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The Abortions of Last Resort : The Question of Ending Pregnancy in Its Later Stages May Be the Most Anguishing of the Entire Abortion Debate

January 07, 1990|KAREN TUMULTY | Karen Tumulty is a Times staff writer.

Abortion rights advocates argue that the truth, while not pretty, is not simple, either. The women who seek the latest abortions are often the saddest, most compelling cases: teen-agers who do not recognize the early signs of pregnancy, rape victims too ashamed to come forward, women who learn that they are carrying deformed fetuses, those whose lives and health are jeopardized, and--perhaps most frequently--the poor.

"Although these late abortions are infrequent, they are terribly important, because the women who need them need them desperately," says Dr. David Grimes, a USC professor of obstetrics and gynecology who is a leading medical voice in the abortion-rights movement.

Abortion-rights groups agree with their opponents on one point: It is a terrible thing that one in three pregnancies now ends in abortion. (California has the nation's highest abortion rate, 48 abortions for every 1,000 women aged 15 through 44 in 1985, the most recent year for which government statistics are available.)

But they insist that passing laws is not going to end abortion, just force it underground. Instead, they argue, opponents should look to the problems that are behind the more than 1.5 million abortions a year in the United States: contraception that is hard to use or hard to get, inadequate sex education and medical care, child abuse, and poverty that makes it all but impossible for some women to properly raise the children they already have.

IT IS EARLY, BUT already the graffiti-covered storefront office near downtown Los Angeles is almost full. At least 40 women and girls, some visibly pregnant, squeeze onto the hard benches in the stark reception area, waiting for their names to be called. Some struggle to quiet the fidgety babies and toddlers they have brought with them.

Poverty shows sharply here, in their faces, in their clothes and in their weariness. One middle-aged woman is called; a few minutes later, she returns. A sonogram has shown that she is 2 1/2 months pregnant, she tells the woman who is waiting for her. The news does not seem to surprise either of them. They talk about something else.

This Los Angeles clinic no longer schedules appointments because many of these women will not keep them. They come when they can. The people who work at inner-city abortion clinics hear the same frustrating stories over and over. They find that when catching a bus on time is too much to ask of a woman, regular contraceptive use is out of the question. Deadlines--whether to refill a birth-control prescription or to get an abortion early--are meaningless.

The administrator agrees to an interview, on the condition that neither her name nor that of the clinic be used. It is a private clinic, run by a former general practitioner, that does about 150 abortions a week. It accepts patients 26 weeks into their pregnancies. Asked the obvious question, the administrator sighs and says, "We have kind of gotten out of the habit of asking why they waited so long."

A 1987 survey by the Alan Guttmacher Institute, a nonprofit research and policy analysis organization dealing with reproductive health issues, indicated that girls under 18, blacks, unemployed women and those covered by Medicaid were far more likely than others to delay their abortions beyond 16 weeks after their last menstrual period.

"This is a poverty issue. Don't let anybody tell you any different. You don't see a lot of middle-class women having second-trimester abortions," says Anne Walshe, the blunt-spoken administrator of a Manhattan abortion clinic that she wants to remain anonymous. Her clinic, one of the nation's busiest, does as many as 16,000 abortions a year. At least half are performed during the second trimester.

Walshe shows little patience for the idea that a later procedure somehow poses a more difficult moral judgment. "What's the difference? Abortion is abortion. The nice folks who are debating this, who want to draw the line and put a limit on gestational age, will just be putting a restriction on poor women. Women who want abortions get them. It will just force the poor women back to unacceptable remedies."

Most Americans, however, do not accept the idea that being poor is reason enough to justify an abortion, even an early one. In a Los Angeles Times poll last year, only 41% answered yes when asked, "Should a pregnant woman be able to obtain a legal abortion if the family has a very low income and cannot afford any more children?"

The realities that Walshe sees every day, she admits, can be unsettling. "These women know they are pregnant, but not until the 16th or 17th week, when the fetus is kicking and bothering them, do they say, 'Oh, I have to deal with this,' " she says. "It's not that these women are bad, or they're wrong. They're just poor. They don't lead organized, routine lives."

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