Ohio bill restricting abortions to before a heartbeat is heard

[bcking 3,157]

I found this to be a pretty troubling read

https://lozierinstitute.org/the-reality-of-late-term-abortion-procedures/

The key bits I would pull from that:

" CDC projections, based largely on voluntary state reporting and abortion provider survey data from the Guttmacher Institute, a former affiliate of Planned Parenthood, estimate that roughly 1%, or over 15,000, abortions are performed after 20 weeks annually in the U.S.[7] Thus, advocates of the women and unborn children affected by these procedures take great interest in mitigating the circumstances that drive women to seek late-term abortions."

I would love to see the numbers if you looked post-22 weeks, or post-23 weeks even. I imagine it is a fraction of that number. That number also doesn't break down the reason. The article tries to then discuss that more:

"Previous survey studies of late-term abortion patients have confirmed that most late-term abortions are performed because of a delay in pregnancy diagnosis and for reasons similar to those given by first-trimester abortion patients: financial stressors, relationship problems, education concerns or parenting challenges.[9]"

Except if you actually follow that link, they are completely misrepresenting a very interesting article. The paper they cite is looking at reasons for an abortion, but it doesn't actually focus on reasons at different gestational ages. >85% of women they surveyed were <13 weeks, and they don't even provide a number of women who were >20 weeks in their survey. They don't break it down, they don't address it at all. It is just plainly beyond the scope of their paper. Likely their survey didn't have enough respondents in that group to meet the required power to be statistically significant so the didn't talk about it (rightly so). It was actually a well written paper, just not addressing what the link you provided made it seem like it addresses.

Practically the rest of their citations are all from the same paper. Also a survey of women. That one didn't break down and look at >20 week abortions (the average was 22, so if you look at it from 20-39 weeks it is clearly skewed towards the younger side) compared to less. The article you posted clearly was cherry picking a little bit with their quotes. They left out the fact that the women >20 weeks were less likely to have private medical insurance, and were four times more likely to have to travel more than 3 hours to obtain an abortion (Odds ratio of 4.6, the study's largest odds ratios and yet the article you linked failed to bring it up).

As for barriers, the statistically significant ones were: not knowing where to go, difficulty getting there (similar to the above), raising money, difficulty securing insurance. Trouble deciding about the abortion was not statistically different. That, to me, would suggest these weren't women who just sat on their feet thinking about it (though they did statistically find out later, more were >8 weeks pregnant when they found out).

Lastly, going back to the methods. They state this in the original paper: "Women were told that the purpose of the study was to learn more about how women's decisions and experiences with unintended pregnancy and abortion affect their lives—for example, in the areas of health, employment, relationships and sense of well-being. "

They had a fairly small number of patients >20 weeks seeking an abortion for lethal fetal conditions. That can't be denied. However, this was a recruitment based study that I can almost guarantee suffered from recruitment bias. That is when there is a characteristic about the kind of people who would agree to your study that would influence the population you look at. If a woman was in a clinic to get an abortion because their child has a lethal condition and will die regardless, I imagine they would be less likely to consent to study aimed at "women's decisions and experiences with unintended pregnancy". They aren't there because their pregnancy is unintended, they aren't there because they are making a "decision" about the pregnancy. They are there because whether they like it or not, their child will die. I'm not surprised that number was low.

TL;DR - When you read 3rd party articles citing actual scientific papers, click through and read the original papers instead of reading the 3rd party article. Websites tend to pick and choose the results from a paper to serve their purpose. If it is a true peer reviewed scientific article, they will have to be more fair about their results and interpretations. However, even then you still have to read their methods to determine sources of bias that would influence their results.

EDIT:

Oriz I really do agree with you that it is a tragedy if a woman comes in seeking an abortion at 22+ weeks. That is sad. I believe it is incredibly small but I agree that even a small number is still sad. However, I think the fact that it is small means that instead of focusing on blanket laws to just flat out limit abortions, we need to look at ways to just focus on those individuals. The very studies listed in the article you linked, to me, suggest that we need to focus more on these women's access to care. The strongest association with a late term abortion was long distance to the center. How are the laws being passed in places like Texas that extremely limit where you can go for an abortion helping that? if anything those laws are going to increase the late term abortions because you limit women's options. These are women who are lower income, less employed but they DID NOT differ on deciding about the abortion. That wasn't statistically significant. So they all decided similarly to get the abortion, but the ones who got it later reported issues relating to cost and access. That is where we should focus.

EDIT:

Finally, I also want to point out that the Lozier institute is far far from an unbiased research institute. They are part of the Susan B Anthony List which quite clearly states in their mission that they are pro-life and want to end abortions period. So an additional form of bias, to me, would be publication bias. An institute funded by an organization with a clear agenda is more likely to publish data that conform to their agenda, as opposed to things that don't. I have to give the primary researchers credit however. They do their best to provide the data as is. The problem is in the "summary" article that you linked, where their bias clearly shows in how they select the data from the paper to present to the lay community. They know a small fraction will actually read the paper, and an even smaller fraction will get past the abstract.

Edited December 9, 2016 by bcking

[smilesammich 10,727]

That was predictable. Try again.

fetal rights think tank. predictable, i agree.

[OriZ 3,157]

Oriz I really do agree with you that it is a tragedy if a woman comes in seeking an abortion at 22+ weeks. That is sad. I believe it is incredibly small but I agree that even a small number is still sad. However, I think the fact that it is small means that instead of focusing on blanket laws to just flat out limit abortions, we need to look at ways to just focus on those individuals. The very studies listed in the article you linked, to me, suggest that we need to focus more on these women's access to care. The strongest association with a late term abortion was long distance to the center. How are the laws being passed in places like Texas that extremely limit where you can go for an abortion helping that? if anything those laws are going to increase the late term abortions because you limit women's options. These are women who are lower income, less employed but they DID NOT differ on deciding about the abortion. That wasn't statistically significant. So they all decided similarly to get the abortion, but the ones who got it later reported issues relating to cost and access. That is where we should focus.

I don't disagree with that. They said the paper "supports these conclusions". They didn't say that's what the paper was about, and I agree, however here is what I would take from it:

Abortion rights advocates have long insisted that late-term abortions are performed only in dire circumstances involving threats to a mother’s life or in cases of severe fetal anomaly. However, the above study, despite its limitations, suggests otherwise. The characteristic similarities and delay commonalities observed across first trimester and late-term abortion groups suggest that women who seek abortion share similar characteristics across gestational ages. The stressful circumstances of unprepared pregnancy, single-motherhood, financial pressure and relationship discord are primary concerns that must be addressed for these women. However, these circumstances are not fundamentally alleviated or ameliorated by late-term abortion. Indeed, late-term abortion places these women at greater risk of surgical complications, subsequent preterm birth, and mental health problems, while simultaneously ending the life of an unborn child.[18] As a medical profession and society, we rightly seek alternative, compassionate responses for the women seeking late-term abortion procedures for such challenging yet elective reasons.

I don't have a problem with that. As I previously said we need to address it. Addressing it to me means preventing it not only via legislation but also by eliminating the causes.

fetal rights think tank. predictable, i agree.

To explore the characteristics of women who choose abortion after 20 weeks of pregnancy, Foster and Kimport used data from a larger abortion study, currently being conducted at the University of California, San Francisco. Interview and questionnaire data from over 400 women were gathered from 16 facilities that offer abortion procedures after 20 weeks gestation. A significant limiting factor of the study is the fact that the authors excluded women who sought abortion for reasons of fetal anomaly or life endangerment, without commenting on how large of a cohort this represented. Another significant limiting factor of the study is that only 44% of the eligible women participated (eligibility defined as women who obtained an abortion after 20 weeks gestation for reasons other than life endangerment or fetal anomaly), leaving room for significant selection bias.[12]

Of the patients interviewed, 272 had received an abortion at or after 20 weeks, while 169 had received a first-trimester abortion. The authors noted that the sample of participating women was “similar in race and ethnicity, age and parity to [the] population of women who receive abortions nationally.” Sixty-nine percent of the study participants were non-white. Women were grouped and compared according to those who had received first-trimester abortions and those who received abortions at or after 20 weeks. Interviews and questionnaires were completed with all women one week after their abortion procedures.

The characteristics of women who sought abortions after 20 weeks were generally similar to those who received first-trimester procedures. “The two groups did not differ by race or ethnicity, number of live births or abortions, mental or physical health history or substance abuse,” write the study authors. Nearly identical majorities of women from both groups were unmarried. Identical majorities from both groups had more than one previous live birth. Only small minorities of women in both groups reported heavy drinking, recreational drug use or a history of depression. [13]

The only statistically significant demographic differences between the first-trimester and late-term abortion recipients were age and employment. Seventy-five percent of women from both groups were between ages 20 and 34. However, women ages 20-24 were found more likely than women ages 25-34 to seek late-term abortions. Unemployed women were more likely to seek late-term abortions than employed women. However, among those women who sought a late-term abortion, equal numbers were employed and unemployed. Not surprisingly, women who sought later abortions were more likely than their first-trimester counterparts to have discovered their pregnancy after eight weeks. Yet, a sizeable percentage within the late-term abortion group, nearly 40%, reported that they knew about their pregnancy prior to eight weeks of gestation.[14]

The study results also showed that, on average, women who obtained later abortions took twice as long as their first-trimester counterparts to obtain an abortion after discovering they were pregnant. Among women who received late-term abortions, the average time between pregnancy discovery and obtaining the abortion was over three months (14 weeks). Women receiving first-trimester abortions averaged a period of seven weeks between the time of pregnancy discovery and the time of their abortion. [15] The above results raise obvious questions as to why the timetable for obtaining an abortion was so much longer for women choosing late-term abortions.

As part of the study, participants were asked questions aimed at identifying possible reasons for delay in obtaining their abortion after discovering their pregnancy. The answers from both groups suggest that women share similar reasons for delaying abortion regardless of the gestational age at which they have the procedure. The majority of women in both groups gave at least one reason for delaying their abortion. Both groups cited the same seven reasons for delaying. Women in both groups reported “not knowing about the pregnancy,” “trouble deciding about the abortion,” and “disagreeing about the abortion with the man involved” with similar frequency.[16]

Among women in the late-term abortion group, the most commonly cited reason for delaying the procedure was “raising money for the procedure and related costs.” Two thirds of women in the late-term abortion group gave this reason, compared with one-third of the women in the first-trimester group. It is worth noting that the average prices paid by women in the study were $2,014 for a late-term abortion compared to $519 for a first-trimester abortion, suggesting that, paradoxically, delaying for financial reasons required significantly more finances in the end. Women who received late-term abortions also cited “difficulty securing insurance coverage,” “difficulty getting to the abortion facility,” and “not knowing where to go for an abortion” as delaying reasons more often when compared to the first-trimester group. However, the two groups gave similar answers when asked how many abortion facilities they contacted before finding one willing to perform their abortion: the first-trimester group called an average of 1.7 facilities and the late-term group called a similar average of 2.2 facilities.[17]

Third time's the charm?

[bcking 3,157]

I don't disagree with that. They said the paper "supports these conclusions". They didn't say that's what the paper was about, and I agree, however here is what I would take from it:

Abortion rights advocates have long insisted that late-term abortions are performed only in dire circumstances involving threats to a mother’s life or in cases of severe fetal anomaly. However, the above study, despite its limitations, suggests otherwise. The characteristic similarities and delay commonalities observed across first trimester and late-term abortion groups suggest that women who seek abortion share similar characteristics across gestational ages. The stressful circumstances of unprepared pregnancy, single-motherhood, financial pressure and relationship discord are primary concerns that must be addressed for these women. However, these circumstances are not fundamentally alleviated or ameliorated by late-term abortion. Indeed, late-term abortion places these women at greater risk of surgical complications, subsequent preterm birth, and mental health problems, while simultaneously ending the life of an unborn child.[18] As a medical profession and society, we rightly seek alternative, compassionate responses for the women seeking late-term abortion procedures for such challenging yet elective reasons.

I don't have a problem with that. As I previously said we need to address it. Addressing it to me means preventing it not only via legislation but also by eliminating the causes.

The problem is they cite two articles to support their first two sentences. The first has nothing to do with it. The second, as I mentioned, has a serious recruitment bias issue. It isn't a study of all women getting abortions. They went around and asked women and they had to consent. Based on the language they chose to put into the paper on how they recruited, I have serious concerns about their ability to recruit a representative population if you wanted ALL women getting abortions >20 weeks and not just women choosing for personal reasons.

They then want to mention the commonalities, without focusing on the STATISTICALLY SIGNIFICANT differences. They were significantly different in many important ways include employment and access to care. They fail to point out that access to care is what the women stated was the reason they ended up getting a late abortion. The women told them directly in the study, and they don't mention that. The strongest thing associated with getting a late term abortion over an early abortion was living more than 3 hours away. That is something that is made worse by the legislation that closes clinics that perform abortion for reasons like their hallways aren't big enough, or they are too close to a school.

The people who are putting these women are greater risk are the people that are making it more difficult for them to get the abortion. That would be people that either A. Limit access to health insurance or care or B. Force closures of clinics so that it is harder, further and more expensive to get an abortion.

The paragraph you quoted, to me, is the perfect example of them trying to spin the articles to support their conclusions while leaving out the actual key results from the study. I read papers like these as part of my career, and I happen to know that I am quite good at it. A critical appraisal of the studies they use for evidence does not support the conclusions they are trying to make. Or if they do, they support another conclusion much stronger.

Edited December 9, 2016 by bcking

[OriZ 3,157]

Practically the rest of their citations are all from the same paper. Also a survey of women. That one didn't break down and look at >20 week abortions (the average was 22, so if you look at it from 20-39 weeks it is clearly skewed towards the younger side) compared to less. The article you posted clearly was cherry picking a little bit with their quotes. They left out the fact that the women >20 weeks were less likely to have private medical insurance, and were four times more likely to have to travel more than 3 hours to obtain an abortion (Odds ratio of 4.6, the study's largest odds ratios and yet the article you linked failed to bring it up).

I don't agree with that. This is what they wrote:

Among women in the late-term abortion group, the most commonly cited reason for delaying the procedure was “raising money for the procedure and related costs.” Two thirds of women in the late-term abortion group gave this reason, compared with one-third of the women in the first-trimester group. It is worth noting that the average prices paid by women in the study were $2,014 for a late-term abortion compared to $519 for a first-trimester abortion, suggesting that, paradoxically, delaying for financial reasons required significantly more finances in the end. Women who received late-term abortions also cited “difficulty securing insurance coverage,” “difficulty getting to the abortion facility,” and “not knowing where to go for an abortion” as delaying reasons more often when compared to the first-trimester group.

Also, I did actually look at the paper as well, but found their summary to be balanced overall and an easier read than the paper itself which is why I posted it(I figured like I did, anyone else can follow the link from the initial link).

[bcking 3,157]

"The stressful circumstances of unprepared pregnancy, single-motherhood, financial pressure and relationship discord are primary concerns that must be addressed for these women."

They are intentionally focusing on the "commonalities" (In scientific terms - the things that were NOT statistically significant) and instead ignoring the statistically significant differences such as access to insurance, difficulty paying for the procedure, and distance from a site to get the procedure.

If they want to look at why women >20 weeks seek abortions they should be focusing on the differences, not the similarities.

EDIT: If they wanted to focus on commonalities, they seemed to have left out the fact that the late term abortion women didn't actually say they had problems deciding to get an abortion. That would suggest the problem isn't that they waited to decide. They decided, but then couldn't get it done. That isn't a problem with the women, problem with the system.

Edited December 9, 2016 by bcking

[bcking 3,157]

I don't agree with that. This is what they wrote:

Among women in the late-term abortion group, the most commonly cited reason for delaying the procedure was “raising money for the procedure and related costs.” Two thirds of women in the late-term abortion group gave this reason, compared with one-third of the women in the first-trimester group. It is worth noting that the average prices paid by women in the study were $2,014 for a late-term abortion compared to $519 for a first-trimester abortion, suggesting that, paradoxically, delaying for financial reasons required significantly more finances in the end. Women who received late-term abortions also cited “difficulty securing insurance coverage,” “difficulty getting to the abortion facility,” and “not knowing where to go for an abortion” as delaying reasons more often when compared to the first-trimester group.

Also, I did actually look at the paper as well, but found their summary to be balanced overall and an easier read than the paper itself which is why I posted it(I figured like I did, anyone else can follow the link from the initial link).

Yes and a fair analysis of the paper would mention that those reasons that they list at the end in one sentence had the highest odds ratios compared to any other reason. That means they were MOST associated with late term abortions. Particularly difficulty getting to it (traveling >3 hours).

"Worth noting" that they paid more in the end adds nothing to the argument. It honestly is just a mean spirited poke at the women who had financial difficulties. Basically say "sucks to be you because in the end you needed to pay more". Just because they had to pay more in the end doesn't mean that financial difficulties weren't originally a valid problem. We see that ALL the time in healthcare. People will show up in the ED for problems because they didn't go to their doctor. The ED is WAY more expensive than the doctor. That doesn't negate the fact that getting insurance and paying for a doctor isn't a barrier.

[OriZ 3,157]

The problem is they cite two articles to support their first two sentences. The first has nothing to do with it. The second, as I mentioned, has a serious recruitment bias issue. It isn't a study of all women getting abortions. They went around and asked women and they had to consent. Based on the language they chose to put into the paper on how they recruited, I have serious concerns about their ability to recruit a representative population if you wanted ALL women getting abortions >20 weeks and not just women choosing for personal reasons.

They then want to mention the commonalities, without focusing on the STATISTICALLY SIGNIFICANT differences. They were significantly different in many important ways include employment and access to care. They fail to point out that access to care is what the women stated was the reason they ended up getting a late abortion. The women told them directly in the study, and they don't mention that. The strongest thing associated with getting a late term abortion over an early abortion was living more than 3 hours away. That is something that is made worse by the legislation that closes clinics that perform abortion for reasons like their hallways aren't big enough, or they are too close to a school.

The people who are putting these women are greater risk are the people that are making it more difficult for them to get the abortion. That would be people that either A. Limit access to health insurance or care or B. Force closures of clinics so that it is harder, further and more expensive to get an abortion.

The paragraph you quoted, to me, is the perfect example of them trying to spin the articles to support their conclusions while leaving out the actual key results from the study. I read papers like these as part of my career, and I happen to know that I am quite good at it. A critical appraisal of the studies they use for evidence does not support the conclusions they are trying to make. Or if they do, they support another conclusion much stronger.

The reason I posted it is not to try and show that there are many women who get abortions for these reasons. We all already agreed there aren't. I don't care honestly, whether or not they believe that to be true either. The point was to show it does exist. True there is no particular example for 38th week but as I deal alot with statistics I can tell you even without looking at a particular example statistically it's very improbable that none exist. I was just trying to show more generally that some, even if few, late term abortions, exist for reasons other than what some may want us to believe they all supposedly are. It is simply not true, and the article as well as the research it is based on proves that imo.

[bcking 3,157]

All of this also continues to ignore than the study design they chose (recruitment based surveys) are one of the weakest and most subject to bias (mostly recruitment bias which I have already said). The study is set up to investigate reasons for women who are electively choosing an abortion. That is, by their own design, going to exclude women who are getting an abortion for what they perceive as "not elective" reasons (their own health, the health of the fetus). They will be asked to consent, and will likely say no. That is based on the description of their consent procedure they provide in their own paper.

[OriZ 3,157]

We see that ALL the time in healthcare. People will show up in the ED for problems because they didn't go to their doctor. The ED is WAY more expensive than the doctor. That doesn't negate the fact that getting insurance and paying for a doctor isn't a barrier.

Oh trust me I know all about how that works

[bcking 3,157]

The reason I posted it is not to try and show that there are many women who get abortions for these reasons. We all already agreed there aren't. I don't care honestly, whether or not they believe that to be true either. The point was to show it does exist. True there is no particular example for 38th week but as I deal alot with statistics I can tell you even without looking at a particular example statistically it's very improbable that none exist. I was just trying to show more generally that some, even if few, late term abortions, exist for reasons other than what some may want us to believe they all supposedly are. It is simply not true, and the article as well as the research it is based on proves that imo.

Ya I agree that technically speaking I'm sure they exist as well. The study cut off was 20 weeks, and the median was 22...I wish they would have given a greater break down as I would honestly like to know how many were say >24 or even >23. Or at least tell us both the median and mean. I am actually quite surprised the paper didn't even list a range (They varied from 20 to x weeks) even without how many were above a certain cut off. That would have been useful information in interpreting the study.

Again my problem with recruitment bias comes up. Not that I'm saying that it proves none exist, but I believe the study "over-represented" those that exist by recruiting specifically for them. Yes even 1,000 patients in a country of 350 million is too high. However if you follow the article to its conclusions the best way to reduce that number would be to make it EASIER for women to obtain the abortion, not harder. The irony of the think tank is their study, when actually read critically, supports their opponents more than it supports themselves.

[The Nature Boy 7,659]

That was predictable. Try again.

A stroll down Memory lane

B. It was not on MSNBC,CNN or the Bill Maher show , so it never happned

[bcking 3,157]

Correction: they just say the "average". They should mention where they are giving a median or a mean. If it is a median, without a range and a mean it can be very misleading.

If there were 100 women the median would be 22 if 50 of them were ranged between 20-21 weeks, and 50 of them were all 22 1/7. A mean would give us more information but I would still also like a range.

Also in terms of their methods, they failed to mention how many women were approached, and then how many consented. A typical study using this study design would mention that. Did they speak to 280 women and 271 consented? Or did they speak to 1,000 women and 271 consented. They need to have some estimation of the "population" they are sampling from.

Edited December 9, 2016 by bcking

[The Nature Boy 7,659]

Correction: they just say the "average". They should mention where they are giving a median or a mean. If it is a median, without a range and a mean it can be very misleading.

If there were 100 women the median would be 22 if 50 of them were ranged between 20-21 weeks, and 50 of them were all 22 1/7.

So you are more in favor off setting a quota for late term viable fetus abortions, as the argument you seem to be having, is the only morality in the situation is numbers. If 500 a month nationwide is wrong so is 1.

Again totally ok for health reasons

[OriZ 3,157]

Ya I agree that technically speaking I'm sure they exist as well. The study cut off was 20 weeks, and the median was 22...I wish they would have given a greater break down as I would honestly like to know how many were say >24 or even >23. Or at least tell us both the median and mean. I am actually quite surprised the paper didn't even list a range (They varied from 20 to x weeks) even without how many were above a certain cut off. That would have been useful information in interpreting the study.

Again my problem with recruitment bias comes up. Not that I'm saying that it proves none exist, but I believe the study "over-represented" those that exist by recruiting specifically for them. Yes even 1,000 patients in a country of 350 million is too high. However if you follow the article to its conclusions the best way to reduce that number would be to make it EASIER for women to obtain the abortion, not harder. The irony of the think tank is their study, when actually read critically, supports their opponents more than it supports themselves.

I really couldn't care less about their reasons for posting it. Their reasons and mine don't have to match for me to find it to be useful in the context of our discussion. Yes, it admittedly over represented them, and it even said so. I don't believe they even tried to hide it, at least from my perspective. It has its limitations, but over representing is not the same as making something up. To over represent something it has to exist, and that was the main reason I posted it, because if even 1 or two people in the study(and it was definitely more than that) were under that category, then at least it shows it exists. Whether it over represents or not, whether they shoot themselves in the foot by supporting their opponents more than themselves is not my business anymore. I think at the end of the day we're in agreement that 1. Late term abortions for the wrong reasons do exist and that 2. They should not happen. Now, how to go about preventing them, which laws and what kind of help/aid is the appropriate manner to address the issue is for a whole nother disucssion a whole nother day.