the U.S. House of Representatives this Wednesday reintroduced a bill banning so-called "partial-birth" abortions. The Senate is due to take up the matter within the next two weeks. Last year Clinton vetoed the ban -- which would have made illegal "any abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery" -- because while it made an exception for life-threatening situations, it did not make exceptions for women who needed the procedure for less threatening health reasons.
Anti-abortion forces were bolstered by a statement made last week by Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, which represents about 200 abortion clinics nationwide. Fitzsimmons said he had previously "lied through my teeth" when he claimed that such procedures were performed only rarely. He also said that some of the women who underwent the procedure were healthy.
Fitzsimmons' statement caused disarray in the abortion-rights ranks. With opinion polls showing the vast majority of Americans opposed to the procedure, political observers believe both houses of Congress will pass the measure easily, and that this time Clinton will feel enough pressure to sign it.
Salon spoke with Dr. Suzanne T. Poppema, co-author of "Why I am an Abortion Doctor" (Prometheus Books) and a board member of the National Abortion Federation and Physicians for Reproductive Choice and Health. Poppema runs the Aurora Medical Services clinic in Seattle.
In light of Ron Fitzsimmons' recantation about the numbers of partial-birth abortions, have you changed your views on legislation to ban it?
No. It's still an attempt by people with an anti-abortion agenda to impose their political beliefs on the medical system, to invade so far into the doctor-patient relationship that they're actually telling doctors what procedures they can use.
How do the anti-abortion people define a "partial-birth" abortion?
I've lost track of what they're doing now. I think their definition changes depending on who they're talking to and who they're trying to affect. What if the cord came down first? What if a limb comes down first? It's so complicated -- just trying to say, "Yes, I did it" or "No, I didn't" is impossible. The bill doesn't clarify under what situation this can occur. It's a very simplistic attempt to deal with exceedingly complicated issues. In medical emergencies, unpredictable things happen and you need to have lots of options to respond. There's no one answer. That's why these bans are horrible.
There seems to be some confusion about when these procedures are performed. Fitzsimmons said that, contrary to public perception, many "partial-birth" abortions are being performed in the second trimester of pregnancy, not just the third, when presumably serious health threats are more apparent.
When this bill was initially introduced (in 1995), the understanding of many of us was that it was aimed at third-trimester abortions. So we responded with information about third-trimester abortions. We said they're exceedingly rare; that they're almost exclusively done when there's a fatal or very severe fetal anomaly and/or when the mother's health is at risk.
Then, all of a sudden, people were talking about "thousands" of these procedures being done and how the pro-choice community had misinformed everyone. What they were talking about were procedures being done in the second trimester, which we never thought was an issue because, as you may know, Roe vs. Wade protects abortions through the second trimester from interference by the state. That's where a lot of the confusion and so-called "misinformation" is coming from. It's a problem of definition: The anti-abortion people think that anything over one and a half minutes after conception is a late-term abortion. We call them late-term abortions after the second trimester.
So what do you think Fitzsimmons meant when he said he had "lied through (his) teeth"?
I'm not a member of his organization so I can't know what was in his head at the time. And I haven't spoken to him, so I don't know what he was thinking. I can't hazard a guess just because, as I say, we gave the information that we thought was required -- about third-trimester abortions. We'd also admit that similar procedures are sometimes carried out in the late second trimester, if that's what we had originally been asked.
So the procedure is more common than many people thought?
I do procedures only through the first 16 weeks of pregnancy, but I probably do some parts of what would be banned by the bill, because it's written so vaguely. Of course, it's written vaguely because they don't know what they're talking about, because they're not doctors. They're trying to regulate a procedure when they don't understand why the procedure's being done. And they're now trying to stop it in the second trimester ...
Which amounts to a challenge to Roe vs. Wade.
You keep saying that legislators simply don't understand what's involved ...
Here's a hypothetical situation. Let's say I have a woman whose cervix is really tight; it's really hard to get the placenta out and there's a little piece of placenta still left in her uterus. So she's bleeding really heavily, but the uterus is also starting to contract and the fetus comes out and the head gets stuck in the birth canal. OK. Now I have a woman who's got a fetal head stuck in the cervix, I can't get it out. I can't stop the bleeding behind that, so now her uterus is hemorrhaging, filling up with blood. Now, how am I supposed to get that all to stop? The only thing I can do is to get the head out of the way and one of the ways to do that is to empty it, Now if I can't do that procedure, I'm stuck. I get to go to jail or watch a woman die in front of me. Well, I'll probably choose to worry about going to jail later and get the fetus out of her uterus. It's very, very, very frustrating trying to argue medical technique with non-medical fanatics.
It does sound like an awful procedure.
Abortion procedures are not aesthetically pleasant. There's no question about it. You think these pictures the anti-abortion forces show in Congress are bad? I think that if you started showing pictures of "normal" procedures, with forceps, those would be equally effective.
Is it true, as the New York Times and other papers have said, that the pro-choice movement is in disarray over this?
The sad thing is that it has created an impression of dissension -- and deceit -- in the pro-choice movement. My major concern about Ron Fitzsimmons is that people somehow get the idea that the pro-choice movement asked him to lie. I have been involved in responding to this politically for a long time because I am a board member of the National Abortion Federation. We were responding in good faith to the questions that we were being asked. It's not until very recently that I realized -- sort of like a light bulb went on in my head -- "Oh, they're talking about way back in the second trimester." Well, yeah, then there could be lots more. We're not exactly sure. Doctors use different techniques.
In your book you write that you would seriously consider continuing to do abortions even if they were illegal. With a "partial-birth" abortion ban, could that happen?
Well, the situation that I just told you, where I have this woman who's bleeding in her uterus, I can't get into her uterus, the fetus is in the way, I'm in an emergency situation and there's a ban on how I can get the fetus out. I'll probably save the woman's life and get the fetus out. It's like telling a physician, "I want you to take the best care you can of this patient but I'm going to handcuff you so you can't use all of the techniques at your disposal."
Other doctors have said there are alternative ways to protect the mother.
Sure. You could do a Caesarean section. But with the same woman I described to you, it's going to take two hours before we can do a C-section on her. She could die in that time. Whereas the procedure that I'm describing, the intact D-and-E (dilation and extraction -- the main "partial-birth" abortion procedure) would take two minutes.
Do you think President Clinton will sign the ban this time, or will he stick to his guns?
I wish I knew. I think that Bill Clinton's trustworthy enough to stand behind his promise to hold out for health exceptions. I can't believe that he'd forget that he's talked to all these women and about what happened to them and why they had to go through with this procedure, and then just forget about it.
Americans overwhelmingly support the right to an abortion, but polls show that three-quarters of them oppose partial-birth abortions. Why?
They're saying, "Oh we think it's a horrible idea to kill little babies about to be born." Well, I'm not going to say I think it's a good idea either. But if you sit down and explain late-trimester abortions they, say, "Gosh, you know, if that could've been explained to me a long time ago ..." But the rhetoric is such that it's hard to ever get a chance to do that.
Especially in a congressional debate
It's always the case. When the anti-abortion movements lobbied Olympia (the state capitol of Washington) on the issue, they got people who stood up and told sob stories and cried. And we look like fools because all we're doing is talking about facts. I mean, sorry, all we have is the truth on our side. I keep telling myself, the truth is on our side, we'll be OK. That's my mantra. We're trying to help women make difficult decisions in a way that's respectful to them. That's the right thing to be doing, so it'll be OK.