAKING ACTION

Q: What can women do who have been injured by abortion or who think they did not receive enough information before their abortion?

A: If a woman would not have had an abortion if she had the proper information and believes that she has suffered a physical, emotional or reproductive injury as a result, she should seriously consider one or more of the following:

1. First, obtain a copy of your records from the abortion facility. This may not be easy, but be persistent.

2. Attempt to determine whether or not this type of situation has arisen among other women and if it is described in the medical, psychological or social literature. This will help determine if a reasonably prudent person should have known about this risk.

3. Seek legal advice from a qualified attorney who is experienced in abortion injury cases. In every state there are relatively short time limitations for bringing any legal action, so act promptly.

4. If the abortion took place in New York City, seriously consider writing a detailed letter to the Commissioner of Health of the City of New York. The letter should describe  the time and place of the abortion, the name of the doctor and any other personnel involved, if known. Also include what information was not disclosed or was misrepresented, and what injuries occurred as a result.

5. Contact your local pro-life pregnancy center. See a list of centers under LINKS on this Web site, or send an e-mail to Project REACH at info@projectreach.org.

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