Medicine: Progress Report on Liberalized Abortion

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California's experience has been comparable. The main difference in principle is the Reagan-dictated exclusion of fetal indications. The numbers are larger, reflecting the difference in the states' populations. In the first half of 1968 there were 2,324 applications for therapeutic abortion, of which 207 were rejected. Of the 2,117 patients who won approval, 92 did not go through with the operation. No fewer than 1,777 of the abortions performed, or 83%, were on the ground that continued pregnancy would gravely impair the woman's mental health, and only 115 because of a threat to her physical health. There were 138 because of rape, and five because of incest. Only 25 operations involved out-of-state patients.

Time to Learn. No one knows how many illegal abortions are performed annually in the U.S. So-called "estimates" are really guesses and range from 200,-000 to 1,500,000. Whatever the true figure may be, it is obvious that legalized therapeutic abortion so far has had negligible, if any, effect on the illegal trade. There are several reasons.

In the first place, say California health officials, it takes time for people to learn when abortions are permitted and how to go about applying for them. Secondly, many women seeking a quick end to an unwanted pregnancy are not interested in the elaborate procedures required for a legal solution. Another factor is cost. Specialists have to be called in to confirm the medical justification advanced, and their fees, added to the usual cost of even minor surgery and a short stay in the hospital, can run the total bill up to $2,000. Many women who can afford such costs prefer to go to Mexico or Puerto Rico, where abortion, although illegal, is easily arranged, with a competent gynecologist performing the operation.

As the state legislatures reconvene next January, many will be asked to modernize their laws along the A.L.I, line followed by Colorado. Even if all 50 states were to do so, the problem of illegal abortion, with its high infection rate and considerable risk of death—especially for the poor—would remain.

At the same time, there will be a continuing campaign for "abortion on demand" on the ground that this is "every woman's birthright." This campaign, in the opinion of Dr. Alan F. Guttmacher, president of Planned Parenthood-World Population, will fail because "the public does not want abortion on demand and is not prepared to accept it." A more realistic approach to reducing the demand for illegal abortion, Guttmacher believes, is to make effective contraception far more widely available.

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