You wanted to know (1) how many "partial birth" abortions are performed in Connecticut, (2) whether there can be a medical necessity for such procedures, and (3) if any bills are pending on the issue.

SUMMARY

Connecticut does not collect data on the types of procedure that is typically termed "partial birth abortion"-intact dilation and extraction (D & X). Consequently, we cannot determine the number that are performed here. In 1999, only seven abortions were performed in the state after the 21^st week of gestation. The Waterbury Republican-American (August 17, 2000) reported a Department of Public Health official as saying these were "probably" partial birth abortions.

Under Connecticut law, abortions after the fetus attains viability (that is, can live outside the mother's womb) can be performed only to preserve the mother's life or health. The conditions causing maternal health problems could arise before, during, or as a result of the pregnancy. Some mothers may choose to undergo a late term abortion because tests show severe fetal abnormalities. Sometimes these abnormalities cannot be detected until the second trimester.

No bills are currently pending on this issue. We found only one introduced this session, HB 6243, An Act Concerning Fetal Death and Homicide, which permitted charging a person for homicide or assault when the victim of the offense is an unborn person. The bill was referred to the Judiciary Committee, which took no action on it.

DATA ON PARTIAL BIRTH ABORTIONS

There is no sure way to determine whether partial birth abortions are being performed in Connecticut. There are two reasons for this. First, there is no single definition of what constitutes such an abortion. Second, while doctors in Connecticut are required to report abortion procedures to the Department of Public Health, the department does not break down the categories enough to determine whether intact D&X abortions (the procedure typically termed a "partial birth abortion") are being performed.

Definition Variations

"Partial birth abortion" is not a medical term and varying definitions exist.

The American Medical Association's (AMA) policy states:

The term `partial birth abortion' is not a medical term. The AMA will use the term "intact dilation and extraction" (or intact D&X) to refer to a specific procedure comprised of the following elements: deliberate dilation of the cervix, usually over a sequence of days; instrumental or manual conversion of the fetus to a footling breech; breech extraction of the body excepting the head; and partial evacuation of the intracranial contents of the fetus to effect vaginal delivery of a dead but otherwise intact fetus. This procedure is distinct from dilation and evacuation (D&E) procedures more commonly used to induce abortion after the first trimester. Because `partial birth abortion' is not a medical term the AMA does not use it.

The American College of Obstetricians and Gynecologists (ACOG) believes the term "partial birth abortion" is intended to describe intact D&X, which they consider to be a form of dilation and extraction (D&E). ACOG defines this procedure as containing all of the four elements, in sequence:

1. deliberate dilation of the cervix, usually over a sequence of days;

2. instrumental conversion of the fetus to a footling breech;

3. breech extraction of the body excepting the head; and

4. partial evacuation of the intercranial contents of a living fetus to effect vaginal delivery of a dead but otherwise intact fetus.

The National Conferences of State Legislatures says the term refers to intact D&E. Intact D & X is considered a form of intact D & E.

Federal legislators defined the partial birth abortion procedure as "abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery" (HR 1122, 1997).

Department of Public Health Data

Table 1 details the types of abortion methods used in Connecticut and when in the gestational cycle they occur. Connecticut does not break down the categories far enough to record specifically intact D& X abortions. But, the only categories in the table under which the intact D&X procedure could fall are "other methods", or "unreported or reported incorrectly". Therefore, one can safely assume that this procedure is used infrequently in Connecticut, if at all.

Table 1: Statistical Summary of Legal Induced Abortions in Connecticut, 1999

Source: Department of Public Health/Bureau of Community Health.

MEDICAL NECESSITY

In Roe v. Wade, the seminal case on abortion rights, the Supreme Court held the state's legitimate interest in potential life becomes compelling when the fetus attains viability (which the Court in 1973 generally placed at 28 weeks, when the fetus potentially can live outside the womb, with artificial assistance). The state can regulate and even prohibit all abortions after that point, except those necessary to preserve the mother's life or health. Connecticut law prohibits abortions after the fetus is viable except when necessary to preserve the mother's live or health (CGS §19a-602(b)).

Little research has been conducted on the reasons for induced abortions in the second trimester according to a 1997 policy statement by ACOG. It says maternal conditions could be a medical reason for these abortions. The conditions could pre-date the pregnancy, could occur during the pregnancy, or could occur result from the pregnancy. Some fetal abnormalities, it states, are not diagnosed until the second trimester, and their discovery could prompt some women to abort.

The statement mentions a 1987 survey of patients in 30 abortion facilities by the Alan Guttmacher Institute (which is related to Planned Parenthood). This survey found that 71% of respondents did not know they were pregnant or misjudged gestation, 48% had difficulty (including raising money) in arranging for the abortion, 33% were afraid to tell their partner or parents, and 24% had trouble in reaching a decision to abort.

The ACOG statement recommended policies to the AMA. Among these were recommendations that

1. abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life and

2. third trimester abortions are generally not necessary to preserve the life or health of the mother.

ACOG stated that except in extraordinary circumstances, maternal health factors that demand terminating the pregnancy could be accomplished without sacrificing the fetus, and the near certainty of the fetus' viability "argues for ending the pregnancy by appropriate delivery."

A 1997 Congressional Research Service report on abortion procedures lists the reasons abortion rights supporters give for why women obtain partial birth abortions. They include preventing the mother's death or the worsening of her medical condition (for example where a mother has rapidly advancing cancer), to abort a fetus diagnosed with serious deformities (especially when the deformities themselves "are incompatible with life"), life crises, lack of money or health insurance, and lack of knowledge about human reproduction. The report also mentioned that doctors who perform partial birth procedures indicated that a significant number of their patients had the procedure done because of fetal abnormalities, maternal illness, and rape and incest. But they assert that most of the procedures are elective.

SS:ts