Late-Term Abortions in Israel: Too Many?

imageMy 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.

My comments:

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.

Source

Related:

Feticide at 40 Weeks?

Genetic Testing in the Religious Community

Abortion in the Religious Zionist Community

Photo credit: JavierPsilocybin

Check out the 2016 fashions at Hydrochic modest swimwear.

Comments

  1. The tragedy is that there are too many people who refuse to believe that a fetus is a living Human Being with feelings, a soul, and rights. Would any sane person suggest murdering a living child because they were diagnosed with brain damage? A heart defect? ADD?! Learning disabilities???!! What gives a parent the right to SUE a doctor for missing a defect and therefore not allowing them to “terminate” (kill) their unborn baby? That is just so sick in my opinion.

    • I don’t think it’s right to judge unless you’ve cared for an 11 year old lacking a corpus collosum yourself. The analogy of ADD or learning disabilities is simply insulting.

      For all you know, they want the kupa to pay up for the astounding number of services the child needs just to get by every day. I’m surprised he’s live this long.

      • Abbi, I couldn’t agree with you more. I volunteered for many years with children with severe physical disabilities. My husband did that as well as volunteer for a while with young adults with mental disabilities. The experience made us both resolved not to bring someone into a life of suffering.
        Unfortunately, we had to test this resolve twice when problems were discovered during pregnancy. I had one second term termination and one first term termination for medical reasons and I firmly believe we made the correct decision.
        It is very easy to judge when the results do not effect you.

        • I’m talking about late-term “abortion” at 32 weeks. That is not an abortion. That is killing a live baby that could survive outside of the womb. As a physical therapist with specialty in working with special needs children I know exactly what the disabilities are. My heart goes out to any parent living with and caring for a disabled child. I’m not judging the decision to abort a fetus with a severe defect however the status of a near term infant is quite different. I stand by my original sentiment that killing a fetus at near term (32 weeks) is sick and I think it should be against the law.

          • Erika, your specific question was :”What gives a parent the right to SUE a doctor for missing a defect and therefore not allowing them to “terminate” (kill) their unborn baby?”

            That is a direct reference to the lawsuit mentioned in the post, where Maccabi missed the defect from which an 11 year old child suffers. You asked how could parents sue an HMO for not finding a defect that would have allowed them to terminate this child. That question is the epitome of judgmentalism in all of its ugliness.

          • I seriously question whether a physical therapist working with special needs children has any idea what kinds of pre-birth disabilities are viewed on ultrasound. Just a small example, my Rabbi once handled a shaila from a couple whose pregnancy was fully sustainable in utero but would die immediately at birth – sad, but not for a physical therapist to claim does not exist and insist they put on life support.

  2. “Mishori-Deri claims that a general recommendation for every pregnant woman to undergo amniocentesis would have prevented a quarter of the late terminations.”

    I don’t know who’d agree that every single pregnant woman should have an amniocentesis. I wouldn’t have one if I had no other reason to other than to prevent a late term abortion.

    I don’t think any woman prefers a late term abortion over the option of terminating early on, before she is showing and before she has a chance to become so attached to the child inside her. But it doesn’t seem like anyone is offering a better option – a scan at 32 weeks is still late term. This is all aside from the issue of not considering a woman’s choice in the matter, but that’s a different issue.

  3. There is apparently a new test to screen for Down’s that is accurate as early as 6 weeks. I wonder when that will be available. I have a lot less difficulty with aborting at 6-8 weeks than with aborting past 23 weeks.

    I find late-term abortion a very troubling thing, though I can’t judge anyone who aborts a disabled fetus. And Erika – have you ever raised a child who will never grow up, will always need care, and may have serious behavioral problems in addition to health problems?

    I think if you had, you might realize that the decision to abort in such cases is a very delicate and complicated one. No one takes it lightly.

    • I don’t believe anyone truly takes any abortion “lightly”, severely disabled fetus or not, late term or very early.

      • Apparently Erika thinks otherwise.

        • Abbi, I find it quite sad that people like you feel free to act with complete lack of tact and derech eretz when they can hide behind the anonymity of the internet.

          • Erika, I’m far from anonymous if you’ve been reading this blog for any length of time and I’m having a hard time figuring out why commenting on an opinion you expressed earlier in this thread is lacking in derech eretz. If you can’t stand the idea of people disagreeing with you, maybe commenting on blogs is not a productive use of your time.

        • Ms. Krieger says:

          Abbi,
          You are entirely entitled to comment on other’s opinions. But this sort of remark is hurtful and trollish.

          • Ms. Krieger says:

            I am referring to the
            “Apparently Erika thinks otherwise,” remark that Abbi posted earlier.

          • What is trollish about pointing out that Erika thinks there are many Israeli women who take abortion lightly and that there seem to be many chomping at the bit to abort fetuses with ADD discovered through a yet-to-be-invented fetal diagnostic tool? This was her clearly stated belief in her first comment on this thread and I merely referenced it, since Chloe can’t believe anyone takes abortion “lightly”, as most women would assume.

            I think it’s trollish to proclaim a judgemental opinion about people who must suffer the daily task of caring for a brain damaged child.

          • I get the impression that Erika works with more severe cases than mere ADD. But that the defects in the study are even more severe – children who would likely be maintained in an institution.

            Still, there are way too many doctors who take it lightly.

            The women don’t take it lightly – I saw it mentioned on some blog that MTV has a reality show interviewing women considering abortion and they all end up agonizing.

          • Abbi, I believe Ms. Krieger is referring to the tone of your words. Without verbal cues, the comment could be read as a personal attack.

    • When I was pregnant with my 3rd child, I was told at a 19 week scan that something is wrong I should get an amnio. I asked the dr. how the amnio. would help. The dr. answered that it could help decide to get an abortion since it appears that my baby has a severe defect. I asked if there was anything else we could do. The dr. said no. My husband and I decided not to get ANY other tests though we were hounded to get many. I continued with u/s every week and every week the doctor told me all of the horrible things we might be missing by not running other tests until I decided to stop seeing that dr.. My son was born weighing over 8 lb.s and thank G’d healthy. He has issues – language delays, ADHD etc.. the idea that my dr. thought I could consider killing him just because he’s not “perfect” makes me cry every time I think about it. He’s 5 years old and I LOVE him very much. I’d love him no matter what.

      • When a fetus is 18 weeks it is not a child – it is a potential child.

        • Elisheva says:

          to-may-to to-mah-to. You’ll never change anyone’s mind on this. I believe and always will believe that any baby conceived in my womb is a child from the moment of conception. I respect your right to believe differently. Seriously. Not an argument worth having.

    • Leah and others,

      Down syndrome in and of itself is NOT a severe disability at all!

      People with Ds bring so much light, spirituality and love into the world. And there is *Much* you can do to reduce the mental aspects and they often live fabulous and full lives.

      This new blood test is a Seek and Destroy Mission for people with Down syndrome.

      My toddler with Ds makes the room light up. She is really doing well- we do have her on excellent nutritional and developmental programs (doing it all myself, we live in Beijing, China) – and we have every intention that she will daven, go to school, drive, marry, and have babies.

      That you would get rid of a person just because of DS is extremely sad. You wouldn’t even know what you’d lost….the love of your life is what!

  4. How many cases of late-term abortions were there, just to get the proportions?

    • Orale: 2029 applications from 1995-2006

      • So, on average, just under 200 a year…

        And I suppose there are around 70’000 births in Israel per year, or are there more?

        So in fact we are talking about just under 3 cases in 1000 births overall. The cases that could have been detected earlier would be 13% of those, so we are talking of more or less 3 cases in 10’000 pregnancies.

        I think this is an important fact to take into consideration, especially when recommanding generalised amniotic fluid tests in early pregnancy, which also has its risks of its own.

        • Ms. Krieger says:

          I agree. These are very rare occurrences. Many women have strong reasons for refusing amnio etc. There needs to be a strong reason, and benefit to many, to push additional testing on women who may be disinclined to accept it.

  5. How about for a disease like Tay sacs or canavan? Does anyone want to bring a baby into the world to have it die horribly in the first two years of life? Again, I don’t feel comfortable with late term abortion, but I can understand why people choose it.

  6. I think a big issue in Israel, and among the world-wide ultra-Orthodox community in general is many women don’t go for ultrasounds until much later, if at all.

    So problems don’t get noticed until much later.

    • Totally agree.

    • Elisheva says:

      Ultrasounds and even amnio are not definitive, though. Gd forbid a pregnancy is terminated based on faulty data or possibilities. I understand why people choose to terminate, just please don’t overestimate the medical science that informs those decisions. Ultrasounds and amnio carry their own risks as well.

  7. This is a sensitive topic for both commenters and lurkers. Please don’t write anything that could be seen as a personal attack.

  8. I’m still shocked by the 30% threshold. It seems like you could say half the population has a 30% chance of having some mental OR physical disability. And I don’t think all those kids are being born into a life of suffering. You could be born without a leg into a loving family and have a nice life, or you could be born in perfect form and develop severe depression. Sometimes the smartest segment of the population is the most unhappy.

    As far as the comment about women who don’t get ultrasounds. I don’t see that it’s such a huge problem. It’s nice for the doctors to know what they’re in for, but there are a wide range of things that don’t show up on ultrasounds. In the orthodox community, people get tested for genetic diseases before they get married, generally garanteeing that they will avoid some of the more common Jewish genetic diseases. If you are commited to not ending a pregnancy, then why go through half your pregnancy knowing that a doctor found and abnormality that might mean there is a problem? Personally, I’d like to know, but I also like to know if I’m having a boy or a girl. I can understand there are reasons not to get ultrasounds.

    • Nathalie says:

      re- about not doing US.
      I have always declined my drs’ offer to test for Downs (as an example), since I would not be doing an abortion anyway.
      However, I have done quite a number of other US when knowledge could help with the baby’s outcome.
      A woman who does not have US during pregnancy might miss out that her future baby has a severe heart (or other) defect. In such a case, early knowlege will mean the family can make sure to give birth at the right hospital, and that the right doctors will be there at birth and help this (often otherwise healthy) baby to live a normal life. Not getting this early knowledge could mean the baby might die for lack of being prepared.
      Also, even in some cases where the family will not have an abortion , early knowledge can mean the parents are emotionnaly prepared to deal with a handicapped child. If the alternative would be rejection of the child (in these cases of a handicap discovered at birth, where families would not abort anyway), I think there is a serious case for testing.

  9. Nurse Yachne says:

    It’s true; canavans and tay-sachs are of an entirely different degree than just ADD and mild problems, even Downs. No one ought to be judged for choosing abortion in the first two cases, especially if they have already had a child with these problems.

    By the way there was a fabulous piece in the latest Mekor Rishon, in the economics section, commenting on the case of parents who are suing their physician for not diagnosing a missing limb in their child.

    The writer, who was born in the70’s befoe ultrasound missing his left hand and arm to the elbow. He has delt with it quite well, and is very successful and happy.

  10. I think the most offensive aspect of all this is that the medical establishment in Israel completely negates the strong sentiment of many that they have no plans to abort based on “reasonable” defects. Which makes them push amnio which itself has a 0.5 % of inducing miscarriage. Which makes them pressure so-resolved mothers growing a baby with so-so stats of having Downs, when all that’s medically relevant is to do an extra scan so there will be a neonatal surgeon available if needed at the birth.

    I am curious whether halacha views an abortion for the same reason suddenly unacceptable because it’s the last trimester.

  11. An issue resolved is that in Israel it is accepted to perform mainly amnio, whereas one can also do the CVS test at 11 weeks.
    In clear cut cases, the answer from this is very soon, and if there is something very seriously wrong, then this is a first term abortion.
    Amnio and additional testing that might be done are much later, or people who take the helbon ubari (feta protein?), at 16-18 weeks and only do amnio much later if the results are problematic, means that it is far later on if they need to end the pregnancy for some reason.

    • the helbon ubari/alphafetal protein test is such a poor indicator. they start with a ratio based on maternal age and then multiply it based on the blood test.

      my maternal-based ratio was 1/68 and the blood test improved the score to 1/130. you would think that’s good, right? no – the doctor actually called me at home to tell me it isn’t too late for amnio…

      here in Israel if the ratio is worse than 1/300 they still consider it a complete reality!!

      oh and by the way I actually refused that test – the doctor tricked me and made it seem like it was another part of the nuchal translucency which is done by 12 weeks (the lab order form says “helbon ubari” for both)

      • Nuchal tranlucency is U/S and chelbon ubari is bloodwork- that requires you to bring in a previous U/S to properly date the pregnancy. How did he slip one in with the other? If you didn’t want to do CU, you could have just not gone to the lab.

        • Nuchal translucency is U/S **plus** bloodwork – you can find pages online that will calculate the ultrasound blood measurements all together. So when she said “more bloodwork for that” and printed out another sheet that said “helbon u’bari” I had no idea it was a different test entirely. Oh, and the ratio on the NU was 1/256 which is why I couldn’t understand why she even sent me for more tests….

          I since changed OB’s.

    • CVS is not an accurate test for chromosomal abnormalities like DS. It is best for families that carry a genetic mutation like Tay sacks.

  12. B”H we have no personal experience of this, but this article might be of interest http://bbc.in/gpU82M it’s about very premature babies, born at about 23 weeks which is within the legal regular abortion limit in the UK.

    • Well What Mrs B writes is a “whole different blog article”….

      This is a link to stories by parents of babies who made it
      http://www.bbc.co.uk/news/health-12666536

      There was also a TV program here in Israel about keeping preemies alive, so these are 2 very contrasting things, on the one hand Israeli neo-natal medicine is very very sophisticated and able to sustain life for babies who once no-one would even have thought about trying to save. On the other hand pre-natal testing has become sophisticated, and in the end the mixture of all this, is that sometimes a decision is taken to terminate pregnancy of a very sick baby, at a stage when the sophistiaced neo-natal medicine of today is able to sustain life (when previously it would not) (and still another discussion, as the article linked to spoke of babies who stayed alive, but were not healthy).

      In the justified cases refered to by MII, in the original article there are halachic authorities who allow this (obviously by speaking to them personally about the specific case, e.g. the Zitz eliezer permitted specific things)

  13. Nurse Yachne says:

    My information would be only anecdotal, but there is a huge difference between surviving and living normal healthy lives as far as very premature babies go. If the odds are overwhelming that the baby will not survive to a normal life (no cp, no brain damage due to intracranial bleeding, minimal lung damage) it becomes more difficult to justify spending the vast sums of money (and small number of NICU beds) involved. Granted, the envelope is pushed out by the exceptions, but at what human cost?

  14. I recently had a still born baby at 32 weeks and can not imagine how anyone could not consider a fetus of that age a baby. If it is true that this is happening, then something needs to be done. The loss of a baby that age is a tremendous trauma- one I am just now trying to work out for myself. if you are interested in my ranting you can feel free to visit http://mygabbi.blogspot.com/ , but the long and short of it is that I can not understand a God that would take away such a gift- much less a human being.

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