My daughter was looking through old newspapers for a project when she called one to my attention. When I say the subtitle “Dozens of Israeli women undergo unnecessary late-term abortions,” I thought it would be about cases where the fetus turned out to be healthy.
But it turned out that the Gartner Institute for Epidemiology and Health Policy Research discovered that these late abortions could have been done earlier. In other words, they were considered necessary, but the timing was bad. My summary is below.
Late-Term Abortions in Israel
Late abortions are defined as those done after 23 weeks, when the fetus could theoretically live outside the womb.
Gartner Institute geneticist Anat Mishori-Deri checked 2029 applications for late abortions submitted to the hospital committees between 1995 and 2006. The committees approved 90% of the applications, and 97% in 2008.
The main reason for late-term abortions was a developmental defect in the fetus. The study determined that in 13% of the cases, the defect could have been detected earlier. These cases included lack of brain and skull development (27), spina bifida (33), or serious heart defect (20).
Mishori-Deri claims that a general recommendation for every pregnant woman to undergo amniocentesis would have prevented a quarter of the late terminations.
Three years ago the health ministry tightened the requirement for permitting late-term abortion. The committee needs proof of a 30% or higher chance of a physical or mental disability. In 2008, 206 were approved, (1 percent of of the total), and 34 of these were performed in the 8th or 9th month. Some western countries do not permit them at that point. [I’m not sure why there were more if the requirements were stricter.]
A similar study from Assaf Harofeh hospital found that half of the defects could have been detected at an earlier stage.
Preventing Late-Term Abortions
Professor Tali Sagi, head of pediatric neurology at Wolfson Medial Center, recommends that parents do an additional scan at 32 weeks, to look for brain defects. This test is performed through the vagina, not through the surface of the abdomen like the 22-week scan. The neurological scan can discover defects in the corpus callosum, cerebellum and cortex. According to Sagi, “late abortions are not caused by medical negligence, but because of improvements in tools that find defects. Sometimes the parents want another medical, or a rabbinic, opinion before deciding, leading to a delay.”
The head of a the ultrasound unit at Wolfson, Dr. Gadi Melinger, claims there is an advantage to allowing late abortions. Pressure to perform them earlier would lead to hundreds of unnecessary terminations.
The health ministry is working on a new form for applications to the committee, because it has been difficult to collect accurate data.
Much of this discussion revolves around a need to avoid lawsuits, like this one where a couple is suing the Maccabi health fund for NIS 30 million. Their 100% disabled 11-year-old lacks a corpus callosum, something that should have been picked up in a 22-week ultrasound.
I was surprised that only a 30% chance of defect is required to request to end the pregnancy. But it’s unlikely to mean that 70% of late-term abortions are performed on healthy fetuses.