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Partial Truths

TIMES STAFF WRITER

In the gut-wrenching debate over “partial-birth abortion,” truth has been elusive:

* In 1995, when abortion foes claimed doctors were poking scissors into the skulls of living fetuses being dragged down the birth canal, abortion rights groups scoffed, insisting that anesthesia given to a pregnant woman kills the fetus beforehand. Anesthesiologists promptly blasted abortion rights leaders for spreading scientific bunk.

* Last April, the nation’s Catholic bishops ran a newspaper ad suggesting that the reasons women seek late-term abortions include “can’t fit into prom dress.” A few days ago, a bishops’ spokeswoman admitted the line was invented by an ad agency.

* In February, after abortion rights lobbyist Ron Fitzsimmons confessed to lying about there being only 450 partial-birth abortions a year, other activists implied that their similarly low numbers were meant to cover just the final three months of pregnancy. But of the three U.S. doctors known to perform abortions that late, two use another method--and the third died in 1995.

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* Haunting illustrations used by antiabortion groups to depict the partial-birth procedure have been attacked by critics for showing “fully developed, Gerber babies” instead of the 5- and 6-month-old fetuses more commonly destroyed by the method. Abortion foes have argued that the drawings are of second-trimester fetuses. But in January, the Catholic bishops had to find a new diagram after their original medical illustrator told them he was “pro-choice” and didn’t like the way his art was being used to inflame public opinion. He also said the bishops’ ad agency had instructed him to draw a third-trimester fetus.

And so it goes. For almost two years, a phalanx of lawmakers, feminists and theologians has waged bitter war over this unusual medical procedure. They’ve also spun so many contradictory facts and figures that some observers call it the “partial-truth abortion debate.”

Now, as a bill to outlaw the procedure once again moves through Congress (which failed to override President Clinton’s veto of a similar measure last year), the claims of both sides are under increasing scrutiny.

But getting to the facts behind the rhetoric is like wandering through a hall of mirrors. Both camps seem willing to fudge and fabricate to gain the public relations high ground.

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The dispute originated in a Dallas hotel in September 1992. There, an Ohio doctor named Martin Haskell presented a how-to paper to the National Abortion Federation on a surgical procedure he called D & X, for dilation and extraction.

Unlike traditional late-term abortions, in which a fetus is dismembered inside the womb and removed in pieces, D & X removes the fetus intact, Haskell wrote. First, the surgeon inserts seaweed-based dilators to expand the woman’s cervix, a three-day process that causes painful cramping (the same method is used for traditional late abortions).

Then, guided by sonogram, he reaches into the womb with forceps and grabs a foot. He pulls out the body except for the head, which is too large to pass without injuring the woman. To overcome that obstacle, the doctor punctures the fetal skull, inserts a vacuum tube and suctions out the brain.

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Not long after the Dallas seminar, a copy of Haskell’s paper found its way to the National Right to Life Committee. And the debate officially drew its first breath.

One of the earliest skirmishes--ignored by most of the media--centered on Brenda Shafer, an Ohio nurse who claimed she witnessed Haskell’s operation while assigned to his clinic by a temporary agency.

In gruesome detail, Shafer told Congress about the abortion of a 26 1/2-week-old fetus with Down’s syndrome. Shafer, who now charges $1,500 per appearance on the lecture circuit, said she saw the fetus’ fingers “clasping and unclasping, and his feet kicking” as the doctor pulled it from the birth canal. When Haskell stuck scissors into the small skull, she testified, the baby’s arms “jerked out in a flinch,” then went limp.

In response, Haskell’s clinic sent a letter noting several errors in the story. The letter said that the fetus wouldn’t have been kicking, that the doctor didn’t use ultrasound and that he never terminated pregnancies beyond 24 weeks.

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But Haskell’s Dallas paper indicated otherwise. It not only described his ultrasound technique, but said he used D & X on “selected patients 25 through 26 weeks.”

Antiabortion forces also produced a 1993 interview with the American Medical Assn.'s weekly newspaper, the American Medical News, in which Haskell said two-thirds of the 700 fetuses he had aborted were alive until the very end.

Haskell hinted he was misquoted. But the interview was on tape. It was just a taste of the fact-bending to come.

The biggest distortions--from both camps--revolve around three questions: How many are done? At what stages of pregnancy? And for what reasons?

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Tallying the Numbers

Throughout, supporters of legal abortion have claimed--and most of the media have repeated--that the D & X procedure happens rarely (450 to 600 times a year), mostly in the third trimester and never unless the fetus is deformed or the mother’s life is jeopardized.

But last September, the Washington Post and the Bergen County (N.J.) Record found evidence of thousands of cases, usually in the fifth or sixth month of pregnancy (a point at which some fetuses can live outside the womb), and most involving healthy women and babies.

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As one clinic physician told the Record, “Most are Medicaid patients, black and white, and most are for elective, not medical reasons: people who didn’t realize or didn’t care how far along they were. Most are teenagers.”

Based on interviews with abortion providers, the Post estimated several thousand partial-birth abortions a year; the Record reported 1,500 in New Jersey alone.

Kate Michelman of the National Abortion and Reproductive Rights Action League swiftly asserted that the Record reporter “got it wrong.” And the National Organization for Women dispatched an Internet memo implying the stories were “planted by abortion opponents.”

(When The Times asked NOW for evidence, a spokeswoman said the organization didn’t have time to bother responding and suggested that a “right-wing plant” supplied the memo to The Times.)

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Even before the articles came out, the abortion rights community was deeply split over D & X, with longtime allies like New York Democratic Sen. Daniel Patrick Moynihan calling it borderline infanticide.

Then lobbyist Fitzsimmons jumped into the fray. As head of the National Coalition of Abortion Providers, Fitzsimmons cuts an unusual figure in the reproductive-rights movement. He has appeared on Pat Robertson’s TV show and hosted antiabortion activists in his office, including Paul Hill, who later murdered a Florida abortion provider.

He also subscribes to feminist author Naomi Wolf’s controversial strategy of defending abortion by admitting it’s a form of killing and honestly discussing the moral ambiguities involved.

Remorseful that he failed to do that in a 1995 interview with ABC’s “Nightline,” Fitzsimmons told the American Medical News he knew of 3,000 to 5,000 procedures a year, mostly second trimester and usually on healthy fetuses and moms.

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Vindication for abortion opponents? Not quite.

Although antiabortion leaders have seized on Fitzsimmons’ numbers, they invariably fail to mention one whopping footnote: All the cases he cites would remain perfectly legal, because the clinics he represents supposedly kill the fetus in the womb--by injecting it with poison or cutting the umbilical cord--before starting the procedure. Under the bill, abortions are forbidden only if the fetus is killed outside the womb, in the birth canal.

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The irony of the whole battle over partial-birth abortion, Fitzsimmons says, is how easily the ban could be skirted.

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At National Right to Life Committee headquarters, spokesman Doug Johnson acknowledges the loophole. But he also doubts that most clinics kill the fetus in advance: Snipping the umbilical cord, for instance, requires waiting four to 20 minutes for the fetus to die, a delay some doctors might want to skip.

Antiabortion forces also trumpet the Record’s report of 1,500 D & X abortions--all involving live fetuses--in New Jersey. But that figure, too, is problematic.

According to the paper, two doctors at Metropolitan Medical of Englewood estimated that their clinic performed 3,000 abortions a year on fetuses 20 to 24 weeks old, half by partial-birth techniques.

Metropolitan, one of only two New Jersey clinics authorized to do abortions that late, fired back with a letter saying that documents it submits to the state health department and medical board “show that the annual number of abortions between 12 and 23.3 weeks is about 4,000, with the majority . . . between 12 and 16 weeks.”

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Others have questioned the article on statistical grounds. For example, according to federal studies, the percentage of abortions occurring past 20 weeks averages about 1.3% nationwide. If the newspaper’s number is correct, New Jersey’s percentage of late abortions would be 5.5%, four times higher than almost any other state in the survey.

Then again, Metropolitan’s math doesn’t inspire great trust.

The abortion numbers it turned over to the health department and medical board last year were completely at odds with each other, say state officials, who after a five-month investigation came up with yet another number. The new total is much lower than the newspaper’s, but officials won’t release an exact number.

Even some skeptics concede privately that the Record probably quoted the doctors accurately. Which leaves two puzzling possibilities: Either the physicians were independently wrong, or New Jersey (and maybe other states) underreports the number of abortions done later in pregnancy.

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And therein lies another flash point in the debate: the number of terminations done after fetuses reach viability.

It’s a tricky question. Some states, including California (which is said to have one of every four U.S. abortions), don’t count pregnancy terminations of any kind. So the closest thing to a ballpark figure, based on 1992 research by the Centers for Disease Control and Prevention and the Alan Guttmacher Institute (an affiliate of Planned Parenthood), is that 20,000 of the nation’s 1.5 million estimated annual abortions occur at 21 or more weeks of pregnancy.

Viability begins several weeks after that cutoff. At 23 weeks, one in four babies survives at least 30 days, says Dr. Valerie Rappaport, professor of maternal medicine at the University of New Mexico. By 25 weeks, which is the national medical standard for viability, about 40% live, but many suffer severe disabilities, usually cerebral palsy, chronic lung problems or blindness.

It’s unclear how many abortions fall into the viable range and what percentage of them are by partial-birth methods. It’s even more uncertain how many happen in the final trimester of pregnancy. Guttmacher says 600 tops. But former Surgeon General C. Everett Koop estimated, in 1984, about 4,000 abortions of all kinds in the seventh, eighth and ninth months (although he now can’t recall his source).

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Fact and Fiction

Perhaps the most explosive facet of the debate is why women abort late in pregnancy. Defenders of D & X have presented a number of women who say tragic fetal deformities or severe health risks forced them to opt for partial-birth abortion, which their doctors advised was the safest method.

Several stood by Clinton as he vetoed the bill last year, and their testimonials made a compelling case for keeping the procedure legal.

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Abortion foes have countered in several ways. One of the most visible is the Physicians’ Ad Hoc Coalition for Truth, which presents itself as an independent, 400-member group of doctors out to dispel medical myths about the procedure.

In various forums, PHACT’s obstetricians and fetal specialists have said D & X is never necessary to preserve a woman’s health--and can be potentially dangerous.

To be sure, many of PHACT’s claims are grudgingly acknowledged as valid by some defenders of the procedure. But PHACT isn’t entirely objective. Co-founder Dr. Pamela Smith is president of the American Assn. of Pro-Life Obstetricians and Gynecologists, and PHACT spokesman Gene Tarne admits that none of the 100 members he’s met are “pro-choice.”

Antiabortion forces have also run a series of provocative newspaper ads.

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“This is infanticide,” declares the latest full-pager from the nation’s Catholic bishops. Abortion rights groups complain that the accompanying illustration is misleading because the fetus--complete with eyelashes, hair, and tiny fingers and toes--looks full term.

Even the bishops’ chief ally at National Right to Life admits the drawing is questionable. “It’s at least 29 weeks,” Johnson says. Then again, NRLC’s illustration, which is said to depict a 22-week fetus, has also come under attack.

So it’s possible that no illustration would be acceptable to supporters of legal abortion. Even at 20 weeks, doctors say, a developing fetus appears remarkably full-formed, right down to fingerprints.

Another ad took on Clinton’s remark that he would sign the partial-birth act if it included an exception for the “health of the mother.”

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As defined by the Supreme Court’s Doe vs. Bolton case, health covers “all factors--physical, emotional, psychological, familial and the woman’s age.”

The ad, paid for by the bishops, listed examples of how a “health” exception might apply in real life. Women would seek abortions, it said, because they “hate being fat” or “can’t afford a baby and a new car.” There was also the infamous “can’t fit into prom dress” excuse.

NARAL’s Michelman denounced the prom line as a lie. Bishops’ lawyer Helen Alvare concedes it was fiction, “inspired by” a file of other, documented frivolous reasons that some women abort. The idea was to shock people into realizing how loose a “health exception” would be, Alvare says.

But the National Abortion Federation’s Vicki Saporta vigorously denies that women seek late abortions for anything but medical crises. She points out that 40 states, including California, have laws restricting post-viability abortions.

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As a practical matter, that’s true. Most doctors won’t touch abortions past 24 weeks or so. And contrary to statements from numerous antiabortion politicians, few, if any, women would want to abort a healthy baby in the eighth or ninth month, Saporta says.

From a legal standpoint, however, Alvare and the bishops are right: If a woman can find a doctor who says her emotional health is disturbed by a pregnancy, she can get an abortion at any stage of pregnancy.

States aren’t allowed to define when a fetus is viable. The Supreme Court leaves that to the physician.

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Backers of legal abortion insist there is “no evidence” of viable fetuses being aborted for light reasons. Those assertions, however, contradict information from doctors who perform the procedures.

In a 1993 interview with American Medical News, Haskell (who no longer speaks to the press) said, “In my particular case, probably 20% are for genetic reasons and the other 80% are purely elective.”

The late Dr. James McMahon, who specialized in third-trimester abortions and helped pioneer partial-birth techniques at his Eve Surgical Center in Los Angeles, submitted documents to Congress analyzing the reasons for nearly 2,000 of his cases.

He said 9% were done for maternal health problems, most commonly depression and rape. Another 54% involved serious fetal defects, ranging from lack of a brain to congenital heart disease. But there were also nine cases of cleft lip, which can be surgically corrected.

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Because McMahon died in 1995--and because his partner, Dr. Robert Bitonte, declined to be interviewed--it’s difficult to interpret his data precisely.

So both sides have tried to put their own spin on his charts and writings. When asked about the oft-cited cleft lips, for example, the National Abortion Federation says the fetuses had multiple defects, so that was never the sole reason for an abortion.

NRLC’s Johnson says that’s illogical: If McMahon’s breakdown of 2,000 abortions includes many with multiple defects, it stands to reason there would be, say, 4,000 fetal and maternal health problems listed. Instead, there are only 1,358, which leaves about a third of his cases with no apparent health troubles at all.

Even in cases where the fetus is “flawed,” antiabortion forces still oppose ending the pregnancy. They argue that some of the abnormalities can be corrected with surgery.

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But Dr. Warren Hern, a Colorado practitioner who wrote the most widely used textbook on abortion, dismisses the notion that late termination can be so easily avoided. Hern, who also does later abortions (although he doesn’t use the D & X method, which he considers potentially dangerous to the woman), rattles off case after case of doomed fetuses and women who wouldn’t survive if they carried to term.

In a 1992 New York Times interview, he said, “The idea that we have to salvage every [baby] no matter how impaired is really crazy. Some people feel that taking care of an impaired child is ennobling and that’s fine for them. But it’s not for everybody. It’s oppressive to say that everyone has to do this.”

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The Move Toward Legislation

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Partial-birth combatants also offer conflicting views on the method’s safety and legality.

One East Coast physician, who performs about 150 per year and has taught the technique at several medical schools, says he uses it “whenever I can because it’s safer.” The main alternative, dismembering the fetus in utero and removing the pieces, entails a small risk of having a fetal bone perforate the woman’s uterus or cervix, he explains.

On the other hand, Hern, who opposes efforts to ban the method as an attempt to undermine Roe vs. Wade, has said he has “very serious reservations” about the procedure and “would dispute any statement that it is the safest” method until there are peer-reviewed studies to back it up.

During congressional hearings on the subject, abortion-rights leaders wouldn’t let Hern testify, he says, because “what I was saying wasn’t ‘politically correct.’ ”

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D & X backers also argue it’s dangerous to let politicians meddle with medical decisions. “Next, they’ll start telling you how to do brain surgery,” complains the East Coast doctor.

Even if Congress’ measure fails, similar bills are on the table in 28 states, including California. And legal challenges are inevitable. Can a partial-birth ban hold up constitutionally?

Some experts note that the Supreme Court has never dealt with a technique quite like partial-birth abortion. Destroying a fetus in the womb is clearly protected, but what happens when the fetus is almost entirely outside the woman’s body?

The NRLC says the Roe decision, which legalized abortion in 1973, left undisturbed a Texas law that made it a felony to kill a baby “in a state of being born and before actual birth.”

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Still, if a ban does stand, it probably won’t reduce the number of abortions. Doctors would simply revert to other, legal methods.

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So what’s the point?

Alvare, the Catholic bishops’ spokeswoman, says it’s largely symbolic: “In a moral sense, all abortions are equally awful. But with this particular procedure, we’re very clearly moving toward infanticide. It’s a perception issue.”

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Supporters of legal abortion see other motives, namely an attempt to chip away at Roe one method at a time. And they’re determined to battle every inch of the way.

As the controversy rages, some doctors on the sidelines complain that it distracts from larger issues.

Dr. Deidre Gifford, a professor of obstetrics at Brown University, says, “Focusing on the particulars of this one procedure is missing the point. Any procedure you use [in the second trimester] is pretty distasteful.

“But what is the alternative? Women whose lives and health are wrecked, babies with severe disabilities that drain precious medical resources, and children born to families who don’t have the psychological or financial means to take care of them. I see the results of unwanted pregnancies daily, and as much as I am saddened by abortion, I am more repelled by a suffering mother and child. Unfortunately, it’s really hard to convey that point, that sometimes abortion is the least objectionable option. The only way you can get a feel for that is to be in the field for years and see it firsthand.”

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And that’s what gets lost in this debate, Gifford says: “You can’t win an argument [in which one side is] talking about puncturing a hole in a baby’s head.”

It doesn’t help when the press does so little digging on the subject. A recent PBS show, “Media Matters,” found coverage of the issue “abysmal.” Most reporters did little more than regurgitate the PR slant put out by lobbyists, especially the supporters of legal abortion, it concluded.

As Bergen Record abortion writer Ruth Padawer puts it: “Journalists always have a responsibility to check and double-check what they’re told. In this case, we need to triple-check.”

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Issues in Dispute

The proposed ban on partial-birth abortion has produced a confusing series of claims and counterclaims. Some key issues:

The Operation: Usually performed on fetuses at least 20 weeks old, like the one pictured in the sonogram above. The fetus is pulled from the womb by its feet, until the head lodges in the cervix. The skull is then collapsed. Claims that anesthesia kills or puts the fetus to sleep have been debunked.

Numbers: At first, supporters of legal abortion insisted there were just 450 to 600 procedures a year. After newspapers and one abortion rights lobbyist produced evidence of thousands of cases, the groups began saying that any estimates were based on “anecdote and speculation.”

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Safety: Defenders of the procedure say it’s safer and quicker than traditional methods, in which the fetus is dismembered in the womb. But some doctors call the technique medically risky. No studies have been done to support either claim.

What’s Next: The House passed the ban in March by a veto-proof margin. The Senate, which failed to override President Clinton’s veto of a similar bill last year, is expected to vote this month. In the meantime, several states have outlawed the procedure and others, including California, have measures in the wings.

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No Agreement, Even on a Name

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Everything seems to be at issue in this dispute, even the name: “partial-birth abortion.”

Critics say the term isn’t a medical one but was concocted to arouse public sentiment against the practice.

On the other hand, defenders of the procedure can’t seem to agree on a label, either. The National Abortion Federation calls it “intact dilatation and evacuation.” Planned Parenthood uses Dr. Martin Haskell’s “D & X” (dilation and extraction). And another prominent practitioner coined the phrase “intrauterine cranial decompression.”

None of those terms appears in any medical literature, says Dr. Warren Hern, who wrote the most widely used textbook on abortion.

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Helen Alvare, a lawyer who represents the National Conference of Catholic Bishops, adds that if a specific procedure were named, abortion clinics might figure out a slight variation and evade the ban. As written, the proposed federal legislation bars any termination in which “the person performing the abortion partially vaginally delivers a living fetus before killing [it] and completing the delivery.”

Critics of the measure contend--and even some antiabortion leaders concede--that the wording could be applied, in isolated instances, to other common (and otherwise legal) methods.

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The Groups Rallying the Troops

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Among the key players who favor abortion rights:

* National Abortion Federation; represents clinics and doctors who perform more than half the nation’s abortions.

* National Abortion and Reproductive Rights Action League; lobbies in favor of legalized abortion and related issues.

* National Coalition of Abortion Providers; a 6-year-old group also representing abortion clinics. NCAP stayed out of the debate until Executive Director Ron Fitzsimmons challenged the honesty of fellow lobbyists. Many members also in NAF.

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* Planned Parenthood; provides abortion and birth-control services at clinics throughout the country.

On the antiabortion side:

* National Conference of Catholic Bishops; represents U.S. bishops.

* National Right to Life Committee; lobbies against abortion and euthanasia.

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* Physicians’ Ad Hoc Coalition for Truth; a group of obstetricians, gynecologists and other doctors opposed to partial-birth abortion.


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