Graphic Rhetoric Harms Patients Seeking Abortion

Friday, November 4, 2016

Arguably the most contentious issue facing politicians is abortion, but when a candidate uses shocking and misleading language to debate the matter, it's the patient who suffers.

Republican presidential nominee Donald Trump used some of the most graphic terms ever heard by a presidential nominee when asked about the issue of abortion during the third presidential debate in October.

“If you go with what Hillary is saying, in the ninth month you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby… on the final day. And that’s not acceptable,” said Trump.

Despite the physicality of this language (and the false characterization of Clinton’s position), this sort of speech is nothing new in terms of anti-abortion rhetoric.

Perhaps more interesting was the prompt that the moderator, Fox News anchor Chris Wallace, used to evoke this response from Trump.

“Mr. Trump, your reaction? Particularly on this issue of late term partial birth abortions.”

Wallace’s easy use of “partial birth” and “late term” in a national forum to describe a particular medical procedure assumes a nationwide acceptance and understanding of these phrases.

To some physicians who provide abortions, such descriptors are opaque political language that adversely affects their patients.

“It’s strategic on the part of the anti-choice movement to [use language] like this, and poison the water for all abortion,” said Dr. Jennifer Kerns, assistant professor of medicine and a OB/GYN physician at UCSF’s Women’s Options Center.

Kern says that these terms are not used clinically because they are not real medical phrases.

“We don’t really know what ‘late term abortion’ means, it’s not a thing. There are three terms, which are really trimesters, there’s first, second, and third trimester.”

Kerns says that non-specific, inaccurate terminology like “partial birth abortions” hinders a patient’s ability to decide over such medical procedures.

She sees the introduction of such terms as an intentional move by anti-abortion groups.

“You enter the word ‘birth’ in there, and you’re confusing the picture to a point that is very hard for people to tease apart, especially when we have such poor health literacy in general in the U.S., not to mention health literacy regarding women’s reproductive health.”

Clinically, abortions are characterized by medical professionals by trimester and method, which can either be surgical (which in the second trimester is a procedure called a dilatation and evacuation, or a D&E) or medically induced.

Kerns’s research concerns patients’ decision-making in choosing one type of abortion or the other.

She says that the two procedures are very different experiences for the patient, and being able to choose between them gives patients agency and an opportunity for closure.

“Practitioners are looking for ways to involve patients’ decision-making in certain treatments. Handing a lot of this back to patients …we have to hear from you in terms of your lifestyle and values to see what matters the most.”

So how did these terms enter the national conversation?

Dr. Karen Meckstroth, clinical professor at UCSF and medical director of both UCSF’s Women’s Options Center and ZSFG’s Women’s Community Clinic, thinks that usage of the terms in federal legislation might have something to do with it. The Partial Birth Abortion Ban Act, which was signed into law in 2003 by President Bush, bans a rare medical procedure called a dilation and extraction, or a D&X, when the fetal heart is still beating.

Meckstroth says the law did not affect most of her patients directly, as very few ask for the procedure, but the presence of the law increases an already-existing stigma.

“[There are laws] where what you can legislate might be a peripheral issue, that abortion might be a small percentage [of the total], but you can get everyone to think, ‘Oh, that sounds like a terrible idea.’”

Meckstroth says that this is evidenced by the rarity of late second trimester and third trimester pregnancies.

UCSF’s Women’s Options Center offers abortions to patients up to the 24th week of pregnancy, and only offers abortion after 24 weeks if it has been found that the fetus is incompatible with life.

ZSFG’s Women’s Community Clinic will perform post-24th week abortions, but on a case-by-case basis, usually in circumstances of rape or incest.

Those situations are vanishingly few, however; the Guttmacher Institute estimates that only 1.3% of abortions happen past the 21st week of pregnancy.

The more widespread effects of laws such as the Partial Birth Abortion Ban are more pernicious, Meckstroth says.

She sees it every day with her patients in clinic.

“There’s so many components of social shaming with abortion, it comes in so many forms. From your parents, or your church, or the media; the fact that the mainstream media uses these terms to make it sound negative. By putting that lexicon in our culture, it’s a way to create more shame.”

Meckstroth is a clinical professor, and instructs medical students in women’s reproductive health, including abortion, in the third year of medical school.

Though she attempts to combat abortion stigma among students, she recognizes that abortion, perhaps more than most other aspects of medical education, is something that students can find uncomfortable.

Abortion is an intense, complex decision, involving culture, spirituality, morality and ethics.

Meckstroth says that she is often skeptical when students say that they have absolutely no issues with abortion.

“If we only wanted students that had absolutely no conflict with abortion to join us, then we wouldn’t have any students. I often have students that come in and tell me, ‘I have no problem with abortion,’ and I say, ‘Well, you haven’t thought about it enough.’

“There’s no question that there is some component that we could find about abortion that would make you feel uncomfortable.”

Meckstroth sees this uncomfortableness as a learning opportunity.

She works with students to be self-reflective about their emotions and how they can approach patients seeking abortion with empathy and lack of stigma. Confronting one’s own stereotypes and values can be intense, Meckstroth says, but also makes for personal growth.

“That level of intensity is one of the reason that a lot of us go into medicine.”