Late-term Abortions on the Rise in Israel, Despite Tougher Approval Process

Increase comes despite significant hurdles facing women who wish to terminate their pregnancies at a late stage; Gynecologists remain deeply split over issue.

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Late-term abortions have spiked by 28 percent since 2010, and with the increase comes intense scrutiny into the legality and practice of pregnancy termination in Israel.

According to a new survey conducted by the Israeli Society of Maternal-Fetal Medicine, conducted for a conference on ethical dilemmas in gynecology, Israeli doctors are sharply divided over the issue of approving abortions, even when they are done in order to avoid medical complications.

Abortions are legal in Israel only after a woman has gone before a panel of doctors and psychologists, also known as a pregnancy termination committee, and explained her reasons for seeking the procedure. The committee is the sole power able to approve or reject each woman's individual case.

According to statistics from these termination committees, which operate according to the 1977 penal code regarding termination of pregnancies, in 2011, 19,214 abortions were performed with the committees’ approval. About half of them were performed according to the law that permits late-term termination of pregnancies resulting from incest or an extramarital affair, 18 percent according to the clause that permits abortions in cases where there is danger to the woman’s physical or emotional health, 19 percent because of a possible danger to the physical or mental health of the fetus and 10 percent because the woman was under the age of 17 or over 40.

Hand-in-hand with these findings comes a new Health Ministry report noting an increase in late-term abortions, or those performed after the 24th week of pregnancy. In 2008, one percent of abortions in Israel were considered late-term. That rate increased to 1.5 percent in 2009 and 2010, and by 2011 was at 1.6 percent. During that year, 355 late-term abortions were performed, an increase of 28 percent over 2010.

The jump comes despite a December 2007 directive stipulating a tougher approval process for late-term abortions.

And at such a late date in a woman's pregnancy, doctors and medical professionals find themselves grappling with significant ethical quandaries.

Up until the 23rd week of pregnancy, a woman seeking termination can appear before a three-person committee comprised of a gynecologist, another specialist and a social worker. Past the 24th week, however, she must present her case to a special five-person committee.

Over the past decade, a lively debate has been taking place in the gynecological community over the obligation to resuscitate premature babies born from the 22nd week to the sixth day of the 24th week of pregnancy, around what is considered the baby’s viability limit. A position paper of medical organizations from 2009, which later became the Health Ministry’s standard procedure, determined that in light of the near-zero chances for survival in the 22nd week of pregnancy, a birth during that week did not require a pediatrician to be present in the delivery room. But in the 23rd and 24th weeks of pregnancy, when the survival rates increase, a pediatrician is the only one permitted to pronounce the baby dead.

As part of the survey, the gynecologists were asked about a birth scenario in the 24th week of pregnancy. While 61 percent opposed terminating the pregnancy at this stage, 37 percent supported the idea. Only one percent said they would support informing the woman of the risks so that she could make her own decision, and another one percent supported terminating the pregnancy unless the woman had undergone several fertility treatments prior to becoming pregnant.

According to Professor Ido Solt, head of the Maternal-Fetal Medicine unit at Rambam Medical Center and a member of the pregnancy termination committee, even the rules for committees show the split in Israeli medical professionals' sentiments about late-term abortions.

“Medicine, and gynecology in particular, are not exact sciences,” Solt says. “We deal … with life-and-death decisions at the day-to-day level.”

During the survey, the gynecologists were given several scenarios in which they had to make a theoretical decision. One particularly polarizing dilemma was the story of L., a 26-year-old woman who had asked for approval for an abortion in the 32nd week, which is considered a particularly advanced stage. An amniocentesis test administered in the 18th week revealed a CMV infection in the amniotic fluid, which could prove a danger to the fetus. L. wavered over terminating her pregnancy for more than two months after the diagnosis, despite the fact that an ultrasound and an MRI showed no damage to the fetus. In this case, the gynecologists were divided in their opinions: 44 percent approved the abortion, 53 percent refused to approve it and three percent said that in such a situation, they would try to convince the woman that no abortion was necessary but would not oppose her if she wished to abort.

Feminist groups, meanwhile, have expressed doubt as to whether or not termination committees should even exist. Officials in the left-wing Meretz party plan to submit a bill abolishing the committees entirely, and over the next few weeks, a coalition of women’s groups will be organizing to support the bill.

Illustration by Ayala Tal.
Abortion in Israel

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