When Senator Lindsey Graham, Republican of South Carolina, proposed a nationwide ban on abortion after 15 weeks of pregnancy, the bill sparked controversy across the political spectrum. But few have spoken of its potential impact on the growing number of women in their thirties who are having children.
The proposed ban would allow exceptions for saving 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 severely restrict options for the growing number of older women whose pregnancies are long delayed and highly sought after, but which also come with an increased risk of diseases like Down’s Syndrome.
The median childbearing age 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 conceive fetuses with chromosomal abnormalities, and the test the most commonly used to detect these disorders can only be performed after 15 weeks of pregnancy, beyond the window proposed by Mr. Graham for abortion.
Some anatomical abnormalities also cannot be diagnosed until later in pregnancy. Older mothers are also more likely to enter a pregnancy with health problems that may worsen as gestation progresses and may require pregnancy termination to save the woman’s life or prevent disability.
While highly educated women have long delayed childbearing, American women of all economic, racial and ethnic backgrounds are having children later in life, according to Census Bureau survey statistician Anne Morse. The biggest changes were among black mothers and women who weren’t born in the United States, whose median age at childbirth increased from 24 to 28 and from 27 to 32, respectively, over the past 30 years.
“There have been steep declines in births among women in their twenties in every demographic group,” Dr. Morse said. And every demographic except Native American and Alaska Native women saw an increase in the birth rate among women ages 35 to 39, she said.
Mr Graham’s bill, which is not expected to pass a Congress tightly controlled by Democrats, has been controversial even among Republicans who oppose abortion, and several Republican senators have told reporters that it was best left to 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 the 16th week.
Most of these rare procedures are performed on younger women and on women with unplanned pregnancies, low income or limited access to care. But older women who have planned their pregnancies may be more likely to have an abortion after 15 weeks due to the higher risk of fetal abnormalities.
While a woman in her early twenties has a 1 in 500 chance of conceiving a child with a chromosomal abnormality, the risk rises to 1 in 270 for a woman in her 30s and 1 in 60 for a woman in her 40s.
Studies have shown that 67-85% of women choose pregnancy termination after a diagnosis of Down syndrome, the most common chromosomal abnormality, which causes a range of physical and developmental problems.
Amniocentesis, a procedure in which amniotic fluid is removed from the uterus and tested for chromosomal abnormalities in the fetus, and the all-important mid-pregnancy ultrasound that detects structural abnormalities, can only be done after 15 weeks and at 20 weeks of gestation, respectively.
Additionally, conditions that can make a pregnancy risky, such as hypertension, asthma, obesity, diabetes, and cardiovascular disease, are more prevalent in older women and pose more problems as the pregnancy progresses. progresses, straining the heart, lungs and kidneys, several doctors have noted.
Women with a university degree have children an average of seven years later than those without a degree, and the average age at first marriage has risen to 28, up from 24 in 1990.
“Many women, myself included, have delayed childbearing to complete at least part of their careers,” said Dr. Melissa Simon, vice chair for research in Northwestern’s department of obstetrics and gynecology. University Feinberg School of Medicine in Chicago.
“That puts you in your mid to late thirties and you’re considered high risk in the world of maternal care,” she added. “You are at higher risk for genetic abnormalities and higher risk for complications.”
At least 13 states have completely banned abortion, and Georgia has banned the procedure at six weeks gestation. But of the states where abortion is legal, Florida is the only one with a 15-week limit. (Utah has an 18-week limit, while others allow later terminations.)
Mr Graham’s rationale for setting 15 weeks as the national threshold is embedded in the title of his legislation, “Protecting Pain-Capable Unborn Children From Late-Term Abortions Act”. The measurement supports that after 15 weeks, a fetus feels pain.
But medical experts say experiencing pain requires the cortex of the brain, which doesn’t develop until late in the second trimester or early in the third trimester – somewhere between 24 weeks and 28 weeks.
Asked about the scientific basis for the claim, a spokesperson for Mr. Graham’s office directed a reporter to the website of the Charlotte Lozier Institute, the Susan B. Anthony Pro-Life America research institute, which seeks to end all abortions.
The entry regarding pain 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 developing earlier may be sufficient for an experiment. which looks like pain.
But in an interview, the author of this article, Stuart Derbyshire, an associate professor at the National University of Singapore, said he did not know why Mr Graham’s bill chose 15 weeks as the limit. The American College of Obstetricians and Gynecologists, which represents some 60,000 providers, called the gestational age cited in the law arbitrary and unscientific.
Many scientists say that the ability to feel pain depends on consciousness, which, Dr. Derbyshire pointed out, the fetus does not have.
“We have been very clear in this document that we are not saying the fetus in the womb is going, ‘Oooh no, that really hurts, damn it’s a bad day,'” Dr Derbyshire said. “The fetus does not have the conscious, reflective experience that you and I have.”
The proposed bill also requires that if an abortion takes place after 15 weeks, the fetus be hospitalized and a physician trained in neonatal resuscitation be present to provide care. But the first viability outside the womb is 22 weeks, according to a study published this year, and experts say fetuses born earlier cannot survive.
While technological advances have made it possible to detect chromosomal abnormalities earlier in pregnancy than in the past, obtaining a definitive diagnosis depends on prenatal screening: either chorionic villus sampling, which involves taking a sample of tissue from the placenta to look for chromosomal abnormalities, or amniocentesis.
The sampling method can be done earlier than amniocentesis, but it can only be done safely after 10 weeks of pregnancy, and the result is often not known until the 12th or 14th week. It’s also not readily available at all medical centers, according to Dr. Stephen Chasen, maternal-fetal medicine specialist at Weill Cornell Medicine.
Many centers rely on amniocentesis, which is not offered before the 15th week of pregnancy because the risk of complications is too high.
Ultrasounds to check for structural abnormalities in the fetus – which are not the same as chromosomal abnormalities – are done as early as around 10 to 12 weeks of pregnancy, but the full head-to-toe anatomy scan is done at 20 weeks.
“There are many structural abnormalities, including some very serious conditions involving the brain, heart, kidneys and skeletal structure that can only be suspected late in the second trimester or even in the third trimester,” said the Dr Chasen.
“The majority of structural abnormalities would not be diagnosed or suspected until 15 weeks,” he added. “A 15-week ban would prevent women with these pregnancies from considering abortion.”