Medicine: Legal Abortion: Who, Why and Where

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Comparatively few who seek abortions have strictly medical reasons, such as their own health or suspected congenital abnormality in the fetus. Rape and incest account for a negligible percentage of unwanted pregnancies. Women seek legal abortions for the familiar reasons: reluctance to interrupt career plans, lack of money, fear of losing personal freedom, uncertainty about their relationship with the man involved.

One of the startling facts is that despite the widespread availability of the Pill and other means of birth control, so many unwanted pregnancies happen, even among the most educated and sophisticated. Subconsciously, many may want to become pregnant, according to Dr. Lawrence Downs, a Manhattan psychiatrist, who, in collaboration with Psychologist David Clayson, has been studying women selected at random at New York Hospital's therapeutic-abortion ward. Downs found that at least one-quarter of the first 108 women studied had suffered psychiatric problems in the previous two years; more than half had lost a parent or close relative during the past year. A slim majority said that members of their families had recently undergone hysterectomies, or that they themselves had experienced gynecological disorders that led them to question their fertility. "It really makes sense for these women to become pregnant," says Downs. "It is a response to the threat of loss, a proof of fertility, and therefore of femininity."

Of course, accidents do happen, though it is usually the user rather than the contraceptive that fails. Pills are forgotten, and diaphragms, condoms or spermicidal foam are either imprudently omitted or improperly used. I.U.D.s sometimes prove ineffective. Women occasionally become pregnant while in the process of changing from one means of contraception to another.

WHERE. So far, 17 states have liberalized their laws. Colorado became the first in 1967 when it adopted the American Law Institute's recommended code. The measure allows abortion up to the 16th week if a board of doctors agrees that the pregnancy endangers the physical or emotional health of the woman, if there is suspicion of fetal abnormality, or if pregnancy is the result of rape or incest. Since then, eleven other states, including California, have adopted variations of the recommended code.

Some states have gone far beyond the A.L.I.'s model. An 18-month-old Hawaii law allows unrestricted abortion of a "nonviable" fetus for any woman who has been a resident of the state for 90 days; a 14-month-old Alaska law permits abortion up to the 19th week for women who have lived in the state for a month. A Washington State law, adopted last December by voter referendum (56% to 44%), removed all restrictions on abortions through the fourth month of pregnancy.

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