Commentary: An Ob/Gyn View of Abortion

by Tia Will

I am that individual that some on the right claim cannot exist. I am both pro-life and pro-choice. Before you conclude that cannot be, hear me out. I write from a medical perspective, not a moral one, since humans do not all share the same moral concepts, but we should share the same facts. So let’s start with the facts.

https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer

Pregnancy is a medical high-risk time for all women, not just those with known increased risk factors. 49% of maternal deaths occur during the pregnancy, in which case the fetus will also die. 51% will occur within one year of delivery. People rightfully object saying that pregnancy is natural. I would point out that so is death, but that does not make it necessarily desirable. 

This is the basis for my belief that it should be the woman’s choice whether she wishes to risk her life to complete the pregnancy, or not. It is her life, and that of the fetus that is at stake. 

As pointed out in the above article, the United States has the highest maternal mortality rate of any comparable country. This is largely because we do not have a universally accessible or affordable health care system in our country. It is also a product of poverty with unhealthy, unsafe environments with unclean water, air & soil in many areas. A product of neglect, domestic violence, and random violence in many of our communities. So, in effect, bans on abortion are forcing women to gestate and bring into the world without sufficient support, the next generation. 

Now, we could choose another path. Many countries have and the Colorado pilot project proved it is possible to reduce abortion through supportive rather than restrictive, oppressive means. This more compassionate approach includes:

  1. Factual, accurate education regarding sex beginning around onset of puberty
  2. Ready access to free, long acting, reversible contraceptives
  3. Financial support for any woman deciding to carry her pregnancy to term and for her and the child once born
  4. Emphasis on joint responsibility of the impregnating male and the woman 

From 35 years in Ob/Gyn, I know we can achieve what most people would agree is desirable, a decrease in abortions and increase in healthy pregnancies and births without coercion or state control of a woman’s body. It is humane, workable as demonstrated, and cost effective. 

About The Author

Tia is a graduate of UCDMC and long time resident of Davis who raised her two now adult children here. She is a local obstetrician gynecologist with special interests in preventive medicine and public health and safety. All articles and posts written by Tia are reflective only of her own opinions and are in no way a reflection of the opinions of her partners or her employer.

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27 Comments

  1. Robb Davis

    You will not find a more succinct and better written analysis of the reality beyond the rhetoric of abortion.  If this were truly about “life”, we would be taking actions to ensure access to care in pregnancy, safe abortions, and clear dialogue-based education about sex at the appropriate time in a person’s life.

    Thanks Tia. This is excellent.

    Personal note: Back in about 1974, in one of the most politically conservative counties in the nation, our rural school district instituted a sex-ed program that spoke frankly about all the things Tia names in this article.  I can tell you that my male friends and I took it VERY seriously, had discussions about safe sex (though in those pre-AIDS days that was not the term used), and male responsibility for children.  Our teacher was a religiously conservative woman who basically told it like it was/is.  She spoke of the intimacy of sex, the responsibilities that come with it, and acknowledged that not everyone was going to abstain.  I will never forget it.  It changed my view on many things and prepared me for adulthood.  I want all students everywhere to have the same opportunity.

  2. Tia Will

    Thank you Robb for sharing your experience. I truly wish we could move this issue beyond the heat of emotion and partisanship, into the realm of problem solving.

    1. Rick Entrikin

      Tia, you wrote:

      From 35 years in Ob/Gyn, I know we can achieve what most people would agree is desirable, a decrease in abortions and increase in healthy pregnancies and births without coercion or state control of a woman’s body. It is humane, workable as demonstrated, and cost effective.

      This seems so logical and so desirable, so why isn’t it being done throughout the country?   And if the Colorado ‘pilot’ is as successful as you indicate, is there any movement to promote it as the basis for a possible bi-partisan agreement?

       

       

      1. Tia Will

        I do not know the answers, but I can give you my opinions.

        1) Sex and pregnancy tend to be taboo subjects in our society. Sure we make jokes about sex, and we talk about pregnancy, but only the happy, idealistic aspects. Very few people have any real concept of the cost of a pregnancy on the female body and far too often the limitations on her future of child raising.

        2) Sex has been weaponized by a religious right that still sees the only utility of sex is for reproduction as far as women are concerned. Men of course are free to pursue sexual satisfaction. It has become a very effective & divisive tool in our society.

        3) While doctors such as myself, and some teachers try their hardest to educate in an objective manner, you can see from current school board meetings and the rights relentless statements about education as “grooming”, just what we are up against.

  3. Edgar Wai

    Even if you tried to avoid it, you ended up making your stance based on conclusion a moral stand point.

    This is the basis for my belief that it should be the woman’s choice whether she wishes to risk her life to complete the pregnancy, or not. It is her life, and that of the fetus that is at stake. 

    The moral argument of the opponent is that once a woman willfully takes the risk, they do not have a right to not take the consequences. The risks you said about pregnancy is irrelevant because the woman took the gamble, so they need to pay and be responsible.

    Facts and statistics do not decide what should be in the law. It starts with a moral judgement. From that a society invent methods and advance technology so that they stop violating people rights.

    Statistics only matter if the opponent argues using statistics.

  4. Edgar Wai

    If you invite someone on a boating trip, you don’t have a right to throw them overboard thinking, “I changed my mind, I want to be alone on the boat today.”

    Even worse would be: “yes I brought on my boat, but my plan has always been to throw you overboard once we reach the open sea.”

    This is the type of moral argument the topic is about. The survival rates are irrelevant in the case of planned-to-abort conception.

  5. Tia Will

    Edgar,

    I reject your premise. There is no such thing as a planned-to-abort pregnancy. Many women who become pregnant are using contraception at the time they become pregnant. They are not “planning to abort” because they are not planning to become pregnant.

    Some women do not know they can become pregnant. Raped 12 year olds come to mind as an example. Some women are lied to by their partner who may say they have had a vasectomy when in fact, they have not. Some claim to be using condoms, when in fact, they have removed it.

    In my entire practice, I have never met a single woman who got pregnant so that she could get an abortion.

     

    1. Edgar Wai

      Tia,

      By “planned to abort conception” I meant any intercourse conducted knowing there is a risk of conception and acceptance of abortion as a planned counter-measure in case of unwanted pregnancy. It includes “I didn’t plan to get pregnant. I used contraception but it didn’t work.” or “I changed my boyfriend” or “I checked the fetus’ eye color and I didn’t like it.”

      But more importantly, Abortion as a Right means that even if there is a way to safely separate a fetus and transfer it to another womb, the original carrier may still choose to abort for any reason. Comments on safety and survival rates are irrelevant to the law because technological advances would make both childbirth and abortion safe.

      If you agree that abortion should be allowed in some situations, but not simply at will, then Abortion is not a right. It is a countermeasure to a circumstance. It would be the same as “killing a person” is not a right, but there are cases where it is legal to kill a person. Abortion not being a right doesn’t mean that all abortions are illegal.

       

      1. Tia Will

        1. There is no means of transferring a fetus to another uterus. So I see no point in pursuing that which cannot be done, even as a theoretical construct.

        2. I do not agree with you that consent to sex equals consent to pregnancy. Just as I do not agree that consent to drive a care means consent to the injuries sustained in an accident.

        3. I do not agree with you that rights cannot be conditional.

         

        1. Edgar Wai

          1. Constitution rulings are meant to last forever, thus withstanding technological changes.

          2. I didn’t say that consent to sex equals consent to pregnancy. Consent to driving a car means to consent to be liable for injuries and deaths that your driving causes. 

          3. The statement “Abortion is a right” implies an unconditional right. Otherwise, the statement would be, “Abortion when ………. is a right”.

  6. Ron Oertel

    Curious as to Tia’s opinion if there’s ever a “cut-off” point at which she would not support abortion.

    I’m not seeing a great deal of difference between “aborting” a fetus the day before it’s born, vs. “killing” a baby, the day after it’s born.  (Other than the obvious fact that a baby is no longer physically tethered to a mother, and is then independent of the mother.)

    Presumably, a doctor would not “yank” a fetus out of the womb (and keep it alive), as an alternative to abortion.

    With this comment, I am not putting forth an opinion. Just asking a question.

    Also seeing no connection whatsoever, in connection with this comment (which I just noticed):

    Sex has been weaponized by a religious right that still sees the only utility of sex is for reproduction as far as women are concerned. Men of course are free to pursue sexual satisfaction. It has become a very effective & divisive tool in our society.

    While doctors such as myself, and some teachers try their hardest to educate in an objective manner, you can see from current school board meetings and the rights relentless statements about education as “grooming”, just what we are up against.

    In fact, I’d argue that the first comment is false.

    1. Tia Will

      With regard to the veracity of the comment you would argue is “untrue”, I doubt you would maintain that if you read the comments on my Twitter feed from those who take an emotional approach to abortion and who prefer a coercive rather than a supportive approach to abortion reduction, which ultimately is one of my goals.

      1. Ron Oertel

        The parts that I find “untrue” are as follows:

        Men of course are free to pursue sexual satisfaction.

        Pretty sure that most men (young men in particular) have found that it’s actually “up to women” whether or not that happens.  (True in the animal world, as well.)

        I don’t really know what the “religious right” thinks, but I suspect that many of them view it as more than just reproduction. (Seems to me that religion is often closely tied to beliefs regarding abortion, however.)

        It has become a very effective & divisive tool in our society.

        Don’t know what you mean by that.

        While doctors such as myself, and some teachers try their hardest to educate in an objective manner, you can see from current school board meetings and the rights relentless statements about education as “grooming”, just what we are up against.

        I believe that “grooming” is generally not a reference to beliefs regarding abortion.

        I see that you answered my other question, below.  (Thanks.) I would agree with that (regarding viability outside of the uterus).

         

      2. Bill Marshall

        I doubt you would maintain that if you read the comments on my Twitter feed from those who take an emotional approach to abortion and who prefer a coercive rather than a supportive approach to abortion reduction, which ultimately is one of my goals.

        Not sure whether we are finding “common ground” which is so rare in recent years (nationally)… but I’m reaching out to find out if we can…

        “abortion on demand/whim(?)” is abhorrent to me… support for abortion if medically, emotionally (like rape and/or incest) necessary/appropriate isn’t, if done when the pregnancy is first determined.  In some cases, it is arguably “pro-life” if continuation of the pregnancy will likely result in the death of both mother and child.

        Partial birth abortion is murder to me…

        Abortion should not be a ‘simple’ as an alternative to condoms/diaphragms/’the pill’/ or other prophylactic measures if folk choose to have sex.

        I disagree with some who say a fetus is “just” a “product of conception”… allowed not to be aborted, it is human life.  I believe that life begins at conception, not just when someone ‘breathes air’…

        I disagree with the ‘concept’ (pun intended) that absent rape/incest, the father (sperm donor?) has no say.

        I believe, based on testimony from women, that many regret their decision to have an abortion… I’ve known a few who have personally shared that with me, and it was NOT in a religious context.

        I respect a woman’s choice to decide if and when she conceives.

        I believe that women who are carrying a child, should be medically, financially, emotionally supported, by father, friends, community, society.

        The big question is, “can we find common ground”?

        I post this as an only child of a mother pregnant 3 times, by her husband… the definition of ‘abortion’ includes ANY termination of a pregnancy that does not result in a viable birth… subsets include ‘miscarriage’, ‘therapeutic’ abortion, ‘intentional’ abortion… Mom’s abortions would be defined as ‘miscarriages’,  by those who favor the latter… Mom’s “choice” would have been that all 3 pregnancies result in births… the other side of the ‘abortion’/woman’s choice coin…

        I ask again, “can we find common ground”?  Between us, and also society…

  7. Chris Griffith

    Alito writes.

     

    “We hold that Roe and Casey must be overruled,” he writes in the document, labeled as the “Opinion of the Court.” “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.”

     

    Why are liberals running around with their hair on fire? The only thing liberals have to do is hold a special election and this little problem would be solved one way or the other but then again liberals would never go for that because they know they would lose.

    Future psychologists will write hundreds of books about the mass hysteria that this has generated.

     

     

  8. Tia Will

    I am happy to answer. First this is not an easy question and I have given it a great deal of thought. I support abortion to the point where the fetus cannot exist outside the uterus. Whether that is in the 22-24 week range, or at any point at which a diagnosis incompatible with life is made.

    I do want to clarify one point. Abortions outside the range of the weeks above are done under very limited circumstances. They are only done for a diagnosed nonviable condition of the fetus, or to save maternal life. There is a different name for procedures done near term to deliver a the fetus under other circumstances. It is called birth, whether by vaginal or abdominal route. Pediatric teams are present to evaluate and provide appropriate care in those circumstances.

    1. Bill Marshall

      Good points, Tia…

      Our daughter is a neo-natal dietician at a childrens hospital… she has seen many things… including kids whose insides were on their outsides (you probably are aware of that as an OB-GYN… rare, but happens)…  parents who decline health treatment for the child, because they want a post-birth “abortion”… parents who want everything done so the child might live even when they or insurance can’t pay (the hospital our daughter works at goes for the pro-life thingy, even at a ‘loss’ of revenue)…

      Guess I’m saying, I ‘get’ your points, even if we disagree on some… gets back to a question I’ve asked twice now, both “in moderation”, can we find common ground?

      [edited]

      1. Tia Will

        Common ground is exactly what I seek. We have the same goals. Decreasing the number of abortions, while maintaining the optimal control of women over their own bodies.Other societies have done it. Colorado has done it. We could achieve the same results through support rather than coercion. I remain astounded that there is so much resistance to the non coercive means of education, support, and contraception made free and readily available.

        Can you help me understand why the right does not support this approach?

        1. Bill Marshall

          Can you help me understand why the right does not support this approach?

          Can you help me understand what you believe is the right?

          I cannot help you understand “the right” if you mean the political spectrum… I can’t stand them, never been there… I’m slightly “left” of center…

          Unclear what you mean by the right…

          I think we could, individually and as a society, find common ground… but in your other post you have rejected the concept on a ‘technicality’… only one of my posits…

          Partial birth abortion is murder to me…[wm]
          Partial birth abortions are not a part of current medical practice. I would find it difficult to believe common ground can be found when you continue to name a long gone procedure as an issue in current debate. [Tia]

          You pretty much ignored the rest… I concede (although I didn’t know) that PBA’s are not prevalent.  I was positing “outside limits” from what I knew. Do you deny those were a practice?  When you say “long gone”, are we talking 1, 5, 10, 20 years?

          I wish to find common ground… yet you and Don have, on this thread, have pretty much said that is not possible… even when you said you are interested, you later said ‘no’…

          Contact David if you’re interested in finding common ground, and we can discuss ‘off-line’… at one time, thought I had an e-mail for you, but have had some computer data ‘abortions’… so cannot find… David, feel free to share my e-mail address with Tia…

          1. Don Shor

            I wish to find common ground… yet you and Don have, on this thread, have pretty much said that is not possible… even when you said you are interested, you later said ‘no’…

            The problem is that Roe v Wade WAS common ground. It was a compromise establishing the right of the mother up to the point of viability, and then allowing regulation by the state after that point. It balanced the rights of the parties, which is what we expect judges to do. It was a 7 – 2 vote, including justices appointed by presidents of both parties.

  9. Don Shor

    Just voted out of committee in Louisiana:

    (1) Fully recognize the human personhood of an unborn child at all stages of development prior to birth from the moment of fertilization.

    (2) Ensure the right to life and equal protection of the laws to all unborn children from the moment of fertilization by protecting them by the same laws protecting other human beings.

    https://legiscan.com/LA/text/HB813/id/2549012

     

    Bottom line: abortion in Louisiana would be considered a homicide committed by the patient as well as the physician. Just the biological issues of this proposal alone are mind-boggling. Makes it pretty hard to find any common ground with people who are pursuing full criminalization of abortion.

    1. Edgar Wai

      A concept that the world is missing in dealing with this type of legislature is that a state/jurisdiction’s boundary should shift according to people escaping/joining it. Then people who agree with policy A will get their community where everyone agrees and people who don’t agree with policy A could opt out by taking their properties with them.

      At the smallest boundaries, it means that a doctor has a right to choose whether to perform abortion, and each person has a right to choose which doctor or medical practice can receive their jurisdiction resources.

      The result is that two neighbors could disagree but subscribe to different policies. Neither would need to leave where they live.  A doctor who does abortion using money from a jurisdiction that bans abortion would be tried using the law of that jurisdiction. Courthouses can actually be shared with trials happening for different sets of laws based on the moral code that the violator has subscribed to at the time of the crime.

    2. Tia Will

      I think this law alone is ample evidence of why “liberals are running around with their hair on fire”. 700 women/year die in the months before or year after giving birth. States are passing laws saying essentially “too bad, this is the risk you must take” let alone all the other risks inherent in pregnancy and challenges of raising said child. I think perhaps it would be beneficial if we all agreed this is a serious issue not to be taken lightly.

    3. Bill Marshall

      Bottom line: abortion in Louisiana would be considered a homicide committed by the patient as well as the physician. 

      See my 8:45 post, now in moderation (Why?)

      I disagree with the Louisiana legislation, as you have presented it.  So, think I’m agreeing with you there… on the topic, considering it (abortion by choice) a homicide is pretty much above any human’s “pay-grade”… but some forms, some reasons, I find abhorrent, against my ‘wiring’…

      ‘Partial birth’ abortions, if a jury member, unless there were strong extenuation circumstances, I would not only define it as ‘homicide’, I’d say it was 1st degree murder.

      We do need to find “common ground”[edited]

  10. Tia Will

    Bill,

    Partial birth abortions are not a part of current medical practice. I would find it difficult to believe common ground can be found when you continue to name a long gone procedure as an issue in current debate.

     

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